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[Dysphagia] Outpatient FEES



RE: Endoscopy/FEES/Strobe

My understanding has been that if a state licensure/practice act is
silent on the issue, the default position are the Medicare/Federal
guidelines which do permit SLPs to complete these procedures.

RE: Physician presence, I understand that the previous comment was
correct: in a hospital, a physician is presumed to be present somewhere.
Physician office regulations are more restrictive. The reason for this
is patient safety in the event of an adverse reaction NOT a competency
issue of having physician supervision of the procedure.

Michael Towey
Voice & swallowing Center of Maine
Waldo County Hospital
Belfast, ME

-----Original Message-----
From: dysphagia-bounces at dysphagia.com
[mailto:dysphagia-bounces at dysphagia.com] On Behalf Of lobsterpam at aol.com
Sent: Saturday, April 28, 2007 6:11 PM
To: blejeune at enduracare.com; ronewman at columbus.rr.com; dysphagia at b9.com
Cc: jdlemma at comcast.net; joanne.wisely at genesishcc.com
Subject: Re: [Dysphagia] Outpatient FEES

 By that standard, SLPs in PA cannot provide videofluoroscopy, either.
 
 My point is merely pointing out the inconsistencies in the
interpretation of the lack of a state statute.
 
 Pam Smith
    
 -----Original Message-----
 From: blejeune at enduracare.com
 To: lobsterpam at aol.com; ronewman at columbus.rr.com; dysphagia at b9.com
 Cc: jdlemma at comcast.net; joanne.wisely at genesishcc.com
 Sent: Sat, 28 Apr 2007 6:05 PM
 Subject: RE: [Dysphagia] Outpatient FEES
 
  Whether it is call practice or title my position remains:  the "act"
does not 
specifiy that FEES is a service SLP's in PA can provide.

    -----Original Message----- 
    From: lobsterpam at aol.com [mailto:lobsterpam at aol.com] 
    Sent: Sat 4/28/2007 5:59 PM 
    To: Bob LeJeune; ronewman at columbus.rr.com; dysphagia at b9.com 
    Cc: jdlemma at comcast.net; joanne.wisely at genesishcc.com 
    Subject: Re: [Dysphagia] Outpatient FEES
    
    
    The statements in the below posting are not entirely true.  The
state of PA 
does not HAVE a practice act.  It has a TITLE act. This act does not
mention 
endoscopy at all, but it also does not mention videofluoroscopy at all. 
Therefore, in PA, we have no more so-called "authorization" to do 
videofluoroscopy than we do FEES.  Our statutes mention neither.  
Misinterpretation of the LACK of legislation has led many to think that
the SLP 
in PA cannot pass the scope, but there are PA SLPs who do endoscopy!  In
many 
cases the decision of either "Yes, you can" or "No, you can't" is made
by 
administrators (who have the right to state facility policy) regardless
of what 
the statutes do not mention. Or, the decision is made because this is a 
relatively new procedure and people are checking the statutes, and,
finding 
nothing, decide to play it safe.  (This title act is fearfully outdated,
and 
efforts are underway to revise it; these efforts have been going on for
a few 
years now). Many would rather be cautious, but that doesn't mean they
are 
following what the law - or lack thereof - supposedly says.
Interestingly, 
people are not so cautious about videos although our state title act
doesn't 
mention those, either.
    
    The ability to bill Medicare has, I believe, more to do with
independent 
practitioner status than state practice acts.  To my knowledge, there is
nothing 
in PA statute to prevent a PA SLP to do FEES in a nursing home, bill the
nursing 
home in a contractual arrangement agreed upon by both, and the facility
bills 
Medicare.   
    
    Pam Smith, Ph.D.
    Bloomsburg University
    Bloomsburg, PA 
    
     
     
    -----Original Message-----
    From: blejeune at enduracare.com
    To: ronewman at columbus.rr.com; dysphagia at b9.com
    Sent: Sat, 28 Apr 2007 5:10 PM
    Subject: Re: [Dysphagia] Outpatient FEES
    
    
    My understading is that before we think about Medicare you have to
check the 

    state practice act.  For instance in the state of PA there is a
concensus 
that 
    an SLP can not do a FEES and bill Medicare.
    
        -----Original Message----- 
        From: dysphagia-bounces at dysphagia.com on behalf of robert newman

        Sent: Sat 4/28/2007 1:05 PM 
        To: dysphagia at b9.com 
        Cc: 
        Subject: [Dysphagia] Outpatient FEES
        
        
    
        
    
        I have been working with a few SLPs who recently completed a
course on 
FEES. 
    
        They were told that an SLP could pass a scope in an acute care
setting 
        without a physician present in the room, however, a physician
must be 
        present during an outpatient procedure. The reasoning was that
it would 
be a 
    
        given that there are physicians in hospitals, but not
necessarily in 
        outpatient clinics all the time. Their presenters reported that
this was 
a 
        recent Medicare change for reimbursement, maybe in the past
year. 
    
        
    
        I did try to get on the Medicare website, but my internet
navigational 
        skills are not the best and so I could not find anything, if it
was 
there. 
        Does anyone know anything about this? Any information would be
helpful. 
    
        
    
        Thanks in advance, 
    
        
    
        Kelly L. Newman, CCC-SLP 
    
        Columbus, Ohio 
    
        
    
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