More on Productivity in Skilled Nursing Facilities Thank you for writing and publishing your article “Under Pressure” in The ASHA Leader. When reading Wynn’s account of her clinical fellowship experience at an SNF [skilled nursing facility], I read the article aloud to my husband and he responded, “Did you write that?” Her experience was identical to ... Inbox
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Inbox  |   September 01, 2014
More on Productivity in Skilled Nursing Facilities
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Special Populations / Older Adults & Aging / Healthcare Settings / Practice Management / Professional Issues & Training / Inbox
Inbox   |   September 01, 2014
More on Productivity in Skilled Nursing Facilities
The ASHA Leader, September 2014, Vol. 19, 4-5. doi:10.1044/leader.IN1.19092014.4
The ASHA Leader, September 2014, Vol. 19, 4-5. doi:10.1044/leader.IN1.19092014.4
Identical Productivity Experience
Thank you for writing and publishing your article “Under Pressure” in The ASHA Leader. When reading Wynn’s account of her clinical fellowship experience at an SNF [skilled nursing facility], I read the article aloud to my husband and he responded, “Did you write that?” Her experience was identical to mine.
As a new clinician, I had a total of two hours spent in orientation and training, felt forced to see patients who didn’t demonstrate need for services, could never accept patient refusal, and saw every patient at the highest RUG [Resource Utilization Group] level possible. I spent countless hours completing documentation off the clock and was coached in how to document daily progress in the most confusing terms possible to try to reduce likelihood of Medicare payment denial.
Therapist morale was awful and the patients suffered. I only wish I would have had the courage to leave my clinical fellowship just as Wynn did. My experience at the SNF left a bad taste in my mouth about speech pathology in general and left me seriously questioning my own personal moral and ethical character. Fortunately, I was able to leave the SNF setting and have a renewed respect for speech pathology working in an acute care setting.
I am hopeful that this issue is coming to light and companies are working to resolve this issue not only for therapists, but also for high-quality patient care. Thank you again for your work with this issue.
Name withheld by request
More on Productivity
I am a certified speech-language pathologist who worked for a large rehabilitation agency a year ago. At first, I was very excited for the opportunity to care for the geriatric population. But my first day involved absolutely no training, although they have on paper a “mentoring program.” I lasted less than eight months and was devastated, because I had never left a professional position.
The rehabilitation manager complained constantly about numbers, billing and productivity, and changed figures to reach “ultra-high” [Resource Utilization Group] as often as possible. I often stayed late to finish cognitive/communication evaluations on my own time, because they were extremely long and detailed. I told my program manager they were impossible to finish while completing patient care. This made it seem as though my “productivity” was substandard, when I was actually working longer days.
The quote by Garry Pezzano was alarming, and disturbing on many levels. It runs contrary to my experience. I understand productivity as a measure, but using productivity measures to advance a money-making agenda is unethical. Where I worked, I often observed the program manager and her assistant and other staff members change billings from high to ultra-high. This was standard practice at the facility where I was employed.
I have wanted to let ASHA know about this experience since I left that facility. The Leader’s devotion to this critical issue prompted me to finally speak out and have a voice. The federal government and auditing agencies need to take action with regard to this health care crisis.
Name withheld by request

The Leader received many responses to “Under Pressure”—the June 2014 article on productivity requirements for SLPs and other therapists working in skilled nursing facilities—in letters, blog posts and social media, some of which appeared in the August issue. Here are three more.

A Different View on Productivity
I’m disappointed at the completely one-sided view you painted of SNF [skilled nursing facility] therapists. Some of us work for fantastic companies that support us in working with integrity, doing things ethically, and allowing us to take care of our patients! I shouldn’t feel like I have to defend myself against my own professional organization.
ASHA should have published responses to “Under Pressure” in letters to the editor besides the negatives ones. You’ve set a precedent that it’s “therapists vs. therapy companies,” when the real problem is CMS [Centers for Medicare and Medicaid Services] and their continued efforts to restrict patients’ benefits through caps, MMR [manual medical review] processes, and PPS [prospective payment systems] that are clearly not designed to be patient-centered.
If a therapy company wants you to do something unethical, you report them and you walk away. That’s your individual responsibility. If all of these people that wrote in were not still working for these unethical companies, they wouldn’t be in business. Come work for me! I am happy to go to work every day and I sleep soundly every night knowing I do what is right and I have provided good care for my patients. I love the company I work for and that one of our core values is integrity and that we stand by it.
So thanks, ASHA, for making me feel I should be ashamed or defensive about my work setting. For all the improvements I have seen in the Leader in the last few years, this has been a huge disappointment and the bias you’ve shown is blatant and hurtful.
Haley Huckabee, MA, CCC-SLP, Baton Rouge, Louisiana

We appreciate your point of view and thank you for sharing it with us. The Leader did not deliberately omit all but negative letters on this topic; this is the only one we have received that speaks positively about working in a skilled nursing facility. The article also pointed out SNFs that do not place productivity demands on their employees.

1 Comment
September 2, 2014
Haley Huckabee
clarification
Thank you for publishing my letter. It is nice to be heard. I would like to clarify that my company does actually have efficiency standards. I am able to meet the standards that are set because my company supports us and provides means and education for doing so. We have a talented team of rehab coordinators to support us in patient care and handling much of the office support. We have technology available for quality, efficient documentation, and we strive to create "all in" teams so that we can work well together as multi disciplinary teams to take care of patients. When you love your job, have the support you need from your company and your teammates, and have the tools and resources available, working efficiently isn't a burden and doesn't create an ethical problem. I hate to hear that you only received negative responses and I hope that by now you've heard some more positive ones. But if you truly believed that I am the only happy SNF therapist out there, I think you are naive. As a publication that represents all SLPs, you have a responsibility to seek out all sides. Yes, you made mention of some other companies in the original article. But the general bias in "Under Pressure" and the published responses has been quite negative. I can't imagine you would have had to do too much investigation to find the other side too; The people who love working in SNFs, who are happy there, and who are doing incredible things. Please be fair when you report on such important issues. Thank you for your time. Haley Huckabee M.A. CCC/SLP Baton Rouge, LA
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FROM THIS ISSUE
September 2014
Volume 19, Issue 9