Demonstrating the Value of Speech-Language Pathology Services in the New Home Health Payment Model 

Demonstrate Your Value! 

On January 1, 2020, home health agencies (HHAs) will implement the  patient-driven grouping model (PDGM) for Medicare reimbursement, which bases payment for patients with speech-language pathology needs on their clinical characteristics. Here are some ways in which speech-language pathologists (SLPs) can demonstrate their value in this new payment model. 

Success under PDGM will require SLPs to assist in the identification of patient needs. 

SLPs play a critical role in identifying patients for treatment and determining their plan of care.  Comprehensive coding that recognizes all diagnoses and comorbidities/complexities is critical.   

Payment under PDGM will require SLPs to help HHAs maintain high quality. 

Therapists play a critical part in ensuring quality improvement and avoiding payment adjustments under the value-based purchasing program (VBP), the quality reporting program (QRP), and Home Health Compare. 

Involve SLPs in the completion of the Outcome Assessment Information Set (OASIS) 

Engaging SLPs in the completion of relevant sections of the OASIS ensures accuracy of the data, helps identify patients who need speech-language pathology services, and facilitates interprofessional practice. SLPs can contribute to this process either directly or in consultation with the HHA staff who complete the OASIS. For example, the patient’s level of functional impairment is one factor for payment. SLPs can help identify patients at risk for hospitalization as a part of this functional assessment. 

SLPs help prevent Medicare audits by ensuring that claims and documentation are complete and accurate. SLPs play a valuable role in managing the following changes: 

• Changes in payment that result from changes in the coding or classification of HHA patients versus actual changes in case mix. 
• Changes in the volume and intensity of therapy services provided to home health patients under PDGM compared to home health resource utilization groups (RUGs). 
• Agencies whose beneficiaries experience inappropriate early discharge or provision of fewer services (e.g., under utilization due to the 30-day payment periods). 
• Changes in quality reporting performance and star ratings that could indicate a decline in quality or patient satisfaction. 

Serve as a resource to the interdisciplinary care team to make sure that they are identifying and meeting all patient needs. 

All disciplines must step outside their silos and collaborate more to ensure that patients receive adequate care. Agencies must remember that SLPs can improve/enhance goal achievement in other disciplines through improvement of a patient’s communication and cognitive deficits.  

Assist in developing strategies for patient medication management. 

Although the medication management clinical category does not include a therapy payment, SLPs effectively develop strategies and tools to ensure that patients can manage their medications safely and accurately. This is particularly important for patients who are not compliant with their medication regimen due to a swallowing disorder.  

SLPs are essential for maintaining compliance with the Medicare conditions of participation. 

Medicare requires HHAs to have a plan in place to mitigate decline of patients due to pain, falls, skin integrity, and depression. The SLP can be useful in implementing strategies to assist with pain management (e.g., ability to adequately communicate pain, request pain medications) and fall prevention (e.g., using compensatory strategies and valid tools such as The Spaced Retrieval technique). 

ASHA Resources 

• ASHA’s Medicare Home Health Resource Center
• Free Webinar "Demonstrate Value of Therapy Services Before HH Payment Begins"

Questions? Contact ASHA’s health care policy team at reimbursement@asha.org.

Other Resources 

CMS Resource Center on PDGM