Prove Your Services' Value to Thrive, Leaders Advise
As health care service delivery shifts toward a value-based model, speakers at Health Care/Business Institute 2013 strategized on keeping pace.
by Matthew Cutter
A crowd of clinicians drifted from a session on looming changes in health care, and Caroline Ahmon lingered, hoping to ask presenter Ann Kummer a few questions. But her question wasn't about the future because at the Weisman Children's Rehabilitation Hospital in Marleton, N.J., change has already arrived.
"We have been experiencing denials for treatment, based on our evaluation reports," Ahmon said. "Insurers are scrutinizing our progress evaluations for additional authorizations after the first sessions of therapy were approved. They're looking for marked progress—if not the achievement of the goals we set, then marked progress toward them." Ahmon and her colleagues are not alone.
More than 400 professionals gathered in Orlando, Fla., April 27–28 for ASHA's 2013 Health Care/Business Institute. The conference underlined—in addition to tracks focused on adult neurogenic disorders, swallowing and pediatric issues—speech-language pathologists' most pressing needs amid sweeping changes in service provision. Most pressing is the need to prove the value of speech-language services.
Speaker Paul Rao—vice president for clinical services, quality and compliance at the National Rehabilitation Hospital in Washington, D.C.—offered a solution. SLPs need to practice "at the top of the license"—providing services that require their specific skills and expertise—and allow treatment partners (family members or assistants, for example) to perform other tasks.
In her session, Kummer expanded on that idea by noting the importance of teaching new skills to families, rather than "practicing" with patients again and again. Repetition "needs to be done at home," she said. "That will reduce the cost per patient of treatment and allow us to be able to see even more patients, and provide more care."
Rao agreed, saying, "I think we need to use families. In the adult sphere, for example, we use peer mentorship—folks with aphasia who work with patients. I think that's a very important element. Partnership is the thing we need to stress."
And partnership isn't merely a way to show value; according to Kummer, it may also improve outcomes. "Speech therapy is like taking piano lessons," she explained. "If you just go for the therapy and you don't practice at home, you never develop the automaticity of those motor movements." Language treatment, she said, is no different. "You can be taught all about verb conjugation, but unless you actually use it and practice it every day, you never learn another language. The work at home is really important."
Dee Adams Nikjeh, co-chair of ASHA's Health Care Economics Committee, offered improved documentation as another way SLPs can demonstrate value. "Our documentation needs to be able to show functional improvement that matters to the patient—not to the clinician, but to the patient."
And Nikjeh was quick to point out that even if changes in health care provision haven't yet appeared, they are on the way. "Changes are coming, whether we like it or not, and we need to see these changes as opportunities to improve what we do, and how we do things, and to be accountable. It may trickle down—you may not feel it immediately—but eventually you're going to feel it in your paycheck. When you feel it in your paycheck, you're going to know a change is happening."
But despite the fact that change often involves pain, Kummer believes the gains will be worthwhile. "I think this a great opportunity for the field of speech-language pathology, because it will allow us to work to the level of our licensure and provide only skilled work," rather than repetition and practice that can be done outside the session, she said.
Nikjeh agreed, "I think the objective is good, the rationale behind what is being done to save health care dollars is good, and I think it has been thought out—to a point." But, she said, "there's always going to be a way to game the system, and that is what hurts all of us, in the end. I think it comes down to integrity among service providers.
"We can try to stay ahead of the game, and educate our members, so this does not come as a surprise," Nikjeh continued, "but rather as an opportunity to make changes—changes that we have control of."
Caroline Ahmon and Weisman Rehabilitation Hospital staff members are ready to meet the changes head on. "It's evolution," Ahmon said, "and we're trying to keep up with it and educate our families. That's been a challenge for us—to understand it and then relay it in a parent-friendly way to our families, how it affects their child's therapy. Before, we could just treat from womb to tomb."
Ruth Battiato, owner of Diverse Speech Therapy Solutions LLC in San Antonio, Texas, agreed that education is key. "That's why I came to this conference: to learn more about all the new changes coming about," she said. "Now I know what to look for, what to predict, and how to make changes within our own setting to accommodate the changes that are coming."
Find more Health Care 2013 coverage on ASHAsphere. For more information about upcoming ASHA conferences, visit our Events website.
Matthew Cutter is a writer and editor for The ASHA Leader.
New Online Pages Offer Medicare Audit Guidance
As the federal government cracks down on Medicare fraud, waste and abuse, health care providers—including audiologists and speech-language pathologists—may be subject to a Medicare recovery audit.
