Dysphagia Experts Mobile FEES - Therapy - Consulting - Education. Being a professional Speech-Language Pathologist necessitates understanding the difference between FEES and MBSS diagnostics. Providing your patient with an effective treatment plan means having the ability to choose the most appropriate instrumental diagnostic. Here are some benefits of FEES for both the Patient and Health Care Provider.
Benefits to Patient: Avoiding fluoro radiation* Avoiding barium* Avoiding unnecessary patient transport* Allowing actual food and drink usage (no barium)*
Up to 5 times less expensive than MBSS Accepted by most Insurance provider. Private pay accepted. Same day results. Same day treatment plan
Benefits to Healthcare Provider: Quick diagnostic response (less than 72 hours versus up to 3 weeks). Real time diagnostics and analysis. Isolation-precaution friendly procedure* Full-color HD videography*
Allowing actual food and drink usage (no barium)* Ability to assess without PO trials* Observation of patient fatigue during procedure* Realistic patient positioning* No study time limitation* Comprehensive diagnostic report
Exact aspirant identification* Reimbursable
Benefits to Patient: Avoiding fluoro radiation* Avoiding barium* Avoiding unnecessary patient transport* Allowing actual food and drink usage (no barium)*
Up to 5 times less expensive than MBSS Accepted by most Insurance provider. Private pay accepted. Same day results. Same day treatment plan
Benefits to Healthcare Provider: Quick diagnostic response (less than 72 hours versus up to 3 weeks). Real time diagnostics and analysis. Isolation-precaution friendly procedure* Full-color HD videography*
Allowing actual food and drink usage (no barium)* Ability to assess without PO trials* Observation of patient fatigue during procedure* Realistic patient positioning* No study time limitation* Comprehensive diagnostic report
Exact aspirant identification* Reimbursable
ADD (Advanced Dysphagia Diagnostics, LLC) is an innovative medical services company specializing in FEES (Fiberoptic Endoscopic Evaluation of Swallowing). ADD was created by Kimry Schwarz-Gemmell, M.S.CCC-SLP, an experienced Speech-Language Pathologist who identified a need and created an easy-to-use mobile FEES service. Having provided clinical expertise in Neuro, Pulmonary, HNC, and Cardiac care in the Acute, Rehab, SNF/LTC, and Outpatient Settings since 1998, Kimry brings a wealth of knowledge to each patient evaluation. She teaches university undergraduate courses for SLP students and continues to supervise CF's and Graduate Students during their clinical practicums.
Furthermore, her Rehab Director experience allows her the understanding of how delicate it is to navigate the complexity of billing and scheduling concerns for any facility. All these achievements make Kimry an ideal Service Partner. ADD-ing Value ONSITE – All our evaluations are conducted onsite at your facility where the patient is familiar with the environment. There is no need to arrange transport, which can be costly and causes fatigue and stress to your patient. THERAPY - We can provide Dysphagia therapy on an Outpatient basis for your patients. We can also provide short-term contract therapy services for both Inpatient and Outpatient settings. CONSULTING – During and after the FEES, we will collaborate with the treating Physician or SLP by discussing the results and, if needed, will assist with the Dysphagia treatment planning. We are also available by phone, email, or text for follow-up treatment discussions. EDUCATION – ADD provides educational demonstrations and Dysphagia In-Services to Physician Groups, Healthcare Management Teams, Nursing and Therapy Departments, and to organized support groups. Why Choose ADD Quality and Timely Evaluations – ADD provides quality evaluations in a timely manner. All evaluations have same-day reporting, allowing for quicker decision making about patient care. FEES videos can be downloaded on a memory device and used for Patient and Caregiver education. Respectful & Compassionate Service – ADD understands your patients have diverse backgrounds and varying functional levels. We treat all patients with the utmost respect and compassionate care. Quality Treatment Planning & Documentation – Based on advanced instrumentation diagnostics, FEES allows the treating therapist to specify where the area(s) of swallowing difficulty occur and helps confirm the effectiveness of implemented safety compensatory strategies. FEES can also assist in verifying the most therapeutic electrode placement when NMES is a part of the Dysphagia plan of care.
