November 2019 Newsletter

Happy Thanksgiving!

There is no better time to express our appreciation for your business and trust in us! The friendship of those we serve is the foundation of our success serving the DFW area! This is the season to reflect on your blessings and those things for which you feel most thankful.  I know at DiagnosTEX, we are incredibly thankful for each and every one of you who chose to use us as your preferred mobile MBSS provider and have shared both your friendship and endless support over the years. We truly wish you and your families a very Happy Thanksgiving with many, many blessings as we enter this 2018 holiday season!


Swallow and be thankful for your teeth! Family- fun! Food is the glue holding these 2 things together during holidays.  We celebrate so many events in our lives around food, we take dates to dinner, we celebrate birthdays with cake and ice cream, we toast to wedding and graduation celebrations and we meet for coffee/tea or have lunch with friends. Everything we do in a relationship often revolves around food. You don’t know how much until you cannot eat or drink anymore.


DTEX November Holiday Schedule   - DiagnosTEX will be closed on Thursday, Thanksgiving Day, November 28th and Friday the 29th, to count our blessings and spend time with our families. We want to meet all of your MBSS needs because we know PO feeding becomes important on many levels to many of your patients around the holidays, especially when Thanksgiving is traditionally planned and prepared with a great deal of attention to food.  We also want to be fair and accommodating to each DiagnosTEX employee and their families. We are so thankful for them as well!    Please keep our holiday schedules in mind when scheduling your MBSS at the end of November (and December)!  ******Please take note and keep in mind that during this busy time of year, specific requests for specific times and/or days become exponentially difficult to accommodate.  We may be unable to quickly schedule your patient with a certain time and day requests. Please notify your staff, patients, and families of this. ****** DiagnosTEX bases our mobile clinic schedules by geographical areas for time, efficiency and operational cost. If your patient’s schedule is limited to certain days and times, we recommend an outpatient facility (such as a hospital).  Our mobile service is an option for you that offers convenience in the equipment coming to you, but it is not for the flexibility of specific days and time schedules. Please keep in mind that DiagnosTEX is not a portable X-ray service and we do not provide stat services. DiagnosTEX is an independent physician clinic/office and operates under normal physician office hours Monday through Thursday with an occasional Friday if a holiday or unusual circumstance with mechanical issues with the van interferes and/or effects the other scheduled days. Fridays are typically a day we use to service all of our mobile vehicles and this is company policy.  As with any physician office, every patient’s paperwork must be processed and insurance must be verified before we will schedule an appt.  Also as a physician clinic/office, we schedule our appointments as it fits into our schedules and it may take anywhere from 1-7 days to get scheduled with us.

November is Alzheimer’s awareness month   - Dysphagia and aspiration pneumonia are the 2 most serious medical conditions seen in late-stage Alzheimer's disease patients. Due to the degenerative aspect of Alzheimer's and the varying speed of degeneration, it is important to evaluate and re-evaluate these patients. Malnutrition and dehydration are the major issues in this population, therefore it is important to understand their current level of functioning concerning their feeding and swallowing as they progress through the stages.

ASHA Convention is in Orlando, FL on November 21-23. Please stop by and see Ampcare at booth 1943 

DiagnosTEX QA on October patients – We will start following up soon on patients that we saw in October.  We appreciate everyone who patiently works with us on this. DTEX has been doing QA on our patients annually for the last 16 years. We follow up on our patients at approx. 4-6 weeks after their swallow study to see how they are doing on the diet recommended. We have had some people refuse to speak with us about the patient we are following up about. We would like to emphasize that once we have seen this patient for a consult, they are technically our patient and as the treating consultants, we can actively communicate with the healthcare team, even at the facility on their tolerance of the diet and treatment recommendations. Please be aware that THIS IS NOT A HIPAA compliance issue.  The patient remains an established patient of DTEX for 3 years from the date of service. The Privacy Rule, many are taking to extremes and applying incorrectly,  allows those doctors, nurses, hospitals, laboratory technicians, and other health care providers that are covered entities to use or disclose protected health information, such as X-rays, laboratory and pathology reports, diagnoses, and other medical information for treatment purposes without the patient’s authorization. This includes sharing the information to consult with other providers, including providers who are not covered entities, to treat a different patient, or to refer the patient. Collaboration in health care is defined as health care professionals assuming complementary roles and cooperatively working together, sharing responsibility for problem-solving and making decisions to formulate and carry out plans for patient care. Collaboration between physicians, nurses, and other health care professionals increases team members’ awareness of each other’s type of knowledge and skills, leading to continued improvement in decision making.

