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Issue Focus: Employer Demands
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Welcome to Access SLP Health Care, a bimonthly e-newsletter that addresses the specific needs of speech-language pathologists (SLPs) working in health care. If you have not already subscribed, send a blank e-mail with the word "subscribe" in the subject line to: Access-SLPhealthcare-request@lists.asha.org. If you know of any colleagues who might enjoy this newsletter, please forward this e-mail.
New Features!
Share your expertise and experiences with your colleagues. Access SLP Health Care is soliciting stories from subscribers for two new features:
Tell us what is working for you and improving your treatment. Do you use an old tool in a new way? Have you streamlined your documentation? Are you able to manage cancellations and no-shows in your facility? Share what works for you!
Have you recently been through a Joint Commission, CARF, or state survey? Share your experiences and tips for handling issues that arise during the survey process.
To submit a tip or story, e-mail accessslp@asha.org. Stories may be edited for length and will be included as space allows. ASHA reserves the right to refuse any story or tip. By submitting a story or tip, you are granting ASHA permission to publish your name in this electronic newsletter.
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Breaking News!
- Hot Off the Presses! New Brochure Available to ASHA Members.
Reward Yourself with a career in Health Care is now available free of charge to ASHA members. This brochure can be used when talking with high school or undergraduate students about career options, or to promote the speech-language pathology and audiology professions to anyone interested in a career change. ASHA members can receive up to 25 free copies by contacting the Action Center (actioncenter@asha.org).
- Advocate for the Use of Qualified Providers in Early Intervention
ASHA resources are now available about cross-training and the important role SLPs play in the lives of young children with speech, language, or swallowing issues.
- Infection Control Resources Now Available
Information on hand hygiene, disinfecting equipment and supplies, and isolation precautions all in one place. Includes information about VRE, MRSA, TB, and HIV precautions.
- Cultural Competence Corner
This article asks, "What is the point of conducting an evaluation and making specific recommendations for postures, exercises, or diet modifications, if we cannot ensure that the patient/caregiver will follow up?" Learn more about the importance of cultural competence when working with individuals with dysphagia.
- Medicare Intermediary Covers FEES by SLPs Without Physician Supervision
Learn more about the arguments used and how they may apply when negotiating with other payers.
- Stay on Top of Therapy Cap Developments
Medicare therapy caps are scheduled to return in 2007 unless Congress acts soon. Act now!
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Find information relevant to your specific practice setting, including acute-care hospitals, rehabilitation hospitals, home health, long-term care, and pediatrics. Other items include information on policy and procedure manuals, productivity, and recruitment and retention of SLPs in health care.
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Featured Question - Employer Demands
My manager tells me that I must continue to see patients who I do not feel are appropriate for treatment or who are clearly not interested in receiving my services. How should I respond?
Members in a variety of settings contact ASHA with concerns about employer demands. In fact, the most common reason members contact ASHA's ethics team is for issues related to employer demands. The following examples are excerpted from contacts made to the National Office:
- "I was told that 'it was noticed that I [discharged] these patients sooner than other SLPs who had worked there' who had reportedly continued treating ALL their patients from beginning to end of their length of stay and had no difficulties meeting the productivity expectations. I questioned their policy of continuing to treat patients who had either: 1) reached their functional/maximum potential in skill recovery or 2) who were clearly not benefiting from continued therapy. I was told that, since these patients are billed on a DRG-based system, they would not be charged any more/less if I continued to treat them until the end of stay and that continuing to treat patients in either of the two scenarios would not "harm them". I was also told that (using these rationales), I should not feel as though I was compromising my ethics." - ASHA member
- "Rehab agencies are requiring therapists to be 80% productive or the therapist should go home for the remaining part of the day. In order for therapists to pay their rent, they have to rationalize taking on patients that are noncompliant or not appropriate for therapy or not appropriate for as much therapy as told by the facility and rehab agency. [In addition], patient's right to not have therapy is NOT taken into consideration. I know in regards to speech therapy, this means that patients sit mute and not imitating oral motor exercises for the entire therapy session so that Medicare dollars can be siphoned. Noncompliance is never noted for it would result in not getting the required amount of time for reimbursement."
-ASHA member
Employers experience financial pressures which they may transfer to clinical staff as pressure to include or keep patients on a caseload. Health care is a business and, as with any business, there is a bottom line. Reimbursement for medical services is the primary means by which facilities or agencies pay staff and cover overhead costs. As we are all aware, health care dollars are shrinking and payers are very stringent about what they will pay for and when. However, just because a payer will reimburse for a service does not mean that the service is appropriate and should be provided.
