The DST Is A Good Decision


Utilizing DMS is a Good Rehabilitation Therapy Clinical Decision!

▪  Dysphagia among individuals >50yrs ranges from 16-22%. 

    (Barer et al., 1989; Bloom et al., 1990; Gordon et al., 2010; Winchester & Winchester, 2015)

▪  Up to 60% of nursing home residents have feeding difficulties.

    (Barer et al., 1989; Bloom et al., 1990; Gordon et al., 2010; Winchester & Winchester, 2015)

▪  A substantial proportion of residents are troubled by oral or pharyngeal dysphagia as opposed to esophageal dysphagia. 

   (Barer et al., 1989; Bloom et al., 1990; Gordon et al., 2010; Winchester & Winchester, 2015)

▪  Consequences of having dysphagia can be severe: dehydration, malnutrition, choking, pneumonia and death.

   (Barer et al., 1989; Gordon et al., 2010)

▪  Residents with dysphagia and aspiration have a 45% mortality rate after 1 year, with many episodes of complications if left untreated.

    (Croghan et al., 1994)

▪  COPD, Emphysema, chronic bronchitis, pulmonary edema, CHF, asthma/allergies, respiratory and pneumonia complications from MRSA infections, pleural effusion, and GERD, have a secondary risk factor of Dysphagia that may be undiagnosed and untreated.

     (Winchester & Winchester, 2015)

▪  COPD patients have a 30 day repeat hospitalization of 22.6% with 2/3 of those cases identified as being preventable.

(Martinez et al., 2013)

▪  The risk of aspiration across all diseases is believed to be related to the increased incidence of dysphagia, Gastro-esophageal reflux, and stroke, as well as poor oral care in this age group.

    (Marik, 2001)

▪  Dysphagia accounts for between 13 and 48% of all infections in a SNF. 

   (Langmore et al., 1998)

▪  Dysphagia Management Systems’ DST is designed for ongoing professional collaboration with the Rehab Staff, to better identify and reduce the risks associated with the patient’s dysphagia, for more positive clinical outcomes.

▪  Dysphagia Management Systems offers an immediate in-person or on-line inservice for any new staff member to introduce the DMS process of risk predicting and appropriate establishment of medical necessity for referral.

▪ Dysphagia Management Systems offers in-person and online courses as part of their standard contract, to better serve the Rehab Staff in understanding dysphagia risk and management.


Utilizing DMS is a good Facility Clinical Decision!

▪Individualized objective evaluation with instrumentation eliminates costly guess-work in establishing a Care Plan that   considers all Dysphagia risk factors when the Five Systems of Dysphagia are considered.

   (Winchester & Winchester, 2015)

▪  Stabilizing the Patient within the first two weeks of admission can reduce repeat hospitalizations up to 62% with an individualized Patient risk profile.

     (DMS,Literature Review, Newsletter, April 2015,

▪  Effectively managing dysphagia can reduce 1/3 of infections commonly found in residents, which in a 200 bed SNF could potentially prevent up to 66 Patients from unnecessary complications from infection.

   (Langmore et al, 1998)

Approximately 14% of older Patients experience dysphagia during oral medication administration.  In a 200 bed SNF, accurate identification of risk and proper management could prevent up to 28 Patients from experiencing dysphagia complications.

  (Gillicuddy et al., 2016)

▪ Dysphagia Management System’s DST provides an onsite detailed report of the individual Patient’s needs including food, liquid, medication presentation, positioning, respiratory risks, cognitive cooperation risks, potential therapy and Physician interventions, G-Codes at time of service, and potential for remediation.

▪  DMS provides FREE in-person and online ‘Anytime Inservices’ to Facility staff, including Nursing, Administration, Rehabilitation Therapy Staff, and Nurses Aides, to assist with Facility clinical initiatives as part of the standard contract.



Utilizing DMS is Good Facility Business Decision!

▪  Cost of treating aspiration pneumonia is $15-20,000. DST<2% of the cost of this Dysphagia complication.

(Cichero, & Altman, 2012)

▪  Reduce cost of care and complications with a comprehensive dysphagia management program.

(Winchester & Winchester, 2015)

▪  Stroke with pneumonia has 4 times the number of repeat admissions as patients that have a stroke without pneumonia.