Under HIPAA, a facility may share or disclose patient information for the following purposes:

• Treatment of the patient (e.g. consulting with other healthcare providers on diagnosis and treatment)

• Obtaining payment from the patient’s health plan

• Operational requirements (e.g. quality improvement activities or peer review)

• Complying with legally mandated reporting or disclosure

Please review the HIPAA regulations for further confirmation. Timely communication between healthcare professionals is our ethical mandate in order to support the ongoing development of our field.  Your quick response to our phone calls is vital to our research contribution and collection of data. These calls will only take a few minutes of your time and we sincerely appreciate your time.

PDPM - There are several important things to remember with regards to speech:

  • Even if you do not provide any skilled speech therapy, based on the coding that the MDS coordinator enters into the 5 day MDS, facilities will always receive some money allocated to the SLP component.
  • There are many opportunities to increase the SLP case-mix group and the case mix index, and the reimbursement to the facility based on proper documentation and identification of the SLP component requirements.
  • Because SLP is paid at 100% throughout the length of stay, it is even more important to capture the most accurate coding for the 5 day MDS.
  • The Speech-Language Pathologist needs to work with nursing to ensure that documentation and patient assessment of cognition, diets and swallowing disorders are appropriate and accurate.

The bottom line:  SNFs will need to quickly and accurately identify treatment diagnosis/comorbidities to ensure that they are seeing accurate & appropriate reimbursement.  The supportive documentation (instrumental evaluations) also needs to be in place to ensure payments will stand up to an audit. Under PDPM you cannot guess.  Let DiagnosTEX help you support the diagnosis of swallowing disorders. Call us to schedule your Dysphagia consult including Modified Barium Swallow Study at 817-514-6271.


Dysphagia Tidbit  - Posture Affects Hyoid Bone Movement - Head and neck posture, as well as muscle tone in the anterior cervical region can negatively affect swallow function. Excessive muscle tone affects hyoid bone kinetics during swallowing in a unnatural posture in healthy individuals.  So you know, what it does to our unhealthy patients.   The generation of neck muscle tone due to inappropriate posture can encourage hyoid bone depression and increase the extent of hyoid bone elevation thereby increasing the risk of aspiration. Think of our patients in reclining wheelchairs. Humbert et al found that hyoid depression could be induced by applying surface electrical stim on the anterior portion of the neck, contracting the infrahyoids, and that was consistent with recent research in the referenced below.  In this research muscle tone was also observed in the region of the sternohyoid muscle, which is one of the infrahyoid muscles involved in hyoid depression.  During swallowing, there is contraction of the mylohyoid muscle and diagastric muscles which pull the hyoid bone upward whereas the geniohyoid pulls the hyoid bone forward. The coordinated actions of these muscles lead to anterior superior movement of the hyoid bone.  The findings in the research were that coordinates for the resting position of the hyoid bone were significantly lower with neck muscle tone than without and the generation of high neck muscle tone due to inappropriate posture may encourage hyoid depression and increased the maximum elevated position of the hyoid bone.

Excessive anterior cervical Muscle tone affects hyoid bone kinetics during swallowing in healthy individuals. Clinical Interventions in Aging 2017:12 1903-1910;  Tamazaki, Y., Tohara, H., Hara, K., Nakane, a., Wakasugi., Yamaguchi, Kohei., Minakuchi, S.