Disclosures: Kevin M. Thomas, MD: No financial relationships or conflicts of interest

Objective: Dysphagia is a common impairment encountered by patients at inpatient rehabilitation hospitals. Two acceptable methods for diagnosing and evaluating degree of dysphagia include Modified Barium Swallow (MBS) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES). While FEES may be performed in our facility with presence of the treating speech therapist, MBS requires transportation to an outside facility with fluoroscopy capability, and coordination of radiology, speech therapy, and transportation. In the present study, we sought to compare costs related to these evaluations for patients within our facility.

Design: Cost Analysis Setting : Rusk Rehabilitation Hospital, Columbia, MO Participants : Patients at inpatient rehabilitation hospital

Interventions: None

Main Outcome Measures: The number of inpatients at Rusk Rehabilitation Hospital who were sent out for MBS and those who had on site FEES were collected during a one-year period (2019). Primary outcome measure was the cost analysis for each method. Secondary outcome measures included 1) time efficiencies and 2) swallowing functional outcomes of FEES vs prior standard of care with MBS.

Results: Total cost for MBS including transportation was $1,446, or $1,726 if patient required stretcher transportation. Cost for FEES was $1,185 plus an additional $395 charge if FEES vendor was present (a total cost of $1,580). The vendor fee will be waved when the Rusk speech therapists have completed the privileging process to perform FEES independently. In 2019, 117 patients underwent outside MBS studies and 69 patients had FEES performed at Rusk. Total cost for MBS averaged $185,591. Total cost for FEES averaged $109,020. Average amount of time the patient was occupied for each study was approximately 3 hours for MBS and 30 minutes for FEES. Average Eating Functional Independence Measure change score for all patients improved by 0.1 after implementation of FEES. Conclusions: In-house FEES at Rusk Rehabilitation Hospital has reduced costs and missed therapy hours. Functional outcomes for swallowing status were not compromised.

Level of Evidence: Level II

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/cost-analysis-comparison-of-dysphagia-evaluations-for-a-free-standing-inpatient-rehabilitation-hospital/