February 2010 Newsletter

Happy Valentine’s Day!

February 2010 E-Stim Course – Neuromuscular Re-education of the Submandibular Muscles to Increase Laryngeal Elevation Using Class II NMES Device Saturday, February 20, 2010 in Austin Texas for 7.5 ASHA CEUs. Professional Imaging has invited us as guest speakers; please call their corporate office: 1-866-675-MBSS for more information about the Austin course.

TSHA is coming to Fort Worth, Texas next month! Hope to see you there!

DiagnosTEX Newsletters Medicare cuts directly and dramatically affect DiagnosTEX. These cuts have especially impacted our radiology codes. As a result, we have had to look very closely at our budgets. If the Medicare cuts affect the specialty/radiology codes as anticipated, significant modifications and changes within several levels at DiagnosTEX will be the result. One change may be that beginning in April, the DiagnosTEX newsletters may no longer be mailed to the facilities. They still will be available online at our website at www.dysphagiadiagnostex.com in the Clinical Café. We hate having to do this, and it tugs at my heart personally because I have been writing and sending out monthly newsletters since 1998. Yet every year we take deeper and deeper cuts, and the rates we offer to the facilities (especially for Part A patients) are much lower than the average cost for mobile units in the state of Texas for your benefit. This forces us to be extremely frugal with our budget, and run the company very “lean.”
Keeping these cuts in mind, our focus will be on efficiency in our travel and scheduling studies. It will be increasingly difficult for us to accommodate special requests on day and times. If you absolutely need a specific time or day, please consider a stationary outpatient location to accommodate you. Mobile service is for the convenience of the service coming to you, not a specific time/day convenience. If you decline an attempted scheduled day, your study will go back on the pending list as a new study and may not be rescheduled again until the next time we are in or around your geographical area.
I also ask for your flexibility and understanding if we have to interrupt the lunch hour. This is not an everyday occurrence for us or the specific resident, but there are times that lunchtime may be the only time we can complete the study so you can have it done in a timely manner. For that one day we ask for your flexibility. Thank you!

Part B Rates for 92611 did increase for 2010 after a 2009 dramatic cut
MBSS Testing/Speech Therapy HCPCS/CPT code (92611)
Dallas County: $ 120.71
Tarrant County: $ 116.75
All Other Counties: $ 109.99
These fees were taken directly from the Online Fee Schedule on Trailblazer’s website for 2010.
DiagnosTEX will bill all other technical and professional codes to Medicare for the study.
Part A increased by $5.00 to $130.00. These updates will be sent to your facility.

Authorization form – A new 2010 form is included in this newsletter. Please make sure you replace your old one. This piece of required paperwork gives DiagnosTEX the right to perform and bill for our services and represents that the patient/responsible party fully understands the procedure. Therefore, all statements must be initialed for us to complete the study. Thank you for your assistance in making sure that it is complete prior to scheduling your MBSS.

Texas Voice Project for Parkinson’s Disease is a non-profit organization that offers all Parkinson’s patients in the Dallas area the Lee Silverman Voice Treatment (LSVT). This voice treatment has been clinically proven to help 9 out of 10 people with Parkinson’s improve their functional communication and has also been found to minimize mild swallowing difficulties. In sixteen treatment sessions over four weeks, patients learn to use increased effort when communicating, improving overall strength, endurance, and coordination of speech. Since Parkinson’s is progressive and continually challenges those who have it, Texas Voice Project includes a maintenance program to provide ongoing accountability and encouragement. Upon completion of LSVT, patients participate in weekly speech groups, a singing program, and other engaging activities to help maintain the communication skills they have regained. To view pre/post treatment videos and to learn more about Texas Voice Project, visit their website at www.texasvoiceproject.org or call (469) 375-6500. They are also hosting a Conference on 02/27/10 from 8:30-4:30 called “The Interactive Parkinson’s Workshop” for .6 CEUs. For cost and more information call (469) 375-6500 or visit their website.

Stroke For Stroke is communication software for those with speech impairment and /or limited typing ability (such as someone affected by stroke), and may also be helpful for some patients with ALS, Parkinson’s, CP, MS, MD, apraxia, dysarthria, and certain brain injuries. The software can also serve as a training tool for the SLP. The system is designed to be used exclusively with a mouse; and although a keyboard can be used, it is not required. You may obtain a free copy of the software so you can try it or demonstrate it to patients, or request brochures so that any interested patients can purchase a copy for their own computer, by simply referring to the website. Visit www.daligisoftware.com. The free copy of the software can be downloaded from the website with an “unlock code” (not MAC-compatible). An e-mail request will need to be sent to info@daligisoftware.com in order to access this code. Please identify your state in your e-mail request. CDs are also available for purchase.

Dysphagia Tidbit – Taste Preference and Rating of Commercial and Natural Thickeners
By Horwarth, Melissa; Ball, Angel; Smith, Rebecca This group study (n = 43) investigated the taste preference, taste ratings, and ranking for nectar-thick hot and cold beverages using three types of thickeners: SimplyThick(TM), Thick- It, and noncommercially prepared natural thickeners. Results demonstrated a significant difference between the taste ratings of two commercial thickeners and between one commercial and the natural thickener for the ranking of taste with hot beverages. Every participant rated at least one of the thickener beverages as having an acceptable taste for the hot chocolate and fruit juice beverages. Exploring individual preferences is critical to selecting a beverage that increases compliance to clinical recommendations. The current study investigated whether two commercial thickeners, SimplyThick and Thick-It, and noncommercially prepared natural thickeners, applesauce, chocolate pudding and pie filling, affected taste differently. Significant differences in taste were detected among the hot chocolate beverages. SimplyThick and the natural thickener were found to be superior on the basis of taste to Thick-It. No significant differences were found for ratings of taste among the three thickened fruit juice beverages. The data suggest that all the fruit juice beverages had a high acceptance rating. That significant taste differences were not detected among the cold beverages, but were detected among the hot beverages indicates there might be a relationship between temperature and taste. Further studies testing thickened hot and cold beverages may help determine whether temperature and taste influence the acceptability of thickened liquids. There was a difference of perceived thickness and taste between SimplyThick and Thick-It. The characteristic of being “too thick” was the most frequent response in the perception of the hot chocolate with Thick-It. No participant described Simply Thick hot chocolate as “too thick.” The influence of perceived thickness on ratings of taste was not evaluated in this study, but warrants further investigation. Toward that effort, it is important to ensure consistency of beverage viscosity across thickening agent types. Standardized beverage viscosities across conditions (agent, preparation method, etc.) can ensure that the most desirable and safest beverage for patient consumption is offered (Robbins et al., n.d; Giel & Felt- Gunderson, 1997).
The most encouraging finding from this study was the fact that all participants perceived at least one beverage as acceptable, or rated at least “fair.” At the outset of this study it was proposed that a noncommercial natural thickener would be preferred over two commercially available thickening agents. The results did not support this assumption for the fruit juice. The juice was equally acceptable for the natural and commercial thickeners. In the case of hot chocolate, both the gel-based and natural thickener were preferred to the powdered product, Thick-It, based on taste.