I know. You saw the title and maybe even rolled your eyes. “Here we go again…”

But yes. We’re going there. Again.

Because I hear it all. the. time.
“Did you get an instrumental?”
“No.”
“Why not?”
“Because… I have no way of getting an instrumental assessment for my patient.”

Let’s break this down.

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Reason #1: No Access

The number one reason I hear for skipping an instrumental assessment? Lack of access.

Often the SLP wants the instrumental, but the facility says no. Or there’s no facility nearby that performs MBSS or FEES. Sometimes, it’s just easier to do what’s always been done—make a recommendation based on a bedside and hope for the best.

In some cases, the SLP says they didn’t request one because they already “know” the patient is aspirating. But here’s the thing: you don’t actually know without an instrumental.

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Learn to Advocate (and Bring the Data)

Facilities often don’t speak the language of aspiration. They speak numbers. So bring the numbers.  They want to know cost.   Not only what they are spending but what they may be saving.

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Let’s Talk $$$: The Math of Dysphagia

Thickened Liquid Costs

Start by looking at how many patients are on thickened liquids. If the facility uses pre-thickened products, the costs add up fast. And let’s be real—many of those patients may not even need thickened liquids if they haven’t had an instrumental.

Studies show that bedside-only evaluations can lead to overdiagnosis up to 70% of the time (Bours et al., 2009). That’s a lot of patients getting unnecessary modifications—and a lot of money down the drain.

Rehospitalization

Now add in the cost of rehospitalizations. Facilities not only incur direct costs—they lose revenue every time a patient has to be transferred back to the hospital.

Can dysphagia treatment and proper diagnosis prevent some of these hospitalizations? Absolutely. Especially when we’re talking about aspiration pneumonia.

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It All Adds Up

When you compare the cost of:

• pre-thickened liquids,
• over-prescribing modified diets,
• longer lengths of stay,
• potential malnutrition and dehydration,
• and rehospitalizations…

…to the cost of one instrumental assessment, it becomes clear. Instrumentals save money. Period.

And if you use that instrumental to create a focused, evidence-based treatment plan (with more than just the usual oral motor exercise parade), patients can improve.

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Bonus: Mobile Instrumentals Are a Thing

Did you know that mobile MBSS and mobile FEES providers exist in many areas? Yep—they come to you. And often, the cost is lower than transporting the patient to a hospital.

Start your search. Get quotes. Build your case. Be the squeaky wheel.

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Bottom Line

You can’t treat what you don’t know. And you don’t know unless you look.

Do your research. Crunch the numbers. Advocate.
Because your patients deserve better than guesswork.

Are you ready for a deeper dive with even more resources available? Join the Dysphagia Skills Accelerator today. You will get so many great tools with new tools being added all the time! Click here to join now!

Have you ever wanted a way to create a more standardized protocol for your Clinical Swallow Evaluation?   Do you often forget or leave out parts of the CSE, you know, the parts that are important for your Plan of Care?  You probably need the Clinical Dysphagia Assessment Toolkit if you answered yes.   You can get your copy here.  

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References

• Bours, G. J., Speyer, R., Lemmens, J., Limburg, M., & De Wit, R. (2009). Bedside screening tests vs. videofluoroscopy or fibreoptic endoscopic evaluation of swallowing to detect dysphagia in patients with neurological disorders: A systematic review. Journal of Advanced Nursing, 65(3), 477–493. https://doi.org/10.1111/j.1365-2648.2008.04915.x
• Bonilha, H. S., Simpson, A. N., Ellis, C., Mauldin, P., Martin-Harris, B., & Simpson, K. (2014). The one-year attributable cost of post-stroke dysphagia. Dysphagia, 29(5), 545–552. https://doi.org/10.1007/s00455-014-9543-8
• Ekberg, O., Hamdy, S., Woisard, V., Wuttge–Hannig, A., & Ortega, P. (2002). Social and psychological burden of dysphagia: Its impact on diagnosis and treatment. Dysphagia, 17(2), 139–146. https://doi.org/10.1007/s00455-001-0113-5
• Patel, D. A., Krishnaswami, S., Steger, E., Conover, E., Vaezi, M. F., Ciucci, M. R., & Francis, D. O. (2017). Economic and survival burden of dysphagia among inpatients in the United States. Diseases of the Esophagus, 31(1), dox131. https://doi.org/10.1093/dote/dox131
• Sura, L., Madhavan, A., Carnaby, G., & Crary, M. A. (2012). Dysphagia in the elderly: Management and nutritional considerations. Clinical Interventions in Aging, 7, 287–298. https://doi.org/10.2147/CIA.S23404