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“Moving Over… Transition from a School to a Medical Position”

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1 “Moving Over… Transition from a School to a Medical Position”

2 Presenter: Linda K Pippert, MA, CCC-SLP, MBA Vice President, Clinical Operations AlphaVista Services Adjunct Faculty: Chapman University, Extended Ed CSU Fullerton, Adult Clinic Supervisor Nova Southeastern University, Field Associate for Southern California

3 Course Objectives: Participants will be able to Determine if a transition from a school-based position to a medical setting is a career move to consider. Identify and name sources and topics related to continuing education that would prepare one for a transition to a medical placement. Explore options for establishing a mentoring relationship with an SLP in the targeted setting.

4 What’s involved in making a change? Personal Aspects Clinical Aspects Professional Growth/Interest Continuing Education Training Materials

5 What will be the same…different? You…will still be the SLP You…will still be making decisions about care. You…will still have other professionals to work with You…will still be the “expert” on speech, language, cognitive and swallowing disorders. You…will still be the one who knows most about hearing and hearing disorders. You will be called the speech- language pathologist. You will be making decisions about communication, interacting with family and healthcare workers. You will be working with doctors, nurses, CNAs, RNAs, PTs, OTs You will be called upon to determine diet levels…everyday

6 Change: What is change to you? Are you someone who shies away from change? Are you someone who accepts change? (but would rather stay with the status quo) Are you someone who chases after change?

7 Key Factors to Consider… How much prep will I need? When will I access the continuing ed that I will need to prepare for a change in work settings? How much am I willing to invest in change? Do I have a mentor to assist me with this transition? What is my lead time for making a career transition?

8 Key Factors to Consider… What kind of medical setting do you envision yourself in? Have you had any prior experience in a medical setting? Did you have a great externship in grad school and “don’t want to lose” those skills? How far am I willing to travel for a medical position? Am I will to change facilities mid-day?

9 Key Factors to Consider… How many hours a week do I want to work a medical position? Will working with trachs and vents “gross” me out? Will working with swallowing disorders be disturbing? Do I have a strong support system should I make this change to a permanent position?

10 Things to consider… Personal Aspects Clinical Aspects Professional Growth/Interest Continuing Education Training Materials

11 Continuing Education Topics: Dysphagia Cognitive decline/Dementia Neuro disorders: Parkinsons, CVA, TBI, Huntington’s Disease, ALS, MG

12 Continuing Education Sources: ASHA Healthcare Institute ASHA CSHA Northern Speech Services Medical Speech Council of California:

13 ASHA SIDs Gerentology: Special Interest Group 15, Gerontology Dysphagia: Special Interest Group 13, Swallowing and Swallowing Disorders (Dysphagia) Neurogenics: Special Interest Group 2, Neurophysiology and Neurogenic Speech and Language Disorders.

14 On-line Networks Facebook (FB): Closed groups, but you can request to join. Medical SLP Forum Adult Rehab Speech Therapy py/

15 Other ASHA Resources Clinical Topics: Aphasia Dementia “Search” on the ASHA Web Site: Access to articles and many PPTs from past ASHA Conventions!

16 Billing and Coding: Diagnostic Codes Diagnostic Codes: ICD-9s are still in use until October, 2015. Here are some commonly used ICD-9s for medical facilities: The “Medical Diagnosis” eg the diagnosis given by a medical doctor. The “Treatment Diagnosis” eg the diagnosis given by the SLP The “Medical Diagnosis” will be an illness, injury or disease, such as Parkinson’s Disease: ICD-9 332 CVA: ICD-9 436 ** 2014 ICD-9-CM Diagnosis Codes: Related to Speech and Hearing Disorders is available on the ASHA Web site.

