American Speech-Language-Hearing Association

Examples of NOMS Applications – Health Care

The following two examples have been provided using the most recent data to further illustrate the direct implications of NOMS for speech-language pathologists and administrators.

Example 1

Using National Data to Advocate for Payment of Services

The ACME managed care company has issued a statement that it is reducing the coverage for dysphagia services provided in acute care settings. ACME states that this decision is based on a partial review of the records, and it believes that patients with dysphagia do not make progress in acute care settings. ACME will pay for one hour of evaluation only. It has provided a one-week period of time for comment on this proposed change.

Using data from ASHA's National Outcomes Measurement System (NOMS), you are able to demonstrate that, in fact, patients with dysphagia do make progress in acute care settings (see Figure 1). Looking at the data, we see that, on average, patients treated for swallowing disorders in acute care have an FCM score of 3 upon admission. At discharge, close to two-thirds of these patients have made at least one FCM level of change. In terms of function and progress for these patients, the scores indicate that, on admission, a patient's swallowing disorder prevented him/her from eating by mouth with the majority of his/her nutrition and hydration received by non-oral means (e.g., nasogastric tube or PEG). Furthermore, these patients required one-to-one supervision for eating. However, at discharge, these patients' swallowing skills are functional enough to meet all nutritional needs by mouth. Given the cost of tube feedings and one-to-one supervision, ACME can actually save money by paying for dysphagia services in acute care settings.

Figure 1: Swallowing FCM Progress in Acute Care Settings - Admission Level 3

Swallowing FCM Progress in Acute Care Settings - Admission Level 3

Additionally, the data also reveal that over half (52%) of the patients treated for swallowing are able to get all of their treatment needs met in the acute care setting with no further SLP intervention needed.

Example 2

Using National Data to Advocate for Payment of Services

A managed care company with which your organization has a contract historically has denied speech-language pathology services to preschoolers with articulation disorders. In the past, when asked why coverage for preschoolers is not allowed, the managed care company explained that the benefit it offers is for short-term rehabilitation only and does not cover more than 12 therapy sessions per year. The company also argues that since preschoolers typically exhibit "developmental" communication disorders, they will not show functional gains/improvements in a short-term rehabilitation model. What can you do to advocate for coverage of speech language pathology services to children?

Using data from ASHA's National Outcome Measurement System (NOMS), you are able to prove that children with articulation disorders do make functional gains even when a limited amount of intervention is provided (see Figure 2).

Figure 2: Progress in Articulation FCM by Number of Treatment Sessions

Progress in Articulation FCM by Number of Treatment Sessions

The data reveal that nearly three-fourths (74%) of the preschoolers with articulation disorders who received between 12-20 treatment sessions showed functional gains of at least 1 or more Functional Communication Measure (FCM) levels. With these data, you will be able to effectively advocate for additional coverage of speech-language pathology services to children.

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