Board of Directors Meeting Report: October 15–16, 2011

ASHA’s Board of Directors (BOD) met at the National Office on October 15 and 16. Following are highlights of the Board’s discussions.

President’s Opening Remarks

President Paul Rao convened the meeting at 9:00 a.m. on Saturday, October 15. He welcomed the six newly elected Board members: President-Elect Patricia Prelock, Chair of the Audiology Advisory Council Wayne Foster, Vice President for Finance Carolyn Higdon, Vice President for Government Relations and Public Policy Theresa Rodgers, Vice President for Speech-Language Pathology Practice Gail Richard, and Vice President for Standards and Ethics in Audiology Robert Novak. They will begin their 3-year terms on January 1, 2012. New Board members are invited to participate fully in the discussions of the Board during the October meeting but do not vote. President Rao also thanked the departing Board members who will be leaving the Board at the end of this year, completing their terms of service. Departing members are Immediate Past President Tommie L. Robinson Jr., Chair of the Audiology Advisory Council George Purvis, Vice President for Finance Bob Augustine, Vice President for Government Relations and Public Policy Tom Hallahan, Vice President for Standards and Ethics in Audiology Allan Diefendorf, and Vice President for Speech-Language Pathology Practice Julie Noel.

Executive Director Update

Executive Director Arlene Pietranton highlighted several items from the written report that was sent to Board members in advance of this meeting:

• Certification Maintenance Compliance: members in the 2008–2010 interval are now at 90% compliance, which represents a 47% increase from August 2010. Members in the 2009–2011 interval are now at 46% compliance. This represents a 32% increase from August 2010.
• Applications for SLP certification in 2011 are up 4% from 2010. Applications for audiology certification are up 3% from 2010.
• ASHA’s new online community launched in October. The community combines the member directory, discussion forums, and Listservs into a single state-of-the-art platform.
• The National Quality Forum (NQF) announced on October 2, 2011, that it has concluded its multiyear assessment of eight of ASHA’s Functional Communication Measures (FCMs) with a full and permanent endorsement of all eight measures. These FCMs are disorder-specific, 7-point scales developed by ASHA in the 1990s to measure functional communication. They serve as the cornerstone of ASHA’s National Outcomes Measurement System (NOMS) for speech-language pathology.
• Margaret Rogers, ASHA’s chief staff officer for science and research, submitted a grant application to NIDCD in response to their Request for Applications – National Mentoring Networks to Enhance Clinician-Investigators Workforce (RFA-DC-11-001). The grant proposed to accelerate the generation of fundamental, translational, and patient-oriented research in communication sciences and disorders (CSD) by enhancing the training, retention, and funding success of clinical scientists in CSD. The grant application was favorably reviewed by the review panel in August and also by the NIDCD Advisory Council in September. Pending congressional approval of the 2012 budget, ASHA anticipates launching the Clinician-Scientist Mentoring Network in January 2012.
• There are a number of changes in store for ASHA Convention in 2011.
  • Overflow rooms will be designated throughout the Convention to automatically handle any room that reaches capacity.
  • We will be recording select sessions during the Convention to allow us to test options for creating an online library to be available post-Convention that would also be eligible for CEUs.
  • The opening session has been moved to Thursday morning to help set the stage for the entire Convention.

SLP Summit Subcommittee Report

At the August Board meeting, Vice President for Government Relations and Public Policy Tom Hallahan, Vice President for Speech-Language Pathology Practice Julie Noel, and Chief Staff Officer for Speech-Language Pathology Lemmie McNeilly presented a report regarding the outcomes of a summit on the various provider roles in speech-language pathology, in which more than 70 individuals participated representing academia, supervisors of speech-language-pathology assistants, speech-language-pathology assistants, state education consultants, state education advocacy leaders, and state licensing boards. As a result of those discussions, a subcommittee of the Board chaired by President-Elect Shelly Chabon and including Chair of the Speech-Language Pathology Advisory Council Nancy Alarcon, Vice President for Government Relations and Public Policy Tom Hallahan, Vice President for Speech-Language Pathology Practice Julie Noel, Vice President for Planning Barbara Moore, Vice President for Academic Affairs in Audiology Neil Shepard, and Chief Staff Officer for Speech-Language Pathology Lemmie McNeilly met to determine what specific actions should be considered by the full Board.

