When a patient's physician orders a swallowing study to be performed, the facility must decide whether to have the study performed on-site or at the hospital on an outpatient basis. If the patient is a medicare beneficiary, the prudent buyer concept must be applied after the care-plan team has eliminated unsafe alternatives. For other types of patients such as private pay, insurance, or managed care, sound business decisions and existing contractual relationships also apply.
When considering the efficacy of the treatment you choose for your patient, factors that should be considered are:
- stress incurred during transportation
- disorientation due to unfamiliar environments
- fatigue caused by the length of time it takes to complete the outpatient study
Study results are immediate, and in all cases MBS Envision will have a physician present and provide a radiologist's report within two working days.
Typically the MBS Envision study will take approximately 40 minutes of the patient's time and takes place in his or her familiar environment, with the patient in his or her own chair. As a result, the success rate for completion is substantially higher, and repeats trip are therefore usually unnecessary.
Economically, the facility will:
- incur no one-on-one staff time
- incur no special environmental setup costs
- be reimbursed reasonable cost plus overhead
The MBS Envision Team maintains impeccable credentials and uses the highest-quality equipment available.
Factors to Consider
Potential Health Costs to the Resident
As you know, the potential for health complications are much greater whenever a resident is transported to the hospital:
- They are gone for 3-4 hours for a 10-minute test.
- They are transported by people who, while very qualified, do not know your resident.
- They are taken to an environment that can create stress, anxiety, and fatigue, as well as exposing them to sick people.
- They are placed in an extremely confined space for the exam.
- There are generally no familiar faces to comfort them. (If the facility sends a nursing assistant with them, the facility risks non-compliance due to a staff shortage.)
Ever have a resident admitted while at the hospital for an out-patient procedure?
Limitations of the Hospital MBS Exam
The hospital MBS exam is generally controlled by the radiologist, who is trained to “rule out” R/O fractures, R/O pneumonia, etc.
With the radiology-based MBS exam, the exam is considered complete if the patient aspirates; the radiologist has the information he needs. He therefore does not give the hospital SLP enough information to tell you, for example, if a chin tuck would work or if fatigue is a factor. This type of exam leads to more residents on thickened liquids and more PEG tubes.
Additionally, the AP view is rarely, if ever, done. This is very valuable if the problem is esophageal in nature (reflux, for example).
An MBS study is not just an x-ray, it should be a swallowing evaluation. Your residents deserve a thorough and accurate evaluation. I know I would hate to have my diet determined by only three or four presentations.
The Envision MBS Difference
We follow Dr. Logemann's protocol, so our SLP will be able to tell you not only if aspiration occurs, but when (before, during, or after the swallow) and why it occurs.
We take into consideration all factors that can affect safe swallowing.
Our team is made up of a highly trained and experienced SLP, a physician, and a unit assistant. The physician is present to ensure that the patient is medically stable before, during, and after the test. The SLP is in charge of the team.
The SNF SLP is able to attend and consult with the MBS Envision SLP before, during, and after the evaluation. This is especially important when recommending treatment. We do not recommend anything unless we test it. Our SLPs are much more comfortable recommending a diet knowing that it has been thoroughly tested.
As you can see from the SLP recommendations report [WHERE IS THIS REPORT?], you receive all the information you need.
Family members, staff members and students are welcome to attend our study. Education and communication are very important to us.