A mobile FEES procedure provides objective, measurable data to prove medical necessity of speech therapy services and document progress, or lack thereof, and to justify accurate calculation of RUG levels. How many times have you doubted yourself as a clinician, wasn’t quite sure how to document the suspected problem, or just unsure which exercises to do? With a mobile FEES done in the patient’s natural environment, you are now able to confidently take the documented impairments and look up the most research based treatments for this underlying pathophysiology. No more arbitrary lingual exercises for everyone, real EVIDENCE-BASED patient-specific treatments. Having a mobile FEES done at the bedside allows for the flexibility of time. There are no radiation restrictions or barium limits that have to be followed. If you are suspecting fatigue with a patient, the study can be performed for the entire meal. Have you ever recommended a diet only to have the CNAs tell you that after 15 minutes he’s too tired to stay upright in his ‘perfect eating positioning’ and is coughing and choking on everything? The MBSS is great at giving us an objective snapshot of the swallow, but is not ideal for a patient that fatigues easily. A mobile FEES procedure provides a realistic assessment, and captures the “true picture” of what is happening at meals by the patient self feeding in his/her natural eating position over time.

The following five conditions – congestive heart failure (CHF), upper respiratory infections (URI), urinary tract infections (UTI), sepsis, and electrolyte imbalance -all account for 78% of all 30-day SNF re-hospitalizations, and have all been deemed as potentially avoidable. CHF can be reduced by adherence to any fluid or dietary restrictions. URIs may be reduced by following appropriate positioning of residents with swallowing problems to avoid aspiration that could lead to pneumonia. UTIs, sepsis, and electrolyte imbalance can all result from dehydration or poor nutrition, which may be prevented with careful monitoring of patient fluid and nutrient intake. All of these have been found to be preventable with a mobile FEES procedure. As explained above, nothing good happens when the patient does not agree with or is not capable of following the recommended diet or compensatory strategies.

As discussed above, often patients comes from the hospital on a modified diet and/or thickened liquids and as their overall condition approves, a diet upgrade is often necessary, but the diet upgrade doesn’t always occur. Some patients can live at a SNF for several months, and even years before a family member stirs the pot to see if they may be appropriate for an upgrade. The cost of keeping 1 patient, just 1 out of 100s of residents in your facility on thickened liquids for 1 year costs approximately $7,000 in annual operating costs. Just think of how many residents may be living at your facility that have been on thickened liquids for an extended period of time! Also keep in mind, that overall physical condition has no correlation in requiring thickened liquids. The oldest, weakest, and frailest of them all have been known to live out their years happily drinking thin liquids.

So to help you recap: You can spend upwards of $1600 to send your patient to a hospital for an MBSS that can not visualize some of the conditions that are prevalent in the geriatric population, then spend upwards of $35,000+++ for a re-hospitalization, then when they come back from the hospital on thickened liquids, you can tack on $7,000 that year to cover the cost… Or you can spend a couple hundred bucks to have a mobile FEES done at the facility.

A recent study found that SNFs that have access to mobile FEES show a significant increase in instrumental assessments, and subsequently a significant reduction in pneumonia rates in that  same group. I’m sure you would love to throw those bragging rights around along with you new found cost savings!