April 11, 2013
This is another in a series of occasional ASHA Chief Executive Officer Updates. These Updates are intended to provide ASHA members with a more in-depth view of various National Office units, their key member services and initiatives, and the names and roles of ASHA staff. Information about staff changes and ASHA National Office recognitions/awards is also included.
Many thanks to those of you who have provided feedback regarding previous Updates or suggestions for future Updates.
Changing Health Care Landscape
It is widely acknowledged that health care, and especially the economics of health care, is undergoing dramatic changes. Although momentum for these changes has been developing over the past decade, concrete changes in health care delivery and payment have already begun. Factors causing these changes include the increasing cost of medical care, the Patient Protection and Accountable Care Act of 2010 (ACA), and the increasing demands for quality, efficiency, and accountability by regulators, health care rating organizations, accrediting bodies, employers, commercial payers, and the public. Changes are focused on achieving the "Triple Aim" promoted by the Institute for Health Care Improvement (IHI): improving the patient experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of health care.
The concept of value in health care is featured prominently as a key part of health care reform. The professions of audiology and speech-language pathology will need to develop strategies to achieve success in this transforming health industry. Providers must understand that they will be accountable for achieving outcomes with informed patients-balancing performance, utilization, and financial risks.
Changing Health Care Landscape
In early October 2012, ASHA convened a Summit on the Changing Health Care Landscape to address the many present, pending, and proposed issues that face practitioners and the discipline of communication sciences and disorders. The purposes of the Summit were to
- provide a forum for knowledge transfer, open discussion, and deliberation about the rapidly changing health care landscape;
- discern specific implications of health care reform;
- identify a set of options and seek consensus recommendations for a strategic course of action;
- determine ASHA's role in proactively safeguarding the professions in light of the changing landscape in health care.
The participants in the Health Care Summit identified a wide variety of critical "areas of coming change" to health care.
Audiology Areas of Coming Change
Patient-centered care has as one of its tenets that high-quality care must make the patient a central part of the health care team. Optimal patient-centered hearing health care must include clinicians (audiologists) who use best practices and who measure universally accepted outcomes. These changes will require that (a) patient-centered care is promoted, including what the patient wants/needs and incorporating the patient's goals, and (b) audiologists are incentivized to measure/value outcomes and to consistently use best practices.
Because audiologists do not just deal with patients during acute episodes of hearing/vestibular problems, but also provide hearing health care throughout the lifespan, professional education must also focus on patient-centered care, evidence-based practice, preferred practice patterns, online (or blended) learning, and interprofessional education. With a focus on patient-centered care, there will be a need to
- educate audiologists and students about reimbursement models involved in bundling, hair cell regeneration, vestibular prostheses, and other treatments;
- create academic training models where students learn preferred practice patterns;
- develop an online or blended learning course (online plus live component) that addresses the changing landscape in health care;
- encourage consistent use of agreed-upon definitions;
- educate primary care practitioners, nurse practitioners, and physician assistants about what audiologists do and about the value they add to the team;
- incorporate interprofessional education.
Data and Databases
Changes in health care will require an extensive registry of patient data related to audiologic services. This registry will be the key to developing defensible arguments about best practice, use of patient outcomes, cost of services, and so forth. New data needs will include
- the ability to query existing databases/systems to inform health care policy development and practice,
- creation of an index of what is available in existing databases,
- creation of a centralized registry of de-identified audiologic data, which will be publically accessible for data input and data mining to be used to continually update best practices and demonstrate value in patient-centered care.
Speech-Language Pathology Areas of Coming Change
The Clinical Paradigm
Changes in health care will require that SLPs move from a focus on deficits and impairments to context-based communicative effectiveness based on outcomes. Superior outcomes and the reliable delivery of high-quality care will need to be combined with personalized treatment plans and streamlined processes that reduce waste and lower overall health care costs. Further, it is clear that SLPs will need to fully adopt the ICF (International Classification of Functioning, Disability and Health) framework into speech-language pathology practice resources, so that the ICF becomes a unifying language for clinical reasoning and problem solving across professional roles and venues. Finally, SLPs will need to expand the clinical paradigm beyond traditional CSD services to include patient-provider communication strategies, services to communication-vulnerable (not necessarily disordered) populations participating in health care services, and providing consultation regarding altering and enabling the communication environment in care venues such as ICUs and stroke units.
