Administrator/ Physician info

ASHA scope of practice specifically states SLPs have an inability to fully assess pharyngeal phase of swallowing at bedside and must use an instrumental in order to fully assess the pharyngeal phase.

This idea extends to the actions of changing diets at bedside without an instrumental – if you don’t know what’s wrong, how can you be sure you’re fixing “it” and not doing more harm to the patient?

We would balk at the idea of a physical therapist treating a hip fracture or a physician treating a stroke without first confirming diagnosis with the aid of imaging diagnostics and using that information to form an appropriate treatment plan.  Equally, SLPs should have access to objective imaging diagnostic information in order to identify dysphagia and treat effectively.

Patients frequently cite dislike as the reason for limiting/avoiding intake of thickened liquids and pureed foods. These patients have higher rates of dehydration and urinary tract infections – two of the top five reasons for unplanned rehospitalizations. 

Rehospitalization costs for pneumonia not requiring use of the ICU is a minimum of $14,400 per episode. Then add in the cost of thickener per year: $2088-$3468 per patient and enteral feeds: $31,832 ($46,257 adjusted for inflation) per patient. (O’Keeffe 2018, Callahan et. al 2001, respectively. See Research Resources).

Multiply by the number of affected residents in the facility and the numbers begin to skyrocket.  Having access to FEES can help to minimize these costs and help to lower readmission rates.

With rehospitalization for an uncomplicated course of pneumonia costing over $14,400 per episode and care costs for a PEG averaging $46,257 (adjusted for inflation) per year, it’s in the best interest and health of the patient and the facility to minimize these occurrences as much as possible.  Let SuperiorView Swallowing Diagnostics help you lower these risks. 

By incorporating FEES into the ongoing dysphagia management plan, the SLP and physician is equipped with valuable information regarding the swallow function that can NOT be gained from a bedside exam.  Results are immediate, preventing delays in care decisions.  

With this objective information, we assist the SLP in developing an effective treatment plan which includes minimizing pneumonia risk and need for more invasive procedures (e.g. feeding tubes).  

Both exams are valid and specific assessments to assess dysphagia in a patient with research showing FEES (Flexible Endoscopic Evaluation of Swallowing) to be more sensitive and specific than VFSS (Videofluoroscopic Swallow Study). However, there are certain parameters where a FEES may provide more valuable information than a VFSS.

Accommodate positioning restrictions including halos/braces, head of bed restrictions/spinal cord injuries, and contractures, which may otherwise limit the view capabilities in the radiology suite.

No radiation exposure or barium in test materials.

No limitations on length of exam; easily assess patient endurance during a meal.

Assess patient specific food preferences, pills, and carbonated beverages.

Directly view the larynx and pharynx including vocal fold appearance and movement, tissue integrity including signs of reflux, and secretion management.

Portability to perform exam in the patient’s environment – intensive/specialty care type units/vents, medical floor, inpatient rehab, skilled nursing. No fatiguing transportation for medically fragile/cognitively impaired patients. Outpatient services are also available.

Record entire exam (unlike VFSS where the fluoro is turned on and off during the exam). The endoscope is always “on” to view management of pharyngeal residues and secretions.

Significantly less expensive than the VFSS.

Research has repeatedly proven FEES to be a safe, reliable, and well tolerated exam to assess dysphagia.

With a < 1% complications rate, potential risks including gagging, epistaxis, laryngospams and vasovagal response are quite infrequent  Per the research, when complications do occur, severity is mild.

Check out the Research Resources page for specific articles on FEES safety.

With a trained, experienced SLP passing the endoscope, discomfort is minimized as the endoscope is passed transnasally. Majority of patients typically describe the sensation as “weird” or “odd” rather than one of pain.

Once the scope is in place, most patients show no sign of discomfort.  Research indicates patients are willing to repeat the procedure.

SuperiorView Swallow Diagnostics utilizes 3.6mm nasopharyngoscopes for comfort and are smaller than the diameter of your index finger. 

Multiple studies have shown no significant difference in swallowing performance between non-anesthetized patients and those anesthetized with lidocaine.  High levels of topical anesthesia has been shown to negatively affect swallow performance.

