This week our Columbus team had one facility with two great examples of why we need imaging…for two very different reasons. Patient 1 was a long term care resident of the facility and had been on honey thick liquids for over two years with no instrumental assessment completed in that time (or even before the diet was first was changed, as far as we or the facility SLP could figure out from a deep chart dive). The facility SLP had been hired on full time somewhat recently, and had been working her way through reassessing the long term care dysphagia patients. During her clinical eval, she found no overt signs of aspiration, no history of lung compromise, and no clear reason why he had been on thickened liquids in the first place. Our MBS study showed: a lovely normal swallow-and we promptly recommended getting rid of the thickened liquids. The patient (one of the most mellow fellas we‘ve seen in a while) had never complained about the thickened liquid, but was still pretty happy with the prospect of some regular coffee.
Patient 2 had some coughing and choking with PO, lots of complaints of food stuck, no appetite and weight loss. The lateral view showed a pretty good looking swallow, so we decided an esophageal view was definitely indicated to further assess. This showed a pretty torturous esophagus and a large suspected hiatal hernia (radiologist confirmed).
Even though these patients had very different outcomes, they both highlight the impact and cost of not completing imaging studies-not only in patient quality of life and appropriate recommendations, but also in financial cost to the healthcare facility. Patient 1 had been on thickened liquids, most likely needlessly, for two years at a conservative cost estimate of well over $2,500-not even including the staff time to prepare and manage. Patient 2 had been referred to the SLP and the Registered Dietitian, when in fact her issue was not dysphagia or nutrition, but an esophageal issue that would need a completely different plan of care.
We do sometimes get pushback from facilities that don’t want to “pay” for imaging (a discussion on billing for studies needs to be a whole other post!) but the cost of NOT completing these needed assessments can have a much greater financial impact in the long run.
*Apologies and thanks to Dickens for the title of this post
**Huge shout out to the facility SLP mentioned for advocating so well for her patients. Would have been the easy road for her to just leave the non-complaining Patient 1 on thickened liquids, and go ahead try to manage Patient 2 for weeks based on clinical symptoms. Instead, she pushed hard to make sure the instrumentals happened. Wish we could name her here!!