Furthermore, her Rehab Director experience allows her the understanding of how delicate it is to navigate the complexity of billing and scheduling concerns for any facility. All these achievements make Kimry an ideal Service Partner. ADD-ing Value ONSITE – All our evaluations are conducted onsite at your facility where the patient is familiar with the environment. There is no need to arrange transport, which can be costly and causes fatigue and stress to your patient. THERAPY - We can provide Dysphagia therapy on an Outpatient basis for your patients. We can also provide short-term contract therapy services for both Inpatient and Outpatient settings. CONSULTING – During and after the FEES, we will collaborate with the treating Physician or SLP by discussing the results and, if needed, will assist with the Dysphagia treatment planning. We are also available by phone, email, or text for follow-up treatment discussions. EDUCATION – ADD provides educational demonstrations and Dysphagia In-Services to Physician Groups, Healthcare Management Teams, Nursing and Therapy Departments, and to organized support groups. Why Choose ADD Quality and Timely Evaluations – ADD provides quality evaluations in a timely manner. All evaluations have same-day reporting, allowing for quicker decision making about patient care. FEES videos can be downloaded on a memory device and used for Patient and Caregiver education. Respectful & Compassionate Service – ADD understands your patients have diverse backgrounds and varying functional levels. We treat all patients with the utmost respect and compassionate care. Quality Treatment Planning & Documentation – Based on advanced instrumentation diagnostics, FEES allows the treating therapist to specify where the area(s) of swallowing difficulty occur and helps confirm the effectiveness of implemented safety compensatory strategies. FEES can also assist in verifying the most therapeutic electrode placement when NMES is a part of the Dysphagia plan of care.
What Is FEES?
FEES is an acronym for Fiberoptic Endoscopic Evaluation of Swallowing. This evaluation is completed by a privileged Speech-Language Pathologist using a flexible endoscope which is passed transnasally to allow viewing of the pharyngeal and laryngeal structures, assessing motor and sensory function as the patient completes a series of tasks. The swallowing process is observed and evaluated as the patient is given various food and liquid textures during the exam.
The following is an excerpt from the ASHA document, The Role of the Speech-Language Pathologist in the Performance and Interpretation of Endoscopic Evaluation of Swallowing: Technical Report developed by ASHA Special Interest Division 13, Swallowing and Swallowing Disorders (Dysphagia) Committee on Endoscopic Evaluation of Swallowing:
“FEES is a comprehensive assessment of swallowing. It includes five components:
Observation of the anatomy involved in the oropharyngeal stage of swallowing,
Observation of the movement and sensation of critical structures within the hypopharynx, Observation of secretions, Direct assessment of swallowing function for food and liquid, and Response to therapeutic maneuvers and interventions to improve the swallow. The purpose of the procedure is the comprehensive functional evaluation of the oropharyngeal stage of swallowing, leading to recommendations regarding the adequacy of the swallow, the advisability of oral feeding, and the use of appropriate interventions to facilitate safe and efficient swallowing. ASHA affirms the role of the speech-language pathologist in performing FEES independently to evaluate swallowing function, and distinguishes it from that of physicians, who use endoscopy to assess the integrity of the laryngeal and pharyngeal structures in order to render a medical diagnosis.” Aspiration of Thin Liquids. Decreased VF Adduction. Medications in Vallecula. Penetration Through the Interarytenoid Space. Pharyngeal Residue. Secretions Observed Upon Endoscope Insertion. Benefits of FEES over MBS FEES offers a direct full-colored view of the anatomical structures and is beneficial to assess for s/s oral, pharyngeal or esophageal dysphagia including Laryngopharyngeal reflux (LPR), and Vocal Fold function. FEES also benefits a patient who has had a MBSS with inconclusive results, or when they need another advanced instrumentation diagnostic study.
A FEES service is significantly more cost effective than an MBSS. All ADD Endoscopists are CCC-SLP's licensed in your state and, if desired, your facility can bill for their services. There is no need to transport your patient out of the facility for a FEES. Patients who are bed-bound, on Isolation precautions, or connected to critical monitors benefit from FEES due to its ability to be performed bedside. Your patient's size or positioning restrictions (obesity, hip precautions/fusion, contractures, pain, kyphosis, torticollis, etc.) are not barriers for a FEES. No concern of radiation exposure exists with a FEES. Your patient consumes normal food and liquids during the FEES. No barium is required, which can be difficult to eat (especially for confused patients) and can be constipating, potentially remaining in the colon for up to 6 weeks. There are no time limitations for a FEES. If indicated and necessary, your patient's swallow function can be evaluated for the entire duration of a meal. Which Patients Are Appropriate For A FEES?
FEES is an acronym for Fiberoptic Endoscopic Evaluation of Swallowing. This evaluation is completed by a privileged Speech-Language Pathologist using a flexible endoscope which is passed transnasally to allow viewing of the pharyngeal and laryngeal structures, assessing motor and sensory function as the patient completes a series of tasks. The swallowing process is observed and evaluated as the patient is given various food and liquid textures during the exam.