17 Billing and Coding: Diagnostic Codes The “Treatment Diagnosis” will be the diagnosis which the SLP determines 784.3 Aphasia 784.3 Voice Disturbance 784.40 Voice and resonance disorder, unspecified 784.41 Aphonia 784.42 Dysphonia, Hoarseness 784.51 Dysarthria 784.60 Symbolic dysfunction, unspecified 787.2 Dysphagia 787.20 Dysphagia, unspecified 787.21 Dysphagia, oral phase 787.22 Dysphagia, oropharyngeal phase 787.23 Dysphagia, pharyngeal phase 787.24 Dysphagia, pharyngoesophageal phases

18 Billing and Coding: Diagnostic Codes “Treatment Diagnosis” related to CVA 438 Late effects CVA 438.1 Late effects, CA Speech/Language Deficits 438.11 Late effects CVA Aphasia 438.12 Late effects CVA Dysphasia 438.81 Late effects CVA Apraxia 438.82 Late effects CVA Dysphagia

19 Billing and Coding: Procedure Codes The code to indicate what procedure that you have completed with the patient: Evaluation Codes 92521 Evaluation of Speech Fluency 92522 Evaluation of Speech Sound Production: artic, phono, apraxia, dysarthria 92523 Evaluation of Speech Sound Production with Evaluation of Language Comprehension and Expression 92524 Behavioral and Qualitative Analysis of Voice and Resonance 92610 Evaluation of Oral and Pharyngeal Swallowing Function 92611 Motion Fluoroscopic Evaluation of Swallowing Function by cine or video recording 96105 Assessment of Aphasia 96125 Standardized Cognitive Performance Testing (eg RIPA-G, ABCD, etc) per hour.

20 Billing and Coding: Procedure Codes The code to indicate what procedure that you have completed with the patient: Treatment Codes 92507 Speech Therapy, Individual 92508 Speech Therapy, Group 92626 Dysphagia Treatment 92532 Cognitive Treatment

21 Working in a Skilled Nursing Facility Part-A: Up to 100 days of “skilled care” (nursing and/or rehab) following a 3-day “qualifying stay” in an acute hospital Part-B: Out-patient therapy, but may be provided at an acute hospital, rehab or Skilled Nursing Facility (SNF) Working with Geriatrics: Changes in the physical condition due to aging: skin, respiratory/circulatory systems, eye sight, hearing, bone condition. Multiple diseases/conditions/illnesses Affects of multiple medications

22 Tests for use with the adult/geriatric population Communication Activities of Daily Living (CADL-2) ABCD RIPA-G WAB BDAE CLQT E/ROWPVT-4 Burns Brief Inventory of Communication and Cognition (Burns Inventory)

23 My Favorite Materials… Show and Tell… Source for… books from Linguisystems Aphasia Dysphagia Alzheimer’s and Dementia Executive Function Disorders Also from Linguisystems Results for Adults Just For Adults Photo Cards VNA Books: Kathryn Kilpatrick English and Spanish (See Handout for books, workbooks, textbooks)

24 Contact Information Linda K Pippert, MA, CCC-SLP, MBA 714-932-3931

25 References (Handout has a complete list) ASHA Web site: Examples of Documentation of Skilled and Unskilled Care for Medicare Beneficiaries: Speech-Language Pathology Services Medicare Coding Rules for SLP Services Coding for Reimbursement FAQs: SLP 2014 ICD-9-CM Diagnosis Coding: Related to Speech and Hearing Disroders “Search” for the disorder that you are interested in learning more about: Apraxia Dysarthria Dysphagia Aphasia Cognitive Decline Dementia

26 Courses on O’Hara, Lorelei. Medicare Muscle: Creating Defensible Documentation Swigert, Nancy. Documenting to Demonstrate Skilled Service and Focus on Function Swigert, Nancy. Decoding the Coding Systems: When, How and Why to Code What Swigert, NancyUnderstanding the Physiology of Impaired Pharyngeal Swallowing Ludlow, Christy. The Effects of Transcutaneous Electrical Stimulation During Dysphagia Management: What it does and whether it alters recovery Prakup, Barbara. What Should I Do? Ethical Considerations for SLPs who Work with Adults (See handout for additional courses)

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