January 2010 Newsletter

Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP

JANUARY 2010
Happy New Year!!!!!

Fun-Facts about New Year Resolutions
Here are some fun facts related to New Year as observed in America:
• About 40 to 45% of American adults make one or more New Year’s resolutions each year.
• Most popular resolutions include promises of weight loss, exercise and quitting smoking.
• Also common are resolutions dealing with better money management / debt reduction.
• The following statistics reveal how many of these resolutions are maintained as time goes on:
1. Past the first week: 75%
2. Past 2 weeks: 71%
3. After one month: 64%
4. After 6 months: 46%
5. About 67% of people make three or more resolutions.

Heads up on Upcoming 2009 conference on E-Stim I have had many inquiries about the next
E-Stim conference. It is Saturday, January 16, 2009 in Shreveport, Louisiana, 7.5 TSHA CEU”, LA Imaging is a Mobile MBSS company in Louisiana. not a part of DiagnosTEX, LLC. They have invited us as guest speakers; please call their Corp office at 318-798-2648 to register or for any questions about the conference. Limited seating. Austin, Texas will be our next stop on February 20th. Contact Professional Imaging at 1-866-675-MBSS for more information about the Austin course.

2010 Medicare Changes –Analysis of 2010 Medicare Fee Schedule The Centers for Medicare and Medicaid Services issued the 2010 Outpatient Medicare Physician Fee Schedule for Part B services on October 30, 2009. There was a 21.2% reduction in the conversion factor ($28.4061) that affects all services paid under the physician fee schedule. The reduction stems from a provision in the Medicare law, known as the sustainable growth rate (SGR) that mandates an adjustment to the conversion factor when total Medicare physician expenditures in the prior year exceed a target. In December the U.S. House of Representatives passed a short-term fix to Medicare’s sustainable growth rate (SGR) formula, averting what would have been a 21.2% pay cut in physician payments as of January 1. The SGR Band-Aid was included in a defense appropriations bill that the House passed on a 395 to 34 vote. The provision would postpone the cuts until February -March 2010, presumably giving Congress time to repair an SGR formula that everyone agrees is broken but few can agree on how to fix. Previous legislation that would have implemented a more permanent fix has been delayed due to concerns that it might contribute to the federal government’s worsening debt load. Any cuts will directly and dramatically affect DiagnosTEX, so we are all holding our breath and praying for the best!
DiagnosTEX 2010 Dysphagia Calendar – Be sure you get the new DiagnosTEX 2010 Dysphagia Calendar if you haven’t already!!

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 much higher. Our decisions to run the vans that day may be based upon whether or not public schools are closed because of road conditions. In the case of a cancelled day, we will do our best to get your study rescheduled as promptly as we can. Please drive carefully during these winter ice storms!

Flu season – DiagnosTEX keeps stock of Airborne in the office and hand sanitizer everywhere!!  We service many elderly and medically fragile individuals in a day and we are very concerned and conscientious that we do 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.

New dysphagia product – Wedgecup – We saw this product at ASHA. We are carrying a sample of one on each van with brochures. Unlike the Provale cup this cup can limit bolus size on thickened liquids. It has a fully adjustable flow control and can be used with either hot or cold liquids. The 3 piece cup (similar to Provale) has a single hand design with adjustable rotating inner liner, allowing function for both left and right handed patients. You can find more information at www.wedgecup.net and if you order one (985-722-8269) do not forget the referral came from DiagnosTEX for a small discount.

Dysphagia Tidbit – Fracture of the hyoid bone – This is common in traumatic injuries to the neck through hanging, strangulation, and MVA in which the anterior body of the hyoid is thrust against the steering wheel, and even seen as an Iatrogentic fracture during surgery to the neck, in particular during cervical spine surgery is also reported in the literature. The effect of swallowing is often severe despite the various etiologies. Odynophagia (Pain) and inability to swallow are often the diagnostic indicators and focal vagus/recurrent laryngeal nerve damage can cause specific onset of dysphonia. Strangulation fractures with displaced bone fragments can result in obstruction in the pharynx and pain can occur with elevation and tongue base retraction. Focal vagus and recurrent laryngeal nerve damage usually results in aspiration. If the hyoid bone is damaged, the amount of forward and upward movement may be reduced which can decrease laryngeal closure and opening of the UES. Fractures at either of the greater horns may also impair superior and anterior hyolaryngeal movement. Hyoid competence must be evaluated with an MBSS. This allows for biomechanical assessment of the swallow function and also show the hyoid fracture at the same time (Anthony et al, 2000)