January 2014 Newsletter
Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP
JANUARY 2014
DiagnosTEX 2014 Dysphagia Calendar – Be sure you get the new DiagnosTEX 2014 Dysphagia Calendar if you haven’t already, there is a limited supply.
QA – Quality Assurance – Thank you to all of you who spoke with us during the day and also tolerated our phone calls, but especially for calling us back after we left voice messages. We appreciate all of those who took the time to return our call and talk with us briefly! The follow up on the patients we evaluated is important to us and this information has been so helpful to us over the years, not only as a company, but to our profession at a national level. We have shared the numbers/percentages of our QA with ASHA, Medicare, and Healthcare Reform Committee. MANY thanks to those of you who also saw the benefit and were willing to work with us collecting the data on your patients, as this benefits us all in the long run! We will share the results with you when we get it complete.
Unpredictable Weather in Texas Unfortunately in Texas we do not get a beautiful flaky snowfall, we get ice (usually black ice). Our weather can change overnight! Last year we had a terrible snowstorm and it shut our vans down for 4 days. This kind of weather obviously becomes a problem for anyone who travels. Most of our daily routine is traveling extensively 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 immediately if we are unable to meet our appointments for that day. If the weather conditions are severe, we will cancel the day and reschedule the studies as promptly as possible. If bad weather arises during the workday, an owner and the driver(s) present on the mobile unit(s) will decide together if any changes in the schedule should be made. The patients are extremely important, and our top priority has to be the safety of the patients, our employees and vehicles! Avoiding these kinds of risk is also important to prevent further delay of our service to you (resulting from injury or damaged vehicles). Even minor damage to the mobile vehicle can put us “down” for several days. Our workdays are heavily weighted with travel (all over the D/FW metroplex and surrounding areas, on multiple roads and bridges, through varying amounts/degrees of traffic), which naturally increases our risk of difficulties (especially weather-related). Our decision to run the
vans on a particular 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!
Documentation = Complete HX and consult forms and new healthcare policies Due to the forward motion of the new healthcare system, things are being implemented to prepare for 2014 when several Obamacare regulations go into place. There are over 40 billion dollars being directed to new boards to implement these systems, new policies and new regulations. Documentation is becoming much more critical. Documentation has always been important but is now being scrutinized more. It is predicted in 2014 that a doctor’s order will be required to provide diagnostic information, signs and symptoms and a diagnosis code on the written order for it to be valid. Medical necessity is a big concern with the implementation of the new policies.
I cannot emphasize enough that the DiagnosTEX consult request forms are a part of the medical record and the person filling it out will be held responsible for the information placed on it. Consequences from lack of documentation can fall back on the treating professional. The consult forms must be complete and provide all necessary information including any progress made or changes in patient status. Please take careful consideration of this when you fill out the form before sending it in to us. If there is ever an audit to the patient’s medical record, this is representative of your license and you will be judged on the information you provide. We are handing out scheduling packets for 2014, be sure you are updated on all of the forms.
FEES vs MBSS – The use of fiberoptic endoscopy to evaluate the pharyngeal stage of the swallowing is a procedure developed by Susan Langmore, Ph.D., Kenneth Schatz, M.A., and Nels Olsen, M.D. Parameters that can be evaluated include pharyngeal pooling, premature spillage, penetration/aspiration, and residue. The procedure is mildly invasive and is limited to the events immediately before the swallow and after the swallow event. With FEES, during the time of the swallow/airway closure, the swallow cannot be visualized. As the pharyngeal walls contract over the bolus it collapses the lumen over the endoscope (“whiteout phase”). Oral phases are only indirectly evaluated and no evaluation of the esophageal phase occurs. (Gerber, M., Vaeronneau, M., 2002, ASHA, 2002). MBSS is necessary to determine “WHEN” penetration or aspiration is occurring. An MBSS provides more information about the oral phase dynamics, coordination of oropharyngeal movements, posterior tongue movement and apposition with the posterior pharyngeal wall, hyolaryngeal elevation, aspiration DURING the swallow, UES opening, esophageal phase dynamics, and evaluation of the effortful swallow technique and the Mendelsohn maneuver (Langmore & McCulloch, 1997). The MBSS remain the pre-eminent method to view the oral, pharyngeal, and esophageal phase in real time and to diagnose the underlying cause(s) for the symptoms of aspiration and penetration, as it also allows visualization of the pharyngeal phase while compensatory strategies are tested for their ability to increase swallowing safety and efficiency. Currently, no other technology has this versatility (Lewis, K., Liss, J., Sciortino, K., 2004). SLP’s should be aware of current research that continues to support the efficacy of the MBSS and its overall cost efficiency against inpatient hospital costs for the management of pneumonia or pulmonary complications secondary to aspiration (Lewis, K., Liss, J., Sciortino, K., 2004). Call DiagnosTEX for diagnosis of your dysphagia patients.
CEU course hosted by Rehab Synergies – Saturday, January 25th, 2014 – Facilitating Functional and Quality- of-Life Potential: The Therapeutic Approach for Dementia. 7.5 TSHA CEUs. Presented by Melissa Collier M.S. CCC-SLP and Lindsey Roberts M.S. CCC-SLP. For more information or to register call 817-607-7601
Dysphagia Tidbit – Retroverted Epiglottis presenting as a variant of globus pharyngeus
Agada FO et. Al J Laryngol Otol 2007 April;121(4):390-2York Hospital, York UK
They described a series of 4 patients who presented with “high globus pharyngeus”, who had an abnormally curled epiglottis tip touching and indenting the tongue base. Following CO2 laser partial epiglottectomy, all four patient experienced complete relief of their symptoms.