January 2009 Newsletter


Consultants in Dysphagia Evaluation and Management
817-514-MBS1 or 1-888-514-MBS1
Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP

Monthly Motivator
It is not what you say, it is what they hear that counts!
Rain and sun are to the flower as praise and encouragement are to the human spirit!

DiagnosTEX 2009 Dysphagia Calendar
Be sure you get the new DiagnosTEX 2009 Dysphagia Calendar!

Heads up on Upcoming 2009 conference on E-Stim I have had many inquiries about the next E-Stim conference: Saturday February 28, 2009, 7.5 TSHA CEU”S – San Antonio, TX Texas Professional Imaging LLC is a Mobile MBSS company in East Texas, Houston, Austin, and San Antonio, not a part of DiagnosTEX, LLC. They have invited us as a guest speaker, please call their Corp office 1-866-675-MBSS to register or for any questions about the conference. Limited seating

Unpredictable Weather in Texas -Unfortunately here in Texas we do not get a beautiful flaky snow fall, we get ice and usually black ice. This becomes a problem for anyone who travels, and we do a lot of that in all directions! As winter approaches and the threat of severe weather conditions arise, DiagnosTEX owners and drivers will evaluate the conditions of the roads and DiagnosTEX will contact all scheduled facilities scheduled immediately if we are unable to meet our schedule for that day. If the weather conditions are so severe, as not to put our staff at risk driving in to work, we will cancel the day and reschedule the facilities as promptly as possible. If bad weather begins to occur during the work day, the owner and the driver present on the mobile unit will decide together if any changes in the schedule should be made. Although the patients are extremely important we do not want to risk the safety of our employees or vehicles to prevent further delay of our service to you due to injury or damaged vehicles. Even minor damage to the mobile vehicle can put us down for several days. It also very different than someone driving into one location and staying at that location all day versus our schedules that require driving all over the Dallas Forth Worth Metroplex and surrounding areas on various roads and bridges all day long, the risks become higher. Our decisions to run the vans that day may be based upon whether or not public schools are closed because of road conditions. Please drive carefully during these winter ice storms!

Flu season – DiagnosTEX keeps stock of Airborne in the office and on our vans!!  We service many elderly and medically fragile individuals in a day and we are very concerned and conscientious that we not unnecessarily expose them to anything. We would like to ask all of the facility SLP’s, staff, or family members that are ill, coughing, and/or may have a cold, to take precaution and reconsider coming onto the van, as our small contained environment is easily contaminated. Thank you for your consideration of this and our patients as well as our own staff.

2009 Medicare Changes – The Centers for Medicare and Medicaid Services (CMS) issued the 2009 Outpatient Medicare Physician Fee Schedule (MPFS) for Part B services on October 30, 2008. There is a 5.3% reduction in the conversion factor ($36.0666) that affects all services paid under the physician fee schedule. The application of a congressionally mandated Sustainable Growth Rate (SGR) formula required a negative adjustment because the prior year’s rate of spending on “physician” services exceeded a set target rate. The Medicare Improvement for Patients and Providers Act of 2008 (MIPPA) averted a steeper across the board reduction. The fact that 92610 + 92611 have no work RVUs is a problem. There has been a 20% cut and now the MBSS is less than $100.00 at $84.76 and the Bedside Swallow Evaluation is $77.90. Regarding the “work component” you will see in our fee schedule analysis that 92610 and 92611 have ZERO in the work column. The reason why 92506 and 92507 have work is a carryover from when the RVU system was initiated in 1992 and a team made a decision to show physician work. When 92610/11 was revalued in the past couple years it was understood that our services could not be represented in the work column because we could not directly bill to Medicare. In 2009 they will hopefully be revaluing 92610/11 again because of the recent Medicare private practice legislation. Let ASHA know your thoughts on this! The therapy cap remains in effect but the exceptions process has been extended through 2009 by MIPPA. The new cap amount is $1,840 for the combined services of speech-language pathologists and physical therapists. You probably noticed our ASHA dues went up too!

History Form and Physician name On the dysphagia consult requested sheet, please give the first and last name of the primary physician. We have a number of physicians with the same last name in our system, so we have to call the facility to get the physician’s first name. It would save a lot of time on the phone for our office staff and the facility SLP’s if the first name is on the page when we receive the request for the MBSS. Thank you for your help with this.

Dysphagia Tidbit – Eosinophillic Esophagitis – How does it cause Dysphagia? -Eosinophillic esophagitis is more common in men and individuals with other allergies such as asthma and hay fever. Eosinophils are white blood cells (leukocytes) manufactured in the bone marrow that actively promote inflammation. Eosinophillic esophagitis decreases the ability of the esophagus to stretch and accommodate mouthfuls of swallowed food. As a result, mostly solid foods (steak, chicken etc) will have difficulty passing through the esophagus and causes an uncomfortable sensation in the chest. Rarely does it become impacted and either pass or is vomited up. Impacted food can mimic a heart attack. Treatment is gentle dilatation and medications. Doctors have observed that some patients with Eosinophillic Esophagitis develop tears in the esophageal lining. Esophageal tears can be serious and lead to infections in the chest. Medications used are proton pump inhibitors (Nexium, Protonix, Prilosec, Prevacid), or Fluticasone propionate which is a man made steroid administered with the same inhaler as for asthma. Side effects are minimal but oral thrush is possible. Improvement is noted within weeks but some patients develop recurrent symptoms months after stopping treatment and require additional treatment.