October 2012 Newsletter

October 2012

Clinical Café Newsletter

By: Ronda Polansky M.S. CCC-SLP

Monthly Motivator: 

Everyone enjoys doing the kind of work for which he is best suited. Far and away the best prize that life has to offer is the chance to work hard

at work worth doing.

Quick facts

• 5.4 million Americans are living with Alzheimer’s disease.
• One in eight older Americans has Alzheimer’s disease.
• Alzheimer’s disease is the sixth-leading cause of death in the United States and the only cause of death among the top 10 in the United States that cannot be prevented, cured or even slowed.
• More than 15 million Americans provide unpaid care valued at $210 billion for persons with Alzheimer’s and other dementias. 
• Payments for care are estimated to be $200 billion in the United States in 2012

The Alzheimer’s Association Walk to End Alzheimer’s™ is the nation’s largest event to raise awareness and funds for Alzheimer’s care, support and research. Held annually in more than 600 communities nationwide, this inspiring event calls on participants of all ages and abilities to reclaim the future for millions. Take the first step to a world without Alzheimer’s by finding a Walk near you. Once you register, you will have access to a wide range of tools and support through your Participant Center, ensuring a successful and fulfilling experience.

When you participate in Walk, your fundraising dollars fuel mission-related initiatives of care, support and research. In addition, your actions, both through fundraising and participating in the event, help to change the level of Alzheimer’s awareness in your community.

FLU season – We ask that if you or a family member (or even the patient) is ill with an active cough, sneezing, and/or fever that you do not attend the MBSS on the mobile clinic or reschedule the patient, as we do not want to contaminate our small area. We see many fragile individuals in a day in this small environment.  In addition, our staff number is limited and their absence is greatly felt if they become ill.  Please be considerate during this flu season and refrain from being on the van if you or a family member does not feel well. If the patient is ill, please reschedule for another day.  Thank you!

ASHA presenting to Medicare

Medicare Payment Advisory Commission (MedPAC) invited ASHA to present information on NOMS as they review a new Medicare payment system for outpatient therapy that reflects individual acuity, condition and therapy needs. Congress is also responding to increased therapy services disappropriate to the number of beneficiaries. MedPAC also requested ASHA representation on an on-time in-person meeting to discuss Medicare payment policy issues.  Nancy Swigert represented ASHA on the panel.  SLPs should get prepared to become very familiar with NOMS.

What is Episode Payment and is this our future?

An example of episode payment would be one fixed payment for swallowing or other speech language treatment services provided through a specified plan of care designed to meet specific goals.  This is similar to PPS. Applying this principle to allied health providers raises many questions and concerns, including quality, what would be included in the payment, and the transition from fee for service to episode payment. Congress, the Medicare Payment Advisory Commission and CMS are debating these issues in this new health care era.

Medicare Manual Review Rules – All claims for Part B outpatient therapy that exceed $3700, with no exceptions will receive scrutiny on or after October 1, 2012. The reviews for Phase 1 (high volume providers) begin Oct 1, Phase 2 (mid-range providers) begins Nov 1, and Phase 3 (low range providers) begins Dec 1. Providers can request pre-approval for services above $3700 in 20 day treatment day increments. MACs have 10 days to respond; requests that do not receive notification within 10 days are automatically approved. Claims without approval will be stopped and review of 45-60 days process will begin. ASHA concerns are:

1. Administrative burden on providers
2. No standard exists to determine what claims will be rejected
3. Medicare has a 12-point scale that has not been subject to reliability or validity studies, let alone who is making the decisions.

Dysphagia Tidbit – Swallowing exercises show improvement among patients with head and neck cancer

A study conducted at Mount Sinai of medicine and published in April issue of the Archives of Otolaryngology – Head and Neck Surgery suggests clinicians should consider giving all patients undergoing CRT an exercise regimen to improve QOL after treatment. A randomized control trial of 26 patients with head and neck cancer undergoing CRT were split into 2 randomized groups. Half were in an intervention group performing 5 targeted swallowing exercises throughout CRT and participated weekly in therapy sessions.  The other half was a control group and conducted no swallowing exercises until after completion of CRT.  Patients were assessed using Functional Oral Intake Scale and the Performance Status Scale of Head and Neck Cancer. The intervention group showed significantly better scores on both scales at 3 and 6 months following treatment.  The authors plan on studying benefits of exercises at 9 and 12 months using a larger sample size. This study showed that intensive team approach assisted the patient in the best possible outcome after treatment of head and neck cancer.  www.advanceweb.com/Speech.  August 20, 2012