These audits are conducted by recovery audit contractors, which in 2011 identified and corrected 887,291 claims for improper payments. Those claims included $797.4 million overpaid by Medicare to providers and $141.9 million owed to providers by Medicare.
A new Electronic Submission of Medical Documentation (esMD) System allows providers to submit and track their medical reviews electronically.
Two new pages on the ASHA website help members through audits:
Board of Ethics Decisions
The ASHA Board of Ethics has found two speech-language pathologists in violation of the Association's Code of Ethics (2010).
Justine Lariviere, Dover, N.H.—By completing paperwork indicating services rendered for 330 minutes when she provided only 131 minutes, the respondent violated the following principles:
Principle of Ethics I, Rule O: Individuals shall not charge for services not rendered, nor shall they misrepresent services rendered, products dispensed, or research and scholarly activities conducted.
Principle III, Rule E: Individuals shall not defraud or engage in any scheme to defraud in connection with obtaining payment, reimbursement, or grants for services rendered, research conducted, or products dispensed.
Principle IV, Rule C: Individuals shall not engage in dishonesty, fraud, deceit, or misrepresentation.
The sanction imposed is revocation of membership and certification for 12 months, effective April 12, 2013.
Susan Kocipak, Tijeras, N.M.—By not submitting appropriate clinical records to her employer and accepting the consequences of such behavior as determined by the New Mexico Practices Board, the respondent violated the following principle:
Principle I, Rule K: Individuals shall adequately maintain and appropriately secure records of professional services rendered, research and scholarly activities conducted, and products dispensed, and they shall allow access to these records only when authorized or when required by law.
The sanction imposed is censure, effective April 12, 2013.
Access Academics and Research to Focus on Clinician-Researcher Collaborations
In the June issue of Access Academics and Research, featured author Patricia M. Chute, dean of the School of Health Professions at the New York Institute of Technology, examines the critical need for and importance of clinician-scientist partnerships. Other articles focus on some of the main benefits and challenges in establishing and implementing this type of research relationship.
ASHA Access Academics and Research is a bimonthly electronic newsletter that addresses the specific needs of faculty, researchers, post-doctoral fellows and PhD students.
To subscribe, send a blank e-mail with the word "subscribe" in the subject line to firstname.lastname@example.org.
Faculty, CE Providers Focus on Interprofessional Education at Special Convention Event
Academic faculty and researchers will join with continuing education providers to examine interprofessional education at a first-of-its-kind event at the 2013 ASHA Convention.
The Researcher-Academic Town Meeting, a popular invitation-only event for academic faculty and researchers, will team up this year with the ASHA Continuing Education Board Providers Workshop for "Interprofessional Education: Leading Audiologists and Speech-Language Pathologists Into a Collaborative Era."
As at previous town meetings, the dinner event provides an opportunity for networking and a keynote presentation. A special addition this year will be a pre-dinner presentation on the foundation of interprofessional education, including terminology, definitions, methodology and goals.
The after-dinner keynote address will feature Barbara Brandt, director of the National Center for Interprofessional Practice. At the University of Minnesota, Brandt is the associate vice president for education of the Academic Health Center and professor in the Department of Pharmaceutical Care and Health Systems in the College of Pharmacy.
In recognition of the relevance and importance of interprofessional education and collaboration to improve outcomes for patients, clients and students, town meeting organizers have invited ASHA continuing education providers to participate in the event. ASHA is seeking to broaden interprofessional education opportunities for members across the continuum of pre-service education and continuing professional development.
ASHA's Continuing Education unit and Academic Affairs & Research Education unit are cohosting the event, which begins at 5:15 p.m. on Wednesday, Nov. 13. Electronic invitations will be sent in mid-September. For more information, contact email@example.com.
Did You Know?
- ASHA's State Advocacy Team works with state association leaders and members to enhance communication and collaboration between ASHA and ASHA-recognized speech-language-hearing associations. Find information on your state related to licensure, regulations and important contacts. View model bills and policy resources and see the latest trends in state licensure.
- ASHA has launched the new Practice Portal, which offers one-stop access to resources to guide evidence-based decision-making on clinical and professional issues.
- You can connect with your colleagues on the ASHA Community. Create a member profile, upload your photo and join in the many online conversations.
- The Associate Center has everything you need to know about the ASHA Associates Program. Check here for new updates, exciting developments and all associates-related information.
See what the ASHA Board of Directors recently voted on [PDF].