Reimbursement: SLP Health Care Survey 2002
Health care has changed dramatically in recent years due to the growth of managed care systems and implementation of the Prospective Payment System for Medicare beneficiaries. These changes have had a profound effect on speech-language pathologists working in all health care settings with respect to service delivery, working conditions, caseloads, demographics, and practice patterns. Anecdotal reports and recent data from the Omnibus Survey and Member Counts have indicated a declining rate of employment of speech-language pathologists (SLPs) in health care settings.
To address these issues, current and accurate survey data were needed. Therefore, a survey of speech-language pathology clinical service providers across health care settings was conducted. The survey was sent to 5,000 ASHA-certified SLPs working in health care settings. The overall response rate to the ASHA SLP Health Care Survey was 42% (2,093 responses). The results presented in this report are based on 1,955 responses that were usable for data analysis purposes. Respondents came from all nine geographic regions of the country used by ASHA in its national database with representation of facilities located in metropolitan/urban, suburban, and rural settings.
In health care settings, reimbursement typically comes from either federally funded sources (Medicare, Medicaid) or private health insurance. Overall, respondents noted that Medicare was the primary reimbursement source for a majority of patients served (36%), with private insurance (19%) and Medicaid (16%) following. Out-of-pocket payment for services occurred in 8% of patients and "other" made up 12% of funding. Other sources possibly include Early Intervention programs for pediatric populations or grant monies from private sources, such as Sertoma or Lions Clubs.
Medicare Prospective Payment Systems (PPS)
Medicare beneficiaries typically receive funding for SLP services under one of Medicare's Prospective Payment Systems (PPS). These systems vary, with different requirements, timeframes, and reimbursement amounts, depending on the setting and patient need. Not surprisingly, the highest number of PPS beneficiaries are found in skilled nursing facilities (95%), followed by rehabilitation hospitals (72%) and general medical hospitals (60%).
When asked how PPS has affected staffing in each setting, 47% of respondents indicated that there had been no change and 26% indicated that there were fewer positions available since PPS. However, respondents from skilled nursing facilities did report a higher frequency of staffing reductions (53%). Nineteen percent of respondents were unaware of how PPS had affected staffing.
Although PPS was implemented to control health care costs, 73% percent of respondents indicated that they believed there are more barriers to providing good patient care now than before PPS. This number was fairly consistent across all settings, with skilled nursing facilities reporting the most barriers (83%) and pediatric hospitals the least (55%). A frequently cited barrier to quality care across settings was increased documentation demands (69%). Other common barriers included: pressure to contain services within predetermined limits (number of visits or minutes) (80%), reduced length of stay (54%), pressure to limit referrals for instrumental swallowing studies (39%), insufficient SLP staffing (26%), fewer opportunities to screen patients (25%), and services being provided by other professionals (9%).
For more information
If you have questions regarding the survey, contact Janet Brown, Director of ASHA's Health Care Services at 301-296-5679 (firstname.lastname@example.org) or Amy Hasselkus, Associate Director, Health Care Services at 301-296-5686 (email@example.com).