Medicare Caps

[Guest guest]

I remember that years ago, OT worked with Dysphagia/ cognitively impaired

patients. I am unsure of the total capacity that OT performed such services and

do not want to minimize the Role of ST with our patients. However, with the Caps

in place, I am wondering if it is some value to revisit this again? This would

allow ST to focus on more of the specifics and allow OT to work on other areas.

I would like any info and educational resources in the area.

Tamera J Bounds

Regional Rehad Director

---------------------------------

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[Guest guest]

As a point of reference, you might want to visit the aota site. They have

guidelines for dysphagia treatment with OT. Here is a link to a fact sheet

published by AOTA. I would keep something like this handy, along with

training certificates in case of denial or medical complications.

http://www.aota.org/featured/area6/docs/DysFact.pdf

I also saw that AOTA is listing continuing ed on dysphagia.

The SLPs frequently don't graduate with sufficient clinical experience in

dysphagia; however, they can pick up the experience in their CFY time. Your

OTs may or may not have sufficient clinical training in dysphagia. ST and

OT each make arguments re academic training (I have even talked to some PTs

who work in the area).

It's a hot topic but I never saw a lot of need to tie it strongly to the

Part B cap argument. I always thought the majority of dysphagia was tied to

an acute episode with Part A implications....but I may be wrong.

Steve Passmore PT

Healthy Recruiting Tools

spass@...

Medicare Caps

I remember that years ago, OT worked with Dysphagia/ cognitively impaired

patients. I am unsure of the total capacity that OT performed such services

and do not want to minimize the Role of ST with our patients. However, with

the Caps in place, I am wondering if it is some value to revisit this again?

This would allow ST to focus on more of the specifics and allow OT to work

on other areas. I would like any info and educational resources in the area.

Tamera J Bounds

Regional Rehad Director

---------------------------------

Yahoo! Photos - Showcase holiday pictures in hardcover

Photo Books. You design it and we'll bind it!

[Guest guest]

It has been my practice over the last 35 years to ALWAYS use a

speech-language pathologist with the Certificate of Clinical Competence

(CCC-SLP) to work

with Dysphagia. In the older decades OTs did work with feeding issues. I have

supervised thousands of OTs, PTs & SLPs and would never allow OT to work

with Dysphagia if a SLP is available. The ASHA Code of Ethics prohibits one

working with something they aren't competent to do, so you would/should be/are

seeing requests for CEU monies to get advanced training for those who have not

had much hands-on experience. In the last 7years it has been brought to my

attention that some OT schools are teaching some dysphagia coursework. I have

evaluated a couple of syllabi and found them not nearly as comprehensive as

those used to teach SLPs. (I also now teach grad school, have taught grad

Dysphagia; am on the Va licensure board as well as an ASHA Legislative

Councilor

& Chair of the ASHA Financial Planning Board. ) I know & respect a SLP who

runs rehab in a CCare Co.all over the USA. She uses OTs for dysphagia work in

rural areas sometimes. My advice to you is to have the OTs handle getting the

food/arm, etc up to the mouth & the SLPs handle everything from the lips

back through the system, etc. There was an attempt a few years ago to obtain

legal injunctions to prohibit OTs from working with Dysphagia. That was not

possible because their Scope of Practice does address feeding. Leaders in the

field of Dysphagia are all SLPs...Logemann, Crary, Groher, Sonies, Perlman, VA

folks. Many now prohibit OTs from attending their advanced Dysphagia training

courses that DID allow this earlier. If you need a text, use one of Groher

or Logemann's; they are the best & I have them all. It has been my

experience that many non -clinical owners/admin-type folks often attend

workshops,

hear that it's ok to solve their lack of SLP problems by having OT handle

Dysphagia, & the next Monday their entire co./staff has a memo telling them OTs

are to see dysphagia pts. The main issue here is that since not knowing what to

do CAN & DOES result in death, appropriate training is key. NO clinically

competent SLP has less than 7-8 years in training; most OTs I know don't have

masters degrees although I know that is changing. Certainly entire semester

courses are absolutely essential to cover the material needed before seeing

pts. There should be a course in Adult Dysphagia & one in Pediatric Dysphagia.

Clinical work with patients is also needed for one to feel competent

treating them, in my humble (yet very-experienced )opinion.

Sally -McNamara, MCS, CCC-SLP, CCP

Consultant - Virginia

[Guest guest]

I do understand what you are saying in your e-mail, and I am fortunate to have a

full time SLP on staff. However, with the shortage of SLP and the lack of ASHA's

vision to use SLP-A patient are the ones that loss out on services. What should

a company do that needs to offer SLP services, but their isn't a SLP to be

found?

Pruitt

Therapy Director

>>> Sallyjmac@... 01/19/06 10:40AM >>>

It has been my practice over the last 35 years to ALWAYS use a

speech-language pathologist with the Certificate of Clinical Competence

(CCC-SLP) to work

with Dysphagia. In the older decades OTs did work with feeding issues. I have

supervised thousands of OTs, PTs & SLPs and would never allow OT to work

with Dysphagia if a SLP is available. The ASHA Code of Ethics prohibits one

working with something they aren't competent to do, so you would/should be/are

seeing requests for CEU monies to get advanced training for those who have not

had much hands-on experience. In the last 7years it has been brought to my

attention that some OT schools are teaching some dysphagia coursework. I have

evaluated a couple of syllabi and found them not nearly as comprehensive as

those used to teach SLPs. (I also now teach grad school, have taught grad

Dysphagia; am on the Va licensure board as well as an ASHA Legislative

Councilor

& Chair of the ASHA Financial Planning Board. ) I know & respect a SLP who

runs rehab in a CCare Co.all over the USA. She uses OTs for dysphagia work in

rural areas sometimes. My advice to you is to have the OTs handle getting the

food/arm, etc up to the mouth & the SLPs handle everything from the lips

back through the system, etc. There was an attempt a few years ago to obtain

legal injunctions to prohibit OTs from working with Dysphagia. That was not

possible because their Scope of Practice does address feeding. Leaders in the

field of Dysphagia are all SLPs...Logemann, Crary, Groher, Sonies, Perlman, VA

folks. Many now prohibit OTs from attending their advanced Dysphagia training

courses that DID allow this earlier. If you need a text, use one of Groher

or Logemann's; they are the best & I have them all. It has been my

experience that many non -clinical owners/admin-type folks often attend

workshops,

hear that it's ok to solve their lack of SLP problems by having OT handle

Dysphagia, & the next Monday their entire co./staff has a memo telling them OTs

are to see dysphagia pts. The main issue here is that since not knowing what to

do CAN & DOES result in death, appropriate training is key. NO clinically

competent SLP has less than 7-8 years in training; most OTs I know don't have

masters degrees although I know that is changing. Certainly entire semester

courses are absolutely essential to cover the material needed before seeing

pts. There should be a course in Adult Dysphagia & one in Pediatric Dysphagia.

Clinical work with patients is also needed for one to feel competent

treating them, in my humble (yet very-experienced )opinion.

Sally -McNamara, MCS, CCC-SLP, CCP

Consultant - Virginia