Making a Case: Individualized Treatment Dosage

Administrative directives that dictate treatment frequency or dosage (e.g., “All Medicare part A patients must receive therapy 5 days/week, for 25 minutes each session”) can conflict with a speech-language pathologist’s (SLP’s) clinical judgment. Such directives also can negatively impact

patient care,
compliance with ethical standards,
organizational outcomes,
adherence to payer requirements, and
clinician effectiveness and well-being.

These directives limit the SLP’s ability to provide individualized, medically necessary care.

22% of surveyed SLPs in skilled nursing facilities felt pressured by an employer or supervisor to provide inappropriate frequency or intensity of services.
ASHA SLP Health Care Survey, 2025 [PDF]

This resource walks you through strategies to make a strong case for clinician-directed treatment frequency, duration, and dosage.

Gather information.

To make a strong case, start by gathering information that helps you understand

the directive from administration,
the directive’s impact on patients and clinicians, and
the evidence supporting individualized treatment dosage.

Understand the rationale for the directive.

Ask leadership why they are making the request or establishing the policy.

Possible reasons may include the following:

standardizing care across patients
responding to financial incentives
meeting perceived payer expectations
managing staffing or workflow

Once you understand the rationale, you can frame your recommendations in a way that addresses the administration’s underlying goals while maintaining ethical, patient-centered, evidence-based practice.

Gather facility-specific data.

Collect data from your facility to demonstrate the impact of treatment dosage directives on patient care, workflow, and staffing:

Track the number of patients who are receiving insufficient or excessive treatment compared with your
Document any missed visits that occur because the directive limits your ability to see other patients.
Track any adverse events, limited progress toward goals or outcome measures, or patient dissatisfaction related to dosage restrictions.

Explore available research data.

Evidence guiding appropriate treatment dosage is limited because patients differ in diagnosis, severity of impairment, comorbidities, social determinants of health, and ability or willingness to participate in therapy, among many other factors. As a result, clinicians determine the appropriate dosage based on individual patient needs, using available research and the patient’s wishes to inform their recommendations.

To explore research studies that contain dosage data, consult and filter the “Service Delivery” section to “Dosage.”

To explore how treatment dosage and patient characteristics impact outcomes, consult ASHA’s National Outcomes Measurement System (NOMS) Data Snapshots and Interactive Reports and Demonstrating Your Value resources.

Reference payer policy.

Medicare and other payers require that services are medically necessary and require the skills of a therapist, but payers do not dictate the frequency, duration, or type of speech-language pathology service.

Refer to codes of ethics and patients’ rights.

ASHA’s Code of Ethics requires SLPs to use independent, evidence-based judgment when deciding treatment dosage. State codes of ethics may include similar expectations.

The following are key ASHA Code of Ethics statements that apply:

Principle IV, Rule B: Use independent judgment even when administrative directives conflict with client welfare.

Principle I, Rule L: Keep the best interests of those being served paramount.

Principle I, Rule K: Provide services only when benefit can reasonably be expected.

Patients and their care partners play an important role in care decisions surrounding treatment dosage. After completing a comprehensive assessment, the SLP explains the recommended treatment plan—including expected benefits, potential risks, and alternatives—in line with the SLP’s Scope of Practice and ASHA’s Code of Ethics.

Patients or their care partners can choose to decline therapy, even if it may negatively affect their health or the facility’s metrics. When patients or care partners choose to decline or modify recommended frequency or duration, document their according to facility and state requirements.

Demonstrate the operational impact.

Use the data you collected from your facility to show how treatment dosage directives affect the organization:

Patient outcomes: Standardized or pre-determined treatment dosage may not meet individual patient needs and could compromise progress or functional recovery.
Compliance and risk exposure: Administering services that do not meet medical necessity criteria can increase the risk of payer denials or recoupments.
Workflow and productivity: Increased or decreased dosage may strain staffing, reduce time for documentation or care planning, or create staffing coverage gaps.

Be Strategic in Your Messaging.

Sometimes the biggest shift isn’t what you say—it’s how you say it. Framing your message in terms of risk, outcomes, and solutions helps administrators hear and act on your recommendations.

Here are a few examples:

Before:: “This directive ignores my clinical judgment.”
After:: “Setting treatment frequency based on each patient’s individual needs ensures therapy is clinically indicated, supports functional progress, protects patients, and keeps the facility aligned with ethical standards and payer requirements.”

Before:: “You’re asking me to over-treat patients.”
After:: “Adjusting therapy frequency to match patient needs reduces unnecessary interventions, ensures our staff is used efficiently, and focuses resources on individuals most likely to benefit.”

Before:: “This directive puts me in an ethical bind.”
After:: “Individualized treatment decisions help us stay compliant with ethical standards, particularly around providing services only when they offer a reasonable expectation of benefit.”