The following is an excerpt from the ASHA document, The Role of the Speech-Language Pathologist in the Performance and Interpretation of Endoscopic Evaluation of Swallowing: Technical Report developed by ASHA Special Interest Division 13, Swallowing and Swallowing Disorders (Dysphagia) Committee on Endoscopic Evaluation of Swallowing:
“FEES is a comprehensive assessment of swallowing. It includes five components:
Observation of the anatomy involved in the oropharyngeal stage of swallowing,
Observation of the movement and sensation of critical structures within the hypopharynx, Observation of secretions, Direct assessment of swallowing function for food and liquid, and Response to therapeutic maneuvers and interventions to improve the swallow. The purpose of the procedure is the comprehensive functional evaluation of the oropharyngeal stage of swallowing, leading to recommendations regarding the adequacy of the swallow, the advisability of oral feeding, and the use of appropriate interventions to facilitate safe and efficient swallowing. ASHA affirms the role of the speech-language pathologist in performing FEES independently to evaluate swallowing function, and distinguishes it from that of physicians, who use endoscopy to assess the integrity of the laryngeal and pharyngeal structures in order to render a medical diagnosis.” Aspiration of Thin Liquids. Decreased VF Adduction. Medications in Vallecula. Penetration Through the Interarytenoid Space. Pharyngeal Residue. Secretions Observed Upon Endoscope Insertion. Benefits of FEES over MBS FEES offers a direct full-colored view of the anatomical structures and is beneficial to assess for s/s oral, pharyngeal or esophageal dysphagia including Laryngopharyngeal reflux (LPR), and Vocal Fold function. FEES also benefits a patient who has had a MBSS with inconclusive results, or when they need another advanced instrumentation diagnostic study.
A FEES service is significantly more cost effective than an MBSS. All ADD Endoscopists are CCC-SLP's licensed in your state and, if desired, your facility can bill for their services. There is no need to transport your patient out of the facility for a FEES. Patients who are bed-bound, on Isolation precautions, or connected to critical monitors benefit from FEES due to its ability to be performed bedside. Your patient's size or positioning restrictions (obesity, hip precautions/fusion, contractures, pain, kyphosis, torticollis, etc.) are not barriers for a FEES. No concern of radiation exposure exists with a FEES. Your patient consumes normal food and liquids during the FEES. No barium is required, which can be difficult to eat (especially for confused patients) and can be constipating, potentially remaining in the colon for up to 6 weeks. There are no time limitations for a FEES. If indicated and necessary, your patient's swallow function can be evaluated for the entire duration of a meal. Which Patients Are Appropriate For A FEES?
What Is Dysphagia? “Dysphagia” dys-pha-gia/ (-fa’jah) is the medical term for difficulty swallowing. There are 3 phases of swallowing:
Phase 1: Oral phase in which food is manipulated and prepared to be swallowed.
Phase 2: Pharyngeal phase in which food must pass from the mouth to the esophagus while being safely directed away from the airway.
Phase 3: Esophageal phase in which food passes through the esophagus to the stomach.
Difficulties can occur during any of these phases and can range from a mild sensation of food feeling “stuck” in the throat to aspiration, in which food or liquids enter the airway.
Dysphagia affects 1 in 25 people, and around 22% of those are over 50 years of age. Complications arising from dysphagia are one of the most common reasons for hospital admissions in the elderly.
Phase 1: Oral phase in which food is manipulated and prepared to be swallowed.
Phase 2: Pharyngeal phase in which food must pass from the mouth to the esophagus while being safely directed away from the airway.
Phase 3: Esophageal phase in which food passes through the esophagus to the stomach.
Difficulties can occur during any of these phases and can range from a mild sensation of food feeling “stuck” in the throat to aspiration, in which food or liquids enter the airway.
Dysphagia affects 1 in 25 people, and around 22% of those are over 50 years of age. Complications arising from dysphagia are one of the most common reasons for hospital admissions in the elderly.
