Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP
Happy Valentines Day!
Please use our new history/consult request form for 2012 when filling out your paperwork and scheduling your patient. If we do not get the correct form, we may call and ask you to fill out a new one before we schedule your patient. New copies of the forms went out in the January newsletter. If you do not have a current copy, you can call the office to have one faxed to you, ask the tech on the mobile clinic for one next time we see you, or download it from the website. Please be aware there are 2 separate forms: a home health form and a facility form. Make sure you are using the correct one for the patient you are scheduling. The top of the form clearly states Home Health or Facility.
Medicare regulations combined with Obama healthcare changes and RAC audits, require us to be much more intense and aggressive on the information we obtain before we complete a study. We can no longer accept incomplete history forms without information regarding payor source, reason for consult, a reasonable diagnosis RELATED to the dysphagia for medical necessity, and a current diet. Your history/consult form goes into our medical record and must be complete. Health care documentation and regulations are not getting any easier for any of us and we must maintain standards. (We have actually had a form faxed to us with no name or facility, just a diagnosis and a diet!) Please make sure you take that extra moment to fill out the medical record in its entirety without leaving blanks. We would also appreciate any H&P (history & physical) you can provide with the other paperwork. It will save us quite a bit of time searching through the chart at your facility. Thank you for your assistance with this.
TSHA is coming to San Antonio, Texas and DRS is in Ontario, Canada next month! These 2 conventions are typically scheduled on the same weekend. This year it is March 8-10th. Pam and I will be presenting at TSHA on “What you can not see at bedside” and Russ Campbell, Rick McAdoo and I will also be presenting an hour course on E-stim, hope to see you there!
Updated DiagnosTEX service contracts – Due to new Medicare fee schedule changes and increasing gas prices, we are increasing our service contract rate to $180.00. This rate includes all of the radiology technical codes for the MBSS that we bill to Medicare or insurance, which is a contracted rate between the service provider and the facility. This contractual agreement can be less or more than the actual sum of the technical codes billed, and our rate of $180.00 is about 75% less than the Medicare allowable. The service agreement updates were sent to your facility in January. Our rate continues to be a significant savings to your facility in comparison to sending the patient out by ambulance to a local hospital. Please keep in mind that every DiagnosTEX mobile clinic that goes out carries a highly trained staff (consisting of a medical doctor, a speech pathologist and technician). Our mobile service eliminates the need for scheduling and transporting the patient out of the facility, with the convenience of us coming to you within 1 week of a request. Recently a home health company sent one of their patients to the hospital instead of using the mobile unit… they called us back the following day to schedule their other patient because the hospital charged them $376.00 for the MBSS, not including transportation!! If you have any questions about billing at any time, feel free to contact our billing manager, Carolyn. (817-514-6271)
2012 Medicare cuts to go into effect in March if Congress does not act – Once again the 92611 code has decreased in reimbursement levels from $113.87 to $71.89 (in Dallas). It is unknown how far the reimbursement rate can drop and allow the VALUE equation to remain the same. If the reduction in reimbursement rates and the increase in medical costs continue, it is likely to degrade the information gathered and knowledge gained by instrumental assessment of MBSS. The rate has dropped by approximately 50% over the last 9 years (i.e., $140 in 2003). We would like you to help us encourage ASHA to advocate this service with more value by making your opinion and voice heard at http://takeaction.asha.org/.
Repeat MBSS – Medical necessity for a repeat MBSS is REQUIRED. For example, we cannot complete a repeat MBSS on hospice patients “because the family wants it.” Once an initial safe diet is established on a previous MBSS, then palliative care is the goal. In addition, we have to start reducing the number of repeat MBSS on those who have signed an AMA (waiver). There is no medical necessity regarding these studies, making reimbursement difficult. Repeat studies are appropriate for a decline in status, an improvement in status, after treatment, and/or following an additional medical event such as trauma, decannulation, CVA, etc. If there is not medical necessity, the patient may have to pay “out of pocket” for the MBSS.
Quality Assurance – For those of you that helped us collect the information we needed for our QA, we thank you!!!! The results were so amazing. We have collected QA on the patients seen for MBSS since 2003. Over 7 years of QA data collection, statistics have shown that 23% of patients seen were silent aspirators, there was a 47% discharge rate from therapy, a 60% reduction in tube feeding and 41% of patients were identified with an esophageal component. This year, 35% of patients seen for MBSS aspirated, and of those, 83% aspirated silently! Sixty-one percent were discharged approximately 4 weeks after the MBSS, 49% had a reduction in tube feeding, and 47% presented with esophageal involvement. Combining these stats actually shows a reduction in health care cost when using the proper instrumental assessment to guide treatment.
