Commonly Asked Questions by Licensees
|NOTICE: The Licensing Board cannot evaluate individual procedures and technique that a practitioner might utilize. The individual practitioner must make decisions based on their training, the standard of care and compliance with facility policies. The Licensing Board relies on the scope of practice issued by the American Hearing and Speech Association (ASHA) and the American Academy of Audiology (AAA). Licensees should also consult the administrative rules regarding welfare of clients (OAR 335-005-0015) and professional competence (OAR 335-005-0020). |
Q: Is it within the SLP scope of practice to change Pt´s diet textures once the physician has given an OK to evaluate and treat for dysphagia with a signed plan of care? Or is the physician the only one who can change diet textures?
A: Our statute does not address this specifically. Our law does require that licensees "provide all services competently" (OAR 335-005-0015.)
Q: Does the Oregon licensing board for speech-language pathology mandate the presence of a radiologist or other physician during a modified barium swallow evaluation performed by a speech-language pathologist?
A: Our statute does not address physician supervision of licensees. Our statute does require that licensees "provide all services competently" (OAR 335-005-0015). If the "standard of care" or "best practice" for any procedure requires a physician to be present during the procedure for the welfare of the patient, then a licensee would not be providing services competently without the physician.
Q: I am currently preparing our hospital and our speech pathology department to begin evaluation of swallow with FEES. I have been researching ASHA position statements on FEES, and I noted the 2003 position statement from the Academy of Otolaryngology-Head and Neck Surgery that contradicts the original 1999 joint ASHA/AAO-HNS statement for roles of SLP´s in performing endoscopic evaluation of swallowing. ASHA continues to support the use of FEES in our practice, but they recommend contacting our individual state licensing boards. Can you please inform me if Oregon has a position statement on the use of FEES by SLPs in the evaluation of dysphagia, and if you specifically have a position on the type of physician supervision required.
A: Here is the Academy of Otolaryngology´s position statement on FEES.
To my knowledge the Oregon Academy of Otolaryngology does not have any position statements. From a personal standpoint providing input to the board. I am not sure it is helpful to be put in a confrontational position and I am aware that the use of procedures in otolaryngology and in speech pathology overlap. The training is quite different between the two professions. From a personal experience standpoint, when I give lectures on swallowing to physicians (family practice, internal medicine) it is apparent to me that there is little to no training in the aspects of swallowing related to the upper airway (mouth, throat). Even when I speak with ENT docs, unless there is a special interest in swallowing, it is easy to miss a great many details of the swallowing exam.
From another viewpoint or way of reasoning, speech therapists perform video swallowing evaluations which is another way of getting at the same information as the FEES. However, to my knowledge, that is always done with a radiologist present.
From another perspective, I would not personally trust a reading that a speech therapist gave on a FEES and would want to see the videotape recording myself. However, that is the same standard that I also apply to a Barium video swallow when both a therapist and radiologist are present and reading the film.
In the end, I wouldn´t recommend pushing for a position statement from the Oregon Academy of Otolaryngology - it would be difficult for them to cross the recommendation of the National Organization. I wouldn´t push for a position statement from the Speech/Audiology Board.
I suspect the therapist who does perform FEES in Oregon would have some support from some of the speech therapy community, but would be on thin ice if a diagnosis is incorrect, a patient suffers, and there was no physician present reading the study. If the SLP would like to do the studies, it would seem prudent to somehow involve a physician who has an interest in and knowledge of the evaluation of dysphagia.
James P. Thomas, MD
Dr. Thomas is a former Board ENT member.
Q: Can a conditional licensee bill Medicaid for services?
A: Yes, but they must bill using their supervising SLP's number. The same applies to SLPA's.
Q: Since I use techs in the office, it is not unusual for me to have an audiogram done by one of them. The audiogram will show the actual tester's name. Since I do the intake interview, supervise the techs, and do post testing counseling, I do not normally report who actually ran the audiometer. As the supervisor, I take responsibility that work was done properly. Why is it important to note in a report and chart notes who actually ran the audiometer?
A: Our current rules require the actual tester to be identified in all documents. The method of identification is not specified and the newsletter just gave an example. For example, you could note the actual tester in identifying information at the beginning of the report:
Patient Name: John Doe
Date of Evaluation: Jan. 10, 2004
Referral Source: James Jones, MD
Tested by: Mary Smith, technician
Q: What are the salary ranges for Audiologists, SLPs, or Assistants?
A: This issue is not a regulatory issue.