Consensus Statement on Productivity and Revenue Conflicts in Health Care Settings

October 10, 2014

ASHA, in collaboration with the American Occupational Therapy Association (AOTA) and the American Physical Therapy Association (APTA), has developed a Consensus Statement on Clinical Judgment in Health Care Settings [PDF]. The Statement reiterates Medicare guidelines, but includes a stronger emphasis on the responsibility of clinicians to identify and refuse to participate in actions that are inappropriate or fraudulent. Guidance is provided on such issues as ethical service delivery, rules and regulations, evaluation and treatment, documentation, and clinical integrity, as well as resources on how to take action if there is a problem.

The document will be circulated to members of all organizations and used for discussions with trade organizations representing owners and staffing agencies for skilled nursing facilities.


ASHA has received an influx of concerns from members working in health care settings (particularly skilled nursing facilities) about administrative pressures for productivity and revenue that conflict with independent clinical judgment for appropriate patient care. In response, ASHA convened a conference call with volunteer leaders and staff members from ASHA, AOTA, and ATPA and subsequently formed a staff workgroup. The Consensus Statement on Clinical Judgment in Health Care Settings was developed as a result of that collaboration.

ASHA Resources

For additional information or questions regarding the Consensus Statement, please contact Janet Brown, ASHA's director of health care services in speech-language pathology, at or Tim Nanof, ASHA's director of health care policy and advocacy, at or 301-296-5676.

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