(Katzan et al., 2007)

▪  75% of stroke patients have Dysphagia with >15% missed without instrumentation, and 37% developing pneumonia.

(AHCPR,1999; Dobson, Vanzo 2014)

▪  Dysphagia contributes to 4 of top 5 reasons for re-hospitalization; CHF, respiratory infection, UTI and electrolyte imbalance.

(Coleman 2004; Teno, 2009)

▪  Diagnoses that contribute to increased cost of care and readmission penalties; COPD, Pneumonia, Hip Fx and Total Knee, with dysphagia can be costly to Facility if not identified and managed.

(Medicare, CMS.Gov, May, 2015; Winchester & Winchester 2015)

▪  Dysphagia Management Systems’ DST costs an average of $400, a fraction of the cost of ignoring the risk of dysphagia complications!



Utilizing DMS is a Good CMS Re-hospitalization Reduction Decision!

▪  Undiagnosed or under diagnosed dysphagia is a major, preventable, contributor to repeat hospital admissions. Unfortunately, the treatment for dysphagia varies greatly.

(Cook & Kahrilas, 1999; Kind et al., 2011; Loeb et al., 2003)

 Studies note a dramatic increase in patient safety and a reduction in penetration and/or aspiration when necessary dietary modifications concentrate patient caloric and protein intake, in lower volumes of food, consumed with greater safety.

(Rofes et al., 2011)

▪  Instrumentation predicts hospital readmission. An effective Dysphagia Management plan should include instrumentation when appropriate, and coordination of the interdisciplinary team to evaluate all Five Systems of Dysphagia, and reduce the patient’s future risk of aspiration, repeat   hospitalization and mortality.

(Cook & Kahrilas, 1999; Irwin, 2006; Rofes et al., 2011; Wilson & Howe, 2012; Winchester & Winchester, 2015)

▪  The risk of aspiration is directly correlated to the presence of Dysphagia, Gastro-esophageal Reflux, Stroke ,and poor oral care.

(Marik, 2001)

 Dysphagia accounts for between 13 and 48% of all infections in a SNF. 

(Langmore et al, 1998)

▪  Dysphagia Management System’s DST in designed to identify, evaluate, and provide information to stabilize and remediate the Patient’s Dysphagia with comprehensive point-of-service reporting that allows the Facility to increase patient safety immediately and decrease the risk of re-hospitalization.



Utilizing DMS is A Good Rehabilitation Therapy Business Decision!

▪  Accurate determination of diagnosis and prognosis is an important medical goal, and functional abnormalities of deglutition should be accurately defined.

(Cook and Kahrilas, 1999)

▪  The clinical bedside evaluation in the absence of utilizing a diagnostic tool (such as FEES) may not be sufficient in diagnosing those patients at risk for complication of Dysphagia, or in preventing aspiration pneumonia.

(Cook & Kahrilas, 1999; DePippo et al., 1994; Irwin, 2006; Rofes et al., 2011; Wilson & Howe, 2012)

▪  Objective baseline measures determine the viability of goals and establish means of tracking future progress

(ASHA, 2011)

▪  Without objective baseline measures, defense of denials for services become cumbersome.

(Dysphagia Café,Eakins A, May 2015)

▪  Demonstration of skill, medical necessity, and objective measures is of the utmost importance to a Medicare Reviewer.

(Centers for Medicare and Medicaid Services, 2014)

▪  Under the Protecting Access to Medicare Act of 2014, SNF’s will have Medicare reimbursement linked to their own readmission rates. 


▪  The Focus of the Medicare Act of 2014 is on preventable readmissions and the SNF role in this process.


▪  SNFs must understand what qualifies and develop a plan for reducing the potential for readmissions.


▪  A significant proportion of acute readmissions are due to unaddressed medical issues at discharge to the SNF.

(Godoy et al., 2015)

▪  The future for the SNF includes the responsibility to reduce readmissions with analysis of the patients with secondary diagnosis of Pneumonia with primary diagnosis of either sepsis or respiratory failure.

(, January, 2016)

▪  Accurate diagnosis and a comprehensive plan for stability and remediation is critical to improve outcomes.

(Cook et al 2010; Langmore et al 1998)

 The DST establishes accurate diagnosis, medical necessity, and provides copious measures to begin or continue the therapy process.



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