The cost of an exam varies depending on the region, setting, and skill level of the endoscopist. Typically, mobile FEES exams may cost between $350-500 per procedure. SOMSAS offers FEES exams at a competitive rate below the national average. The cost savings you could receive in eliminating costs of thickened liquids, reducing a patient’s risk of pneumonia development, and reducing the risk of 30-day rehospitalizations will more than cover the cost of the exam.

When you are completing a clinical swallow evaluation, you use your clinical judgment to determine if the patient is presenting with any signs of dysphagia or risk factors, to form a hypothesis of possible deficits and compensatory strategies to trial, identify the patient’s goals of care, and determine which instrumental exam, if any, will be the most beneficial. However, we do not as clinicians have X-ray vision and cannot treat what we cannot see. Aspiration of thickened liquids often occurs silently. There is also a high error rate for CSEs alone with pt’s either being placed on too restrictive a diet or silent aspiration being missed up to 70% of the time. Why bother guessing when you can KNOW what is occurring when your patient swallows?

The modified barium swallow study is also a gold standard assessment of swallowing function. In cases where significant oral or esophageal impairments are suspected, a MBSS may be the better exam. However, there are also limitations to obtaining MBSS including scheduling, transportation, long wait times, time limitations due to radiation exposure, and often difficulty communicating with the evaluating SLP. Mobile FEES can eliminate those limitations.

When in doubt, ask a physician. However, FEES has been successfully performed across the lifespan with a wide variety of patient populations. Patients with dementia and cognitive impairment from other etiologies can successfully participate in FEES exams with positive results. As long as a patient is suspected to have dysphagia and intervention is within their goals of care, they should be referred for an instrumental. It never hurts to try! If we are unable to scope a patient, the facility will not be charged.

Once a patient has been identified as needing a FEES exam, the physician will write orders for a flexible endoscopic evaluation of swallowing and either the patient or family members will sign a consent form. We will come to your facility within a week to complete the evaluation. Not including set up time, the actual exam takes between 10-20 minutes, but can last as long as necessary. We also encourage the treating SLP to be present during the exam. They can also bill for treatment for any time the scope is not in the patient’s nose. Once the exam is complete, the facility will receive a detailed report in color within 24 hours (often right at the time of exam) and a recording of the exam on a flash drive. Our endoscopist will remain available for any questions relating to the exam or treatment plan for the patient.

FEES is a very safe and effective exam for dysphagia management. Participants should not feel pain with this procedure, but may experience mild discomfort on scope insertion. If for any reason a patient cannot participate, the exam will be immediately terminated. However, we have yet to see this happen.