Join Our Team. The ADD Culture. Autonomy. Manage and control your own time. Practice in a professional environment. Experience respect and integrity. Appreciate a micromanagement - free opportunity
Authority. Have the flexibility to choose your clients. Have control over your caseload. Jurisdiction. Maintain territory exclusivity. Access to marketing assistance. Opening new service areas (CO, UT, PA*, OH*, NY*)
Growth. Expand your skills from FEES to therapy to education and consulting. Potentially grow into leadership positions within ADD Contribution. Expect an open environment to express your ideas
Collaborate with ADD & medical institutions and academia. Labor Relations. Expect a unique subcontractor opportunity. Receive appropriate compensation for expertise. Kimry Schwarz-Gemmell, M.S. CCC-SLP/FEES Endoscopist. Click here to learn more about joining the ADD team
Authority. Have the flexibility to choose your clients. Have control over your caseload. Jurisdiction. Maintain territory exclusivity. Access to marketing assistance. Opening new service areas (CO, UT, PA*, OH*, NY*)
Growth. Expand your skills from FEES to therapy to education and consulting. Potentially grow into leadership positions within ADD Contribution. Expect an open environment to express your ideas
Collaborate with ADD & medical institutions and academia. Labor Relations. Expect a unique subcontractor opportunity. Receive appropriate compensation for expertise. Kimry Schwarz-Gemmell, M.S. CCC-SLP/FEES Endoscopist. Click here to learn more about joining the ADD team
Speech-Language Pathologist and owner of Dysphagia Diagnostics & Consultation. With over 30 years experience from private practice to Level 1 Trauma Hospitals, Susan brings in-depth knowledge and expertise to patient care. Compassionate and professional patient care is the standard that governs her practice. You can be confident that colleagues affiliated with Dysphagia Diagnostics & Consultation are chosen for their shared qualities. Our team consists of skilled and experienced Speech-Language Pathologists dedicated to providing exceptional and state-of-the-art diagnostic and treatment options to our patients. Providing patients with the most appropriate diagnosis and therapeutic interventions to address their swallowing disorder is our mission. As our patients receive therapeutic programming from treating SLP's in the community, we are available to augment the treatment team with invaluable diagnostic information via Fiberoptic Endoscopic Examination of Swallowing through our mobile FEES assessment. Dedication to the patient is what sets Dysphagia Diagnostics & Consultation apart from the others. We understand the loss of swallowing function from neurological events, trauma, head/neck cancers or through the normal aging process affects a person at core levels. Our compassionate care addresses the whole person with the ultimate goal of restoring function and improving quality of life.
1. How is the Fiberoptic Endoscopic Evaluation of Swallowing (FEES) conducted? An endoscope is a medical imaging device that allows us to look inside of a patient for evaluation and diagnosis of dysphagia. The flexible endoscope is passed through one side of the nose and into the throat (pharynx). The scope is held in a position to fully visualize the throat while swallowing liquids and solids. The real-time images are sent to a computer screen for viewing during the evaluation.
2. Is the procedures uncomfortable? Most patients report that the procedure is comfortable. Mild discomfort (not pain) is sometimes reported during the beginning of the procedure when the scope is passed through the nose. 3. Can a topical anesthetic be used during the FEES procedure? We do not utilize topical anesthetics during the procedure as we do not want to alter or diminish a patient's sensation while swallowing. Sensation plays a vital role in safe swallowing and so it is important not to alter your response in any way. 4. Do I have to eat during the procedure? This is one of the benefits of the FEES procedure! Unlike traditional Modified Barium Swallow studies that require you to eat different consistencies of barium, the FEES procedure utilizes REAL FOOD! This creates a much more realistic assessment of how your swallowing mechanism is working. A small amount of food coloring is added to the foods so that we can differentiate swallowed foods from your saliva. 5. Is the FEES procedure contraindicated with any patients? Although the FEES procedures has been proven to be safe, there are patients in which the procedure is contraindicated. Patients with facial or nasal fractures/surgeries, bilateral nasal obstructions, history of severe nose bleeding (epistaxis), extremely low blood platelets (<20), history of vasovagal response, or presence of bradycardia are not candidates for the FEES procedure. This is why a detailed medical history will be obtained from you and your physician prior to undergoing the FEES evaluation. 6. Are there any risks involved with the FEES procedure? The FEES procedure has been shown to be very safe with few remote risks, Risks or adverse reactions might include: discomfort, gagging, nose bleed, laryngospasm or vasovagal response.
2. Is the procedures uncomfortable? Most patients report that the procedure is comfortable. Mild discomfort (not pain) is sometimes reported during the beginning of the procedure when the scope is passed through the nose. 3. Can a topical anesthetic be used during the FEES procedure? We do not utilize topical anesthetics during the procedure as we do not want to alter or diminish a patient's sensation while swallowing. Sensation plays a vital role in safe swallowing and so it is important not to alter your response in any way. 4. Do I have to eat during the procedure? This is one of the benefits of the FEES procedure! Unlike traditional Modified Barium Swallow studies that require you to eat different consistencies of barium, the FEES procedure utilizes REAL FOOD! This creates a much more realistic assessment of how your swallowing mechanism is working. A small amount of food coloring is added to the foods so that we can differentiate swallowed foods from your saliva. 5. Is the FEES procedure contraindicated with any patients? Although the FEES procedures has been proven to be safe, there are patients in which the procedure is contraindicated. Patients with facial or nasal fractures/surgeries, bilateral nasal obstructions, history of severe nose bleeding (epistaxis), extremely low blood platelets (<20), history of vasovagal response, or presence of bradycardia are not candidates for the FEES procedure. This is why a detailed medical history will be obtained from you and your physician prior to undergoing the FEES evaluation. 6. Are there any risks involved with the FEES procedure? The FEES procedure has been shown to be very safe with few remote risks, Risks or adverse reactions might include: discomfort, gagging, nose bleed, laryngospasm or vasovagal response.