Reframe/Rebrand the Profession
Speech-language pathologists need to be positioned as the leaders in communication health. SLPs need to be patient centered, not clinician centered, and stress the importance of effective communication during health care encounters and the unique expertise available within the profession to meet patient and family needs. In addition, we must link communication outcomes to health care quality of life, including societal and personal costs and benefits, and frame the profession as part of primary health care, not as an ancillary specialty. Finally, SLPs should be providing only high-level, "top of license" services and work through others such as assistants and family members to provide practice and follow-up services.
Health care reform will drive changes to the measurement of outcomes data regarding the types of services rendered to different patient populations and frameworks that are transparent and understandable across the continuum of care. As a result, SLPs will need more specific guidance documents for optimal practice and the knowledge and skills to incorporate goals and intervention parameters into these documents. Outcomes measurement was seen as integral to everyday clinical practice. Outcomes measures, critical case-mix data needed for risk adjustment, and resource utilization measures will need to be available in the same data set so that the costs associated with health care utilization can be evaluated in relation to the benefits accrued. Professionals must focus on their "value-added" to global patient outcomes. Payers are looking for core outcomes data-not documentation-that can be efficiently processed and measures integrated into payment systems (claims data).
It is clear that preparation of SLPs who are appropriately prepared and empowered to be leaders and effective partners in the new health care delivery system is paramount. Interprofessional education (IPE) will be needed to enable clinical practice focused on collaboration with other professionals. Cross-continuum care coordination is a critical component of providing value-based health care. Clinicians will need to be prepared for evolving roles and expanded responsibilities in health care. New approaches in education, such as simulation and case-based or problem-based learning, will provide more experiential learning to improve exposure to clinical practice early in the curriculum.
Though members of ASHA continue to participate in professional development activities that enhance their competency, SLPs will need information about the various changes in the health care landscape that will impact how services are provided and professionals are compensated. Information about increasingly complex topics should be shared with members in clear messages that can be easily accessed and may also be shared with consumers as they seek services.
Participants in the Summit also discussed areas where audiologists and speech-language pathologists might want to focus their efforts in the short term. They believe that audiology and speech-language pathology clinicians can actively engage to enhance delivery of services in a changing health care landscape by
- contributing to large- scale outcomes measurement tools, like the National Outcomes Measurement System (NOMS),
- following protocols for treatments that have been proven to yield effective clinical outcomes,
- comfortably and confidently stating the case for treatment-why treatment makes a difference, for example, and when treatment is not needed or appropriate,
- using "extenders" in service delivery (speech-language pathology and audiology assistants, for example) to expand patients' functional outcomes and maintenance of skills in their home environments,
- pursuing connections with accountable care organizations to deliver speech-language pathology services.
As a result of changes in health care, ASHA has focused on three areas of action starting in 2013: (1) education and IPE Core Competencies focused on students, members, and reimbursement models; (2) reframing the professions; and (3) outcomes /databases/quality improvement. Throughout the year, ASHA will be reporting on initiatives in these areas.
National Office Staff Updates
The following individuals are new to the ASHA staff since January 17, 2013:
- Suzanne Grubb, instructional designer, Clinical Research Education Library
- Sam Hewitt, director, Political and Grassroots Advocacy
- Tim Nanof, director, Health Care Economics & Advocacy
- Wendy Roan, director, Enterprise-Wide Marketing
- Monica Sampson, associate director, Health Care Services
The following individuals have left ASHA to pursue other opportunities:
- Janice Brannon, director, State Special Initiatives
- Bruce Herzig, production editor
- Erin Mantz, public relations manager
- Ayana Nickerson, director, Certification
- Sharon Willig, associate director, Clinical Issues in Speech-Language Pathology
The Next CEO Update
The State of the Association