Dysphagia Tidbit: Dysphagia and Candy – Dysphagia aortica may occur exclusively in the elderly when chewing sialogogues (agent that stimulates salivary flow) such as sugarless hard candy or chewing gum. These items get stuck in the esophagus near the aortic arch, especially when the patients are in bed a lot and have poor positioning in a cardiac chair or wheelchair. Usually on a modified dysphagia diet (NDD level 3), the sweets allowed are soft chocolates, honey, jam, jelly, sugar, chocolate syrup, molasses; the sweets not allowed are hard candies, chewing gum, candies with caramel, dried fruits, nuts, coconut, marshmallows, and taffy-type candy.
Fort Worth Star Telegram – Aspiration Pneumonia Replaces Homicide as One of the Top Causes of Death in the USA. Homicide was overtaken at #15 by pneumonitis, seen mainly in people 75 and older, and they specifically refer to the pneumonia as “when food goes down the windpipe and causes deadly damage to the lungs”. Read about it at:
January – January as been a very busy month for us and we know if it is busy for us, it is busy for you too! We are maxing out all of our vans and sincerely trying to get to everyone scheduled as quickly and efficiently as possible. However, we are limited to how thin we can spread ourselves in our travels across the map. If you have an immediate situation, you may want to send your patient to the hospital as an outpatient if you can get it scheduled sooner than we can get to you. We appreciate your patience with the abnormal delay in scheduling.
Estimated Time of Arrival (ETA) – I know I probably sound repetitive on this topic, but I feel like I need to reiterate… We get many calls when we can not meet specific times, or may be running late on certain days, or even early on certain days. Remember that mobile service is for the convenience of us coming to you not the flexibility of a specific time and day. I know that can be inconvenient at times but that is the limitation of using mobile services. We schedule based on geographical areas not only due to gas prices, but for efficiency of scheduling in order to meet the maximum number of pending requests. If there are “add-ons” at a facility, we will likely add them while we are there (within reason). I am sure we have done many of these for most of you.
Our mobile unit is not a STAT service. If you need an MBSS more promptly than we can schedule it, need it on a specific day or time, need multiple days notice, you may need to consider sending the patient out to a free-standing outpatient facility that can be more accommodating to specific days and times. Based on the way we schedule our vans, we are able to provide you with only a day’s notice for scheduling, but no further out than that.
DiagnosTEX can not guarantee nor consistently meet all time requests, work around all personal local SLP schedules and facility coverage locations, accommodate/schedule around overtime staff issues, facility department meetings, patient group treatments, doctor appointments, birthday parties, families work schedules, patient dialysis schedules, “morning or afternoon only” requests, nursing staff limitations at shift change, scheduled meal times, medication administration, availability of a chair, scheduled therapy times of an outpatient, presence of students, etc., etc., etc. We complete over 700 studies a month in the DFW area and there is absolutely no way to meet all of these requests with the number of facilities, patients, and SLPs we service. If we did, we would not be able to operate and be as efficient as we are in meeting those patients’ needs that have no limitations set by them or the facility staff. Mobile service is and always will be subject to travel delays; this is the nature of the mobile business. We encounter traffic, construction, bad weather days, add-ons, difficult patients and involved families, patients not being up and ready when we arrive… (Waiting an extra 15 min on 4 of these in a day can put us at the very least an hour behind for the day!) When we schedule, this is truly an estimated time of arrival (ETA), certainly not a guarantee. Our staff will always call on their way, so please provide us with a solid contact number to reach you as we head your direction.
We love providing you with convenience of mobile MBSS and we work very hard at being on time and being as efficient as possible, but sometimes no matter how hard we work for it, we can encounter obstacles that are out of our control. Mobile service definitely requires flexibility during the day to all involved, including us! Please inform your facility staff, patients and their families that although we schedule an estimated time of arrival, we cannot guarantee that specific time. Unfortunately, the further away your facility is from our home base in the mid-cities, the more likely our scheduled times will vary. The number of obstacles we can encounter that can impact our schedule throughout the day increases as we work our way out 50+ miles. Again, please understand mobile service requires flexibility in time. Our goal is to provide you with the convenience and cost savings of us coming to you and not having to transport the patient out to another location.