See the Research Resources page for study specific articles.

Easy!  Contact us using the contact button to the right or call us directly at 330-388-7050.  We’re happy to answer any questions related to establishing FEES in your facility, provide an onsite demonstration, or address any concerns you may have about instrumentals.

Patients frequently cite dislike as the reason for limiting/avoiding intake of thickened liquids and pureed foods. These patients have higher rates of dehydration and urinary tract infections – two of the top five reasons for unplanned rehospitalizations. 

Rehospitalization costs for pneumonia not requiring use of the ICU is a minimum of $14,400 per episode. Then add in the cost of thickener per year: $2088-$3468 per patient and enteral feeds: $31,832 ($46,257 adjusted for inflation) per patient. (O’Keeffe 2018, Callahan et. al 2001, respectively. See Research Resources).

Multiply by the number of affected residents in the facility and the numbers begin to skyrocket.  Having access to FEES can help to minimize these costs and help to lower readmission rates.

Pneumonia has the highest mortality rate of any hospital acquired (nosocomial) infection and the most frequent reason for hospitalization (Langmore 2002). Uncomplicated pneumonia hospitalizations without use of the ICU is over $14,400 per episode. 

Patients with a diagnosis of dysphagia spend on average 3 additional days in the hospital and have a 46% increase in hospital associated costs.  FEES provide objective imaging and data to identify patients with dysphagia, drive effective treatment, and maximize outcomes.

Utilizing FEES to manage dysphagia offers significant financial savings in the long run all for the cost of a few hundred dollars.

With rehospitalization for an uncomplicated course of pneumonia costing over $14,400 per episode, it’s in the best interest and health of the patient and the facility to minimize these occurrences as much as possible.  Let SuperiorView Swallowing Diagnostics help you lower that risk. 

By incorporating FEES into the dysphagia management plan, your SLP is equipped with valuable information regarding the swallow that can NOT be gained from a bedside exam.  Using this information, we assist the SLP in developing an effective treatment plan which includes minimizing pneumonia risk.  

VFSS or videofluoroscopic swallow study requires the use of radiological equipment and barium in addition to the time and services of a radiologist, radiology tech, and SLP to perform the exam.  These exams typically cost between $1200-$1600 per study and may be difficult to schedule due to time constraints in the radiology suite if performed at a hospital or space constraints if utilizing a mobile company. 

FEES is a truly mobile system with no special space requirements, no radioactive contrast, scheduled within 3-5 days from referral, and requires only the services of a SLP to perform the exam – all for a few hundred dollars. 

CMS regulations require speech therapy services be billed directly to the facility. Under Medicare Part B, private insurances and HMOs, you may recover monies for the speech therapy code(s) indicated on your invoice utilizing the UB-04 or similar form.

92612 – FEES exam

92526 – Dysphagia therapy

Mobile FEES benefits everyone in the facility – no transportation stress to the patient, no loss of staff to accompany the patient, no loss of other therapy or nursing treatment time, and the facility SLP is able to participate in the assessment. 

From scheduling exam time, length of exam, position during exam, use of speaking valve/no valve, to patient specific foods, FEES offers the flexibility to meet the needs of the patient while providing the objective data a SLP needs – all in the comfort of the patient’s own environment. 

SuperiorView Swallowing Diagnostics reviews the procedure and addresses any patient concerns prior to the exam and utilizes surgical lubrication when placing the scope to ensure patient comfort.  Post exam, patients typically describe the exam as a “weird” or “odd” feeling rather than one of pain. 

Exam results are immediately available to the SLP, facility staff, and physician meaning changes in the plan of care happen with no significant delay in care.  Consistent assessment of dysphagia has been shown to reduce incidence of pneumonia and hospital readmissions.  In addition, FEES provides objective data justifying initiating and/or continuing a skilled dysphagia treatment plan.

Scheduling a FEES is hassle-free!  Simply call us with the referral information, and we’ll have the exam completed within 3-5 days.  No loss therapy time gathering information or faxing packets that never arrive to their destination!