At today’s meeting, based on the work of the subcommittee, President-Elect Shelly Chabon, Vice President for Government Relations and Public Policy Tom Hallahan, Vice President for Speech-Language Pathology Practice Julie Noel, and Chief Staff Officer for Speech-Language Pathology Lemmie McNeilly asked the Board to consider possible actions resulting from the SLP summit.

After extensive discussion, the Board agreed that ASHA will take the following actions:

1. Develop and disseminate a PowerPoint presentation that Summit participants can utilize to communicate the Summit’s recommendations with colleagues and stakeholders in their communities.
2. Establish a BOD subcommittee that will monitor the recommendations over the next year.
3. ASHA should develop a scope of practice for support personnel in SLP.
4. The state advocacy team, with consultation from the appropriate constituencies, will develop model language that can be provided to states regarding use of support personnel, utilizing information from the Summit tenets and including common nomenclature where possible.
5. Update information regarding the supervisory requirements for SLPs who supervise support personnel.

Interprofessional Education (IPE)

Issues related to interprofessional education (IPE) have been raised by a number of members and as a result ASHA has been gathering information and participating in discussions on IPE. As this issue has continued to emerge, there has been a need for the BOD to provide perspective on the need for and extent of continued action related to IPE. In August, in response to members’ comments about ASHA’s involvement and role in IPE, the BOD participated in a speed visioning activity related to this issue. As a follow-up to those discussions, Chief Staff Officer for Speech-Language Pathology Lemmie McNeilly led the Board in a discussion to determine the most important actions ASHA should pursue in support of IPE. The Board agreed that the following actions should be pursued.

1. Develop a position regarding the role for involvement of audiologists and speech-language pathologists in IPE.
2. Facilitate a needs assessment regarding competency via a survey, and plan educational offerings based on the results.
3. Collaborate with CAPCSD on IPE for academic programs.
4. Develop a long-range plan that involves IPE in pre-education, clinical practice, and continuing education.
5. Consider a track at the ASHA Convention on IPE, and encourage participation from other disciplines.
6. Consider IPE as a topic of discussion at researcher–academic town meetings.
7. Pursue funding from external organization to develop materials and resources.
8. Work with other health care organizations such as AOTA and APTA, and engage with other organizations that have participated in IPE (e.g., nursing, dentistry, pharmacy, and medicine).

2011 Budget Report

Vice President for Finance Bob Augustine and Chief Staff Officer for Operations Chuck Cochran presented a status report on ASHA’s current operating budget as of August 31, 2011. Dues revenue is higher when compared to 2010, resulting from an increased number of members, ASHA’s high retention rate (98.5%), and the dues increase in 2010. ASHA is showing positive revenue over expense so far this year and is forecasting total revenue will exceed expenses for 2011.

2012 Proposed Budget

The Financial Planning Board (FPB) met in September and reviewed the proposed 2012 budget in detail. The proposed 2012 budget, which projects modest positive revenue over expense in 2012, was presented to the Board with the FPB recommendation that it be approved. For 2012, with the expected growth in membership and some increases in non-dues revenue, we expect an increase in overall revenue. In addition, the additional costs associated with the transition from Special Interest Divisions to Special Interest Groups are fully reflected in the 2012 budget. After careful consideration and discussion, the Board approved the budget for 2012 as presented.

Property Update

Chief Staff Officer for Operations Chuck Cochran updated the Board regarding the current status of the construction of homes at the former Headquarters property and the leasing out of the remaining fifth floor space in the National Office building. He reported that 27 homes are under contract, which is ahead of schedule, and that the model home will open in December. Regarding the fifth floor space, of which 8,000 square feet is still available, one of ASHA’s current tenants wants to increase their amount of space by 2,000 square feet. ASHA continues to market the remaining space.