In addition, administrators may not completely understand the nature of speech-language pathology intervention and may set productivity levels higher than what is realistic for the SLP. Codes for SLP services are typically session-based rather than time-based. Therefore, while a PT may see a patient for one hour and bill for four units of one code, the SLP may only bill one time for the entire hour-long session. If administrators set productivity levels by "units," the SLP's productivity will suffer and there may be pressure to see more patients to improve the numbers. Again, keeping patients on caseload just to meet productivity demands is not appropriate and demands to do so may compromise the SLP professionally and ethically.
Principle of Ethics I of ASHA's Code of Ethics clearly states that "Individuals shall honor their responsibility to hold paramount the welfare of persons they serve." Rule G further clarifies that "Individuals shall evaluate the effectiveness of services rendered and of products dispensed and shall provide services or dispense products only when benefit can reasonably be expected." In addition, Principle of Ethics IV, Rule G states that "Individuals shall not provide professional services without exercising independent professional judgment, regardless of referral source or prescription." Taking these three statements together, it is clear that the SLP's ethical responsibility is to the patient and that providing services when the patient will not benefit from them or because the SLP "was told to" is inappropriate.
As stated in the Issues in Ethics Statement, Prescription, "In all circumstances, it is incumbent on the speech-language pathologist or audiologist to determine when to accept limitations on professional responsibility. As long as the speech-language pathologist or audiologist maintains independence of judgment and preserves the professional prerogatives to plan and provide speech-language pathology or audiology services that are in the best interest of the individual client and accepts responsibility for the plan and services so provided, there is no violation of the Code of Ethics."
In addition to ethical issues, there are potential legal issues around fraudulent billing. Submitting for or accepting payment for services that are not clinically necessary or appropriate is illegal, regardless of the payer source or method of reimbursement (fee-for-service, Prospective Payment System, etc.). More information on this topic is available in the Issues in Ethics Statement, Representation of Services for Insurance Reimbursement of Funding.
Patient rights, as mentioned in the second member statement above, also must be considered. If patients have decision-making capacity and state that they do not want to receive treatment after being fully informed of all of the SLP's recommendations, this decision must be respected, regardless of what it might do to their health (in the case of refusing swallowing recommendations, for example) or the impact on the facility's bottom line. Patients who consistently refuse treatment, verbally or nonverbally, also may not be appropriate candidates for treatment. Continuing to see patients when they do not want to receive services is not appropriate. It may also constitute fraud to continue to see the patient and receive payment for services via direct billing or higher DRG categories if compliance issues are not documented and progress is implied.
You also may be interested in:
Discuss the featured question in the ASHA forums.
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For Your Professional development
Aphasia: The Role of Social Participation in Intervention (text-based self-study; 0.2 ASHA CEUs)
Aphasia: Treatment for Lexical and Sentence Production Skills (text-based self-study, 0.6 ASHA CEUs)
The Dysphagia Evaluation: Consultation to Instrumental Exam (Master Clinician Series, video/DVD, 0.2 ASHA CEUs)
Therapeutic Interventions for Dysphagia (Master Clinician Series, video/DVD, 0.2 ASHA CEUs)
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Products for your practice
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Announcements
Please Complete the Access SLP Health Care E-newsletter Survey!
Be sure to complete the brief e-mail survey that should have arrived in your email box on Sept. 5 to provide valuable information that will help make this newsletter even better.
The Power of Passionate Mentoring can and does change lives!
Get the edge and support your goals with The Student To Empowered Professional (S.T.E.P.) mentoring program. This program is designed for racial/ethnic minority undergraduate and graduate students enrolled in communications sciences and disorders (CSD) programs. Enroll Now! to become a mentee or mentor. Get the inspiration, skills and resources you need to create powerful, productive mentoring relationships. Visit The ASHA Gathering Place for more information.
Get Discovered!
Sign Up For ProSearch - ASHA's Free Referral Service
Want to meet your patients' needs more effectively? ProSearch, ASHA's online directory of audiology and speech-language pathology programs, helps consumers find quality services from more than 7,800 programs that employ ASHA-certified SLPs and audiologists.
Have you ever taught or supervised students?
Check out Teaching Tools, a new resource that includes articles, information, and resources on academic and clinical teaching and teaching with technology.
Interested in AAC?
Please join Division 12 (DAAC) and the AAC-RERC for an exploratory meeting in Miami. This meeting will take place on Wednesday, Nov. 15 from 7 -9 pm (location TBA). For questions or additional information, please contact Carole Zangari (zangaric@nova.edu) or David Beukelman (dbeukelman1@unl.edu).
Register Online today for the Graduate School Fair
Graduate School Fair Exhibitor Registration is now open for the ASHA Convention in Miami, FL, Nov. 16 & 17, 2006.
Award Programs for Students and New Faculty
ASHA's current award programs are available to undergraduate, masters, AuD and PhD students enrolled in CSD programs, as well as to postdoctoral fellows and new faculty. The awards are designed to foster leadership and promote careers in academia and research.
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Watch for the next issue of Access SLP Health Care in November.
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