March 2011 Newsletter

Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP
March 2011
Happy St. Patrick’s Day
“May your blessings outnumber the shamrocks that grow
and may trouble avoid you wherever you go
may your right hand always be stretched out in friendship
and never in want.”
TSHA is coming to Houston and DRS is coming to San Antonio this month! Numerous and exciting educational opportunities in our state!
UPCOMING ESTIM CEU March 19th – Oklahoma City, OK. For more information, go to http://ampcare-okc.eventbrite.com or email ampcare@verizon.net.
We will be planning another E-stim course in Arlington in May. Look for more information on this opportunity in the April newsletter.
*E-stim under fluoro with PO*
We have been asked several times to utilize an E-stim protocol under fluoro during MBSS. Significant controversy exists throughout literature regarding the use of E-stim during PO. I have done my fair share of E-stim under fluoro in my own research. My daily access to the equipment has given me the unique opportunity to view innumerable results. Personally, I am not an advocate for PO feeding with E-stim being on. Depending on the placement of the electrodes, there is the possibility of widening the vestibular space when the hyoid bone is displaced; with premature loss this could be an increased risk to penetrating the airway unnecessarily.
E-stim alone does not create a swallow or create laryngeal closure.
If it did, you would not be able to breathe when stim was on!
The MBSS is used to determine the pathology of the dysphagia and recommend appropriate treatment, determine if treatment has been successful or should be ongoing. Watching E-stim under fluoro during PO does not benefit the outcome of the MBSS. There is no solid research that using E-stim during PO improves that particular swallow. It is a treatment modality, not a strategy. If you would like to view E-stim treatment under fluoro, we have many protocols recorded on a DVD that we can share with you. Due to time constraints, increased patient exposure to fluoro, etc., please understand we cannot accommodate attempting treatment modalities during our diagnostic procedure. Please let me know if you have any questions on this subject.

New history/consult request forms
In January, we implemented new history forms (a result of new Medicare requirements). Some SLPs have explained they have been trying to use up their old forms before using the new ones. We regret any inconvenience, but we need these new forms to be implemented right away. Copies can be found on our website, we have copies on the van, or the office staff can fax you a new one. Please start using these forms immediately when requesting your next study. Thank you!

New hospice forms
Due to current restrictions and billing denials, we are requesting your additional scrutiny when requesting an MBSS on a hospice patient.
1. The patient must have a diagnosis that directly causes dysphagia (CVA, Parkinson’s, GERD, feeding difficulties, etc.) AND this diagnosis must be different from the hospice diagnosis.
We cannot bill Medicare for services conducted on a hospice patient if the hospice diagnosis relates to the dysphagia they are experiencing.
2. This study must be approved by the hospice company prior to provision of the study or payment will be denied.
Medicare eligibility is verified on each patient, but if the patient is recent to hospice care (no claims have yet been filed by hospice) then it is not posted on the eligibility information from Medicare. It is imperative that you contact the hospice company prior to scheduling your patient, to ensure approval for your referral. Please complete and include the new form with your request when faxing paperwork to schedule MBSS for a hospice patient. We appreciate your attention to this matter! 

ASHA visit!
DiagnosTEX was very honored and excited to have an ASHA representative visit us in February to observe our mobile MBSS service. It was an amazing opportunity to showcase the quality of service we provide, and further highlight the need and convenience of mobile modified barium swallow studies.

Dysphagia Tidbit – Recommended books and CEUs for EOL and nutritional needs
• William Plonk Jr., MD. PEG Tubes in Adults
• Jacqueline Kindell. Feeding and Swallowing Disorders in Dementia
• Becky Dorner. Dysphagia Diet Solutions
• American Cancer Society. American Cancer Society Complete Guide to Nutrition for Cancer Survivors: Eating Well, Staying Well During and After Cancer

A few recommendation for feeding people with dementia
1. use a red plate or put each item in an individual bowl
2. dessert needs to be provided last
3. get the patient out of the bedroom and into the dining room
4. assist, but do not feed (use graded assistance)
5. “3oz water test” is not a screen for dysphagia