Getting Started in Outpatient Clinics
Outpatient clinics come in many different shapes and sizes. These clinics provide the speech-language pathologist with a wide range of clients with varied etiologies. Depending on the clinic, the patient population may be primarily adults, primarily children, or a combination of both. Outpatient clinics may exist within a hospital or ambulatory care center or may be free-standing. In a speech and hearing clinic, audiologists are typically on site to offer a wide array of audiologic services. In other outpatient clinics, occupational therapists, physical therapists, psychologists, or others may be employed, as well. In settings where the outpatient clinic is part of a larger facility, the SLP may spend part of their day seeing outpatients and the rest of the day working with inpatients. In some cases, the facility employs "outpatient therapists" and "inpatient therapists" who do not provide services across those boundaries.
Age range of Adults seen in outpatient clinics
- 16–29 years: 7%
- 30–49 years: 20%
- 50–59 years: 17%
- 60–69 years: 20%
- 70–79 years: 24%
- 80 years and older: 12%
General age range of Pediatric clients seen in outpatient clinics
- Infants–toddlers: 18%
- Preschool: 31%
- School-age: 30%
Top 5 primary medical diagnoses of Adults seen in outpatient clinics
- CVA: 44%
- Head injury: 11%
- CNS diseases: 7%
- Respiratory diseases: 6%
- Hemorrhage/injury: 4%
Top 5 Functional Communication Measures for Adults scored by SLPs working in outpatient clinics
- Spoken Language Expression: 35%
- Memory: 29%
- Spoken Language Comprehension: 27%
- Motor Speech: 25%
- Reading: 23%
Top 5 treatment areas for Pediatric clients seen in outpatient clinics
- Language: 38%
- Articulation/Phonology: 29%
- Cognitive-communication: 12%
- Swallowing/Feeding: 9%
- Fluency: 4%
Average length of stay for Adults in outpatient clinics:
* Adult data comes from the National Outcomes Measurement System (NOMS). Pediatric data comes from the 2007 ASHA Health Care Survey.
Payment for services may come from private insurance, Medicaid, or Medicare. The client may pay out-of-pocket, as well. Private insurance companies may negotiate a rate with the clinic for services provided and payment may differ if the clinic is an "in-network" or "out-of-network" provider. Medicaid will pay for qualifying services, typically with a flat rate. Since Medicaid programs are heavily state-regulated, each state's program will vary. Hospital-based outpatient clinics and certified rehabilitation agencies can provide Medicare speech-language pathology services under Part B. This is a fee-for-service model that currently exists under the therapy caps (a limited number of dollars are available for occupational therapy and physical therapy/speech-language pathology services per episode of care per year). An exceptions process has been in place that allows beneficiaries to exceed the cap if documentation supports the need for such an exception. SLPS working in a private practice or non-certified clinic can obtain a provider number and bill Medicare independently.
Outpatient clinics may also contract services to outside agencies, such as early intervention and preschool programs. In these cases, the clinic is reimbursed based on the amount per session or unit set forth in the contract.
Impact of reimbursement on clinicians
Shrinking health care dollars have impacted all areas of care, including speech-language pathology. Payers often set limits on what they will pay for services or on how long they will pay for them. Documentation needs to support the medical necessity of the services and claims are sometimes denied payment if the client's needs do not meet the requirements set forth by the payer. Productivity requirements may be in place to maximize reimbursement and keep the clinic running.
Patients are typically referred by a physician or other agency for outpatient services. In some cases, patients may self-refer, particularly if they are planning to pay out-of-pocket.
Collaboration with other disciplines
If the clinic employs a variety of professionals or is located within a larger facility, SLPs may co-treat with PT or OT or work on specialized teams, such as cleft palate or feeding teams. SLPs and audiologists may work together on specific cases. If the clinic strictly employs SLPs, opportunities for collaboration are diminished.
Documentation varies by facility and payer. Typically evaluation reports, progress notes, attendance and billing records, and discharge summaries are included in the client's chart. The format will vary. In some cases, hard copies may be kept in the office; in others, electronic records may be used.
Go to the SLP Health Care section of ASHA's Web site to access:
- ASHA Speech-Language Pathology Health Care Survey
- Health care frequently asked questions (FAQs)
- ASHA member forums
- Issue briefs
Go to the Billing and Reimbursement section of the ASHA Web site to access:
- Billing and coding information
- Reimbursement frequently asked questions (FAQs)
- Medicare Fee Schedule
Go to ASHA Practice Policy to access documents on preferred practice patterns, dysphagia, clinical record keeping, autonomy, etc.