March 2016 Newsletter


DiagnosTEX March 2016

Clinical Café Newsletter

Consultants in Dysphagia Evaluation and Management

817-514-MBS1 or 1-888-514-MBS1

By: Ronda Polansky M.S. CCC-SLP

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.”


Fun Facts about March:

  • It is the first month of Spring which begins between March 19-21.
  • In the Southern Hemisphere, March is the same as September in the Northern Hemisphere.
  • Each year March and June end on the same day of the week.
  • It is the time of year when animals start to wake up from hibernation.
  • March Madness is a basketball tournament played by the NCAA.
  • Easter is sometimes celebrated in March.
  • Birthstone: aquamarine and bloodstone.
  • March 6, 1836 – Fort Alamo fell to Mexican troops led by General Santa Anna.
  • March 10, 1862 – The first issue of U.S. government paper money occurred as $5, $10 and $20 bills began circulation

March is Brain Injury Awareness Month – By the year 2020, TBI is expected to be the number one health problems in the world. The CDC currently estimates 5.3 million Americans currently have long term need for help performing ADL’s as a result of their TBI. In Texas, close to 150K people sustain TBI each year, and this does not account for those who went to ER and were released or those who never went to ER. TBI hospitalization totals are approximately 1.8 billion each year and only 5% of the survivors receive the rehab they need.  In Texas there is no TBI Medicaid waiver to support long term needs. Advocacy efforts can help by contacting area government representatives and ask that funding be made available to acquired brain injury survivors.


Upcoming CEU Opportunities

TSHA Annual Convention is in Fort Worth this year!!! March 10-12.

DiagnosTEX will be at booth 502.  COME SEE US!

Pam and I will also be presenting Saturday AM at 11:00

Ampcare will be at booth 301 PLEASE STOP BY!

Critical Thinking in Dysphagia Management, University of Florida, March 18-20


Against Medical Advice (AMA) Diet Waivers and Medically Unnecessary – Over the past several years Medicare has been auditing medical charts on patients who have received repeat studies while on a diet waiver. They began to deny payment of studies on patients who maintained the waiver after an NPO or modified diet recommendation.  MC determines that if the patient is going to stay on a diet of their choice no matter the results of the MBSS, then the procedure itself is not medically necessary.  In the situation of AMA/diet waiver in place, DiagnosTEX requires that the patient/family sign an Advance Beneficiary Notice of Noncoverage (ABN) accepting the responsibility for the cost of the evaluation in the event MC denies payment due to their diet waiver and medical necessity. This is necessary for us to be reimbursed for the service we have provided.  Please help educate your patient and families on this risk on non-coverage on future repeat studies while on a diet waiver after a modified diet recommendation. Although the patient has a right to determine their course of treatment and diet despite the MBSS outcome, it does effect reimbursement for continued ongoing evaluation and treatment if the patient is refusing to follow the medical recommendations..  If you have any further questions about this, feel free to contact our billing office.


Cuisine for Healing® is a nonprofit organization dedicated to making nutritious, delicious food readily available to people combating disease, while providing education about the power of healthy food. Based in Fort Worth, Texas, Cuisine for Healing was founded by the late Wendy Wilkie in 2006 as she battled cancer. The U.S. registered Cuisine for Healing Certification Mark signifies that a product, food or menu item meets a specific set of healthy guidelines. These requirements include: that the food item must be organic (when possible) and free from hormones, preservatives, antibiotics, pesticides, trans fats, refined sugar and artificial sweeteners, flavors and colors. Other ingredient and food preparation guidelines are also required to obtain Cuisine for Healing Certification. This kind of healthful food is ideal for disease prevention and for anyone fighting a life-threatening disease, including cancer patients, heart patients, diabetics and more. Those facing a life-threatening disease have an even greater need to nourish their bodies for maximum health. However, cancer patients, (and others fighting illness and/or recovering from surgery) are often too sick or too tired to shop and prepare meals for themselves. The Cuisine for Healing Outreach Food Program provides two healthy, fresh meals seven days per week for four to twelve weeks at no cost to qualifying patients. Cuisine for Healing is now accepting qualified patients to participate in its Outreach Food Program. To learn more about qualifying for the Cuisine for Healing Outreach Food Program, please contact Cuisine for Healing at 817.921.2377. The Cuisine for Healing Food Program meals are also available at retail. Retail orders must be pre-ordered and pre-paid. Their certified meals are available for retail purchase via online shopping cart or calling Cuisine for Healing at 817.921.2377, email to


Dysphagia Tidbit –  Speech and Swallowing in Parkinson’s Disease – Swallowing impairment in PD may be apparent in any or all of the oral, pharyngeal, and esophageal stages of deglutition. Oral stage deficits probably occur most frequently in PD and usually are the first indication of dysphagia in PD. Limited excursion of the mandible contributes to increased time for oral preparation or chewing. Repetitive, backward and forward rocking motion of the tongue termed “tongue pumping” has been widely observed in PD, and is considered by some to be pathognomonic of the disease. To elaborate, tongue pumping refers to an inefficient, non-propulsive, back and forth motion of the tongue which prevents material from leaving the oral cavity. The back and forth motion may be repeated several times for a bolus before the back of the tongue eventually lowers to allow the passage into the pharynx. Liquid or saliva escaping through the lips (i.e., drooling) also occurs fairly often in persons with PD.4 Drooling does not appear to be the result of increased saliva production per se, as saliva production is actually decreased in PD. Rather, a reduction in the frequency of spontaneous swallows as well as an anteriorly flexed neck position are likely responsible for drooling in PD. As many as 55% of patients with PD report xerostomia or dry mouth.48 Xerostomia follows from reduced saliva production and also is related to levadopa dosage, such that higher doses of levadopa therapy increase the problems of xerostomia. Top Geriatr Rehabil. 2008; 24(2): 115–126.

doi:  10.1097/01.TGR.0000318899.87690.44