Council on Clinical Specialty Recognition Report

In January of 2009, the BOD approved a resolution creating the Ad Hoc Committee on Clinical Specialty Recognition. The Committee submitted their report in April 2010. Based on nine principles identified by the Ad Hoc Committee, 21 recommendations were brought forward to the BOD in the summer of 2010. The BOD carefully reviewed the report and the financial modeling based on the Ad Hoc Committee’s report. Following this review and discussion, the BOD determined that it was not fiscally viable to support the recommendations that were based on a financial model that would bring the operations of the Clinical Specialty Recognition Program fully within ASHA. However, the BOD recognized that a number of recommendations contained in the Ad Hoc Committee Report could be referred to the Council for Clinical Specialty Recognition (CCSR) with the expectation that the CCSR would develop an implementation plan. By August 2010, a BOD working group identified 15 recommendations from the original recommendations that the CCSR was asked to respond to. The CCSR met with stakeholders from the three Specialty Boards in November 2010 to initiate a discussion with the intent of reaching consensus on the 15 recommendations made by the BOD Study Group. The CCSR subsequently convened a meeting in May 2011 that included individuals appointed by the three Specialty Boards to finalize their report to the Board.

At today’s meeting the Board voted to receive the CCSR’s July 2011 Report and recommendations and thanked the members of the Ad Hoc Committee and the CCSR for their hard work. Board responses to the CCSR report will be developed at the January 2012 BOD meeting.

ASHA’s 2012 Strategic Pathway to Excellence

One of the responsibilities of members of the BOD is to ensure that the activities of the committees, boards, and councils they monitor are aligned with ASHA’s Strategic Pathway to Excellence. During the October Board meeting, Vice President for Planning Barbara Moore led the Board in an exercise to determine the alignment of each Board member’s committees, boards, and councils with ASHA’s 2012 Strategic Objectives.

HCEC Report: The Changing Landscape of Health Care Reimbursement in America

Stewart Trembath, Chair of the Healthcare Economics Committee (HCEC); members of the HCEC Robert Fifer, Wayne Holland, Becky Cornett, and Dee Nikjeh; and Director of Healthcare Economics and Advocacy Steve White provided an overview of the changing landscape for reimbursement of health care services. They pointed out that:

• Speech-language pathologists and audiologists will increasingly be paid for patient outcomes (value-based purchasing) rather than volume of visits or number of sessions or number of tests.
• Bundled payment models, which are now beginning, potentially disincentivize the use of those providers whose services increase utilization and cost without adding perceived value.
• The federal government is establishing essential health care benefits under the Affordable Care Act. Consequently, states may reduce or eliminate mandated benefits because they themselves will have to pay for those mandated benefits under new Health Insurance Exchange payment systems.
• In 2013 diagnostic coding will change to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision Clinical Modification (ICD-10-CM) diagnostic coding. These codes allow for much more specificity of coding.
• The International Classification of Functioning, Disability and Health (ICF) framework, with emphasis on functional status, is becoming more prevalent in describing rehabilitation health care services. The ICF is a system of health and health-related domains that describe body functions, body structures, activities, and participation. Its general framework is useful for understanding and measuring health outcomes, which we know are vital to today's reimbursement requirements.
• The Medicare Payment Advisory Commission believes primary care physicians should be better compensated at the expense of other practitioners while reimbursement for other Medicare providers, including speech-language pathologists and audiologists, is reduced.

As all of these rules change, it is clear that speech-language pathologists and audiologists need to be successful in showing the value of their services. As a result of all these dramatic changes, the HCEC proposed to the Board that ASHA hold a summit to engage leaders and stakeholders involved in these issues and to develop plans to take appropriate action. The Board agreed that ASHA should do so in the first quarter of 2012. Resolution(s) will be developed in the very near future for the Board to vote on this proposal.

2011 Public Policy Agenda

Vice President for Government Relations and Public Policy Tom Hallahan and Director of Government Relations George Lyons presented ASHA’s 2012 Public Policy Agenda (PPA). ASHA members, committees, boards, and councils were invited to provide input in advance of preparing the proposed 2012 PPA for the Board’s review and approval. As in 2011, members of the Government Relations Public Policy Board (GRPPB) worked collaboratively with ASHA staff to revise and improve the survey tool utilized. As a result, they received input from 2,286 individuals. The GRPPB met in August to review this information and prepare the 2012 PPA for the Association. Two significant changes in the structure of the PPA for 2012 are that priority levels are categorized as either Proactive Advocacy or Opportunistic Advocacy and issues are being categorized in one of three categories: Education, Health Care, or Professional. The Board discussed the proposed agenda and the updated PPA was approved by the Board. It will be posted on ASHA’s website after it is reviewed by the GRPPB.

NSSLHA

ASHA and NSSLHA agreed in 2009 to pursue discussions leading toward a partnership between the two organizations that would restructure the relationship between ASHA and NSSLHA, ensuring that NSSLHA could be maintained as a separate student-led organization with the added benefits and protections of the fiscal and fiduciary authority of ASHA. Starting in 2010, a NSSLHA/ASHA Implementation Team that included ASHA representatives and representatives of the NSSLHA Executive Council worked toward the development of recommended changes to better meet the needs of both organizations. At today’s Board meeting, President-Elect Shelly Chabon, Former President Sue Hale, Vice President for Audiology Practice Jaynee Handelsman, and Chief Staff Officer for Multi-Cultural Affairs Vicki Deal-Williams solicited feedback from the BOD on the Implementation Team’s recommendations for changes that will support the formal integration of the two organizations. Once final, these recommendations will be brought forward to the NSSLHA Executive Council for approval to ensure the student leaders are in agreement, and then to the ASHA BOD for approval.

Governance Restructure Parking Lot

At its March 2007 meeting, the Legislative Council (LC) passed a resolution approving a change in ASHA’s governance structure and process. It was agreed at that time that the new governance structure could not be changed again until 2012. As part of the change, the Ad Hoc Committee on Governance Transition was charged with developing a process for evaluating whether the changes in governance structure and process produced the intended results (i.e., whether governance of the Association better met the needs of the membership). Through the use of an annual survey, ASHA’s Governance Operations unit has assessed the effectiveness of the governance structure each year since 2008. Suggestions for changing the governance structure are held in a “parking lot” for potential action in 2012. At today’s meeting, Immediate Past President Tommie L. Robinson Jr. and Director of Association Governance Operations Andrea Falzarano led a discussion of proposed changes in ASHA’s governance structure that the Board will have an opportunity to further discuss and vote on in 2012.

ADA Lawsuit Update

Executive Director Arlene Pietranton and Chief Staff Officer for Audiology Vic Gladstone updated the Board about a lawsuit filed by the Academy of Doctors of Audiology (ADA) against ASHA. The ADA claims in their lawsuit that, among other things, ASHA has made false statements about the Certificate of Clinical Competence in Audiology (CCC-A) in its communications to certificate holders and applicants. Subsequent to their lawsuit, ADA also filed a Motion for Preliminary Injunction asking the court to stop ASHA from making the allegedly false statements as well as any similar statement. In the past few weeks, ASHA’s attorneys have filed legal motions detailing the inaccuracies in ADA’s claims. An update will be provided to members as we learn the court’s decisions based on their review of our filings. ASHA will continue to defend the Association from these untrue and inaccurate claims, all of which have been clearly refuted in ASHA’s responses.

Associates Program Update

Chief Staff Officer for Communications Marty Rome updated the Board about the status of the Associates program. The Associates Program Free Trial attracted 409 participants, and 32% of the participants who received the most recent issue of the Associates Insights e-newsletter opened the publication. The full program launched in late September and as of October 15, ASHA had processed 25 applications. In addition, 32 people have identified themselves as assistants and have registered for Convention in that category. These registrants have agreed to apply for affiliation as Associates. At the end of this month a recruitment mailing will be sent to approximately 7,400 individuals who we have identified as potential candidates for Associate affiliation.

Members and Affiliates Rights and Benefits

At the August meeting, Chief Staff Officer for Communications Marty Rome presented a summary of the current rights and benefits of member and affiliation (nonmember) categories of the Association. With the addition of the Associate level of affiliation, it was felt that a single document describing all of the various categories would be helpful to the Board. At today’s meeting the Board decided to seek additional feedback about the rights and benefits of International Affiliates from the International Issues Board, Special Interest Group 17 (Global Issues in Communication Sciences and Related Disorders), and the Committee on Honors before finalizing the document.