What’s Your Value? Acute Care Wants to Know When hospital administrators look to cut costs, everything is on the table. SLPs can protect themselves by bolstering efficiency and proving their value. On the Pulse
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On the Pulse  |   April 2015
What’s Your Value? Acute Care Wants to Know
Author Notes
  • Nancy B. Swigert, MA, CCC-SLP, BCS-S, is director of speech-language pathology and respiratory care at Baptist Health Lexington in Kentucky and an adjunct faculty member at the University of Kentucky and Nova Southeastern University. A past chair of ASHA’s Health Care Economics Committee and immediate past chair of the American Board of Swallowing and Swallowing Disorders, she is an affiliate of ASHA Special Interest Group 13, Swallowing and Swallowing Disorders. nancyswigert1066@gmail.com
    Nancy B. Swigert, MA, CCC-SLP, BCS-S, is director of speech-language pathology and respiratory care at Baptist Health Lexington in Kentucky and an adjunct faculty member at the University of Kentucky and Nova Southeastern University. A past chair of ASHA’s Health Care Economics Committee and immediate past chair of the American Board of Swallowing and Swallowing Disorders, she is an affiliate of ASHA Special Interest Group 13, Swallowing and Swallowing Disorders. nancyswigert1066@gmail.com×
Article Information
Speech, Voice & Prosodic Disorders / Swallowing, Dysphagia & Feeding Disorders / Healthcare Settings / Practice Management / On the Pulse
On the Pulse   |   April 2015
What’s Your Value? Acute Care Wants to Know
The ASHA Leader, April 2015, Vol. 20, 36-38. doi:10.1044/leader.OTP.20042015.36
The ASHA Leader, April 2015, Vol. 20, 36-38. doi:10.1044/leader.OTP.20042015.36
The inevitable departure from fee-for-service health care is prompting major changes in service delivery: length and frequency of treatment sessions, complexity of evaluations and use of standardized tests, duration of treatment, and even which patients go on a provider’s caseload.
These adjustments are most evident in acute care, where disciplines will need to prove their value to patients to be included in a patient’s plan of care.
Recent changes in the reimbursement models for acute care—including value-based purchasing—have prompted administrators to enforce strict productivity standards on all departments, including therapy services. Under value-based purchasing, the Centers for Medicare and Medicaid Services links reimbursement to the quality of services, and hospitals forfeit part of their reimbursements if they fail to meet certain outcome targets. A hospital’s reimbursement is also affected by how much it spends for each Medicare beneficiary per episode.
Given these pressures to contain costs, therapy department managers understandably want to ensure clinicians are being “productive,” defined as how much of a clinician’s work day is spent producing a unit of service—typically each visit, procedure code or 15-minute interval. But rehab managers who view productivity levels as their only goal may lose staff and resources as hospitals look to achieve the same outcomes at a lower cost—for example, by shifting dysphagia treatment to nursing assistants.

Rehab managers who view productivity levels as their only goal may lose staff and resources as hospitals look to achieve the same outcomes at a lower cost.

Managers, therefore, must show that SLPs bring additional value to the hospital beyond direct patient service. They must find ways for SLPs to take a critical role in helping hospitals achieve overall quality goals, such as reducing readmission rates and lowering Medicare spending, that affect their reimbursement levels.
The bottom line? The speech-language pathology department must work on two fronts to maintain a viable program that offers value to the acute-care facility.
Productivity
There are adjustments providers can make to meet productivity standards, and resources that can help make that happen. The key is re-examining the traditional acute care model.
  • Are you putting the right patients on the caseload? Does a patient with a new cerebrovascular accident really benefit from daily speech-language sessions? Do patients who are minimally alert really need the speech-language pathologist to check them each day, or can there be a process for a re-consult when the patient is ready?

  • Are you providing the appropriate frequency and intensity of services to the patients you put on the caseload? Do patients with dysphagia improve more during their short stay with daily treatment compared to implementing a safe diet and re-evaluating in a few days? Data from ASHA’s National Outcomes Measurement System could help answer questions like these. NOMS is a voluntary data collection system that illustrates the value of speech-language services provided to adults and children with a variety of diagnoses in different health care and school settings. NOMS uses ASHA’s functional communication measures to depict the amount of change in communication or swallowing abilities after speech-language treatment for a variety of diagnoses and intervention variables. By providing your clinical data to NOMS, you can demonstrate how your facility to compares to national benchmarks in terms of outcomes.

  • Analyze the workflow in the department and eliminate any waste. Lean process improvement methodology can help you identify ways to increase efficiency. Do you experience periods of waiting (for example, while physical therapy finishes a treatment, a physician finishes with a chart, transport takes a patient to radiology)? Could the SLP be doing something “productive” with that wait time? Waiting is just one example of a waste in a process. Learning about lean process improvement can help the SLP view processes in a different way.

  • Are the SLPs working at the top of their license? For example, are you sending two SLPs to perform instrumental swallowing studies when the second person could be a nursing assistant, tech or student? Are the SLPs making copies, filing, faxing? Could you institute a volunteer program using undergraduate students to help complete those tasks, while also providing students valuable observations of speech-language services and freeing up the SLP to render more skilled—and, therefore, “productive”—services?

Value-added
These adjustments are just a start. SLPs in acute care also must demonstrate their value in areas other than direct patient care. It may seem counterintuitive: How can I add more to my plate while trying to be more efficient?
But it’s crucial to be forward-thinking. Don’t wait for the hospital administration to ask how the speech-language pathology department can help meet quality indicators. Take an active role in understanding these indicators and make suggestions about SLPs’ roles. If administrators are talking about staff cuts, and the only role of SLPs is direct service provision, administrators may find less expensive ways to provide the same service.
Consider these ways that SLPs can integrate the hospital’s goals and demonstrate their unique value to the hospital.
  • Learn all you can about the changes in payment methods to acute care facilities so that you understand the reasons for administrators’ decisions.

  • Volunteer to lead initiatives that may not logically fall to a specific department. For example, the 2012 Joint Commission patient-centered communication standards offer an ideal opportunity for SLPs to showcase their knowledge. Health literacy is another initiative that SLPs could work with educators to implement.

  • Look for hospital teams on which the SLP could play a vital role. Hospitals are scrutinizing re-admissions, and for two of the top re-admission diagnoses—stroke and pneumonia—SLPs have a wealth of knowledge to share.

  • Develop programs or processes that could help the hospital reach its re-admission target. For example, developing a nurse screening for all patients admitted with pneumonia could reveal which of those patients presumed to have community-acquired pneumonia really have an aspiration pneumonia.

SLPs, skilled in communication and swallowing, are uniquely qualified to meet the needs of patients in acute care hospitals, while at the same time meeting the needs of the hospital.
Study Up on Efficient Care at ASHA’s Health Care and Business Institute

Proving your value in acute care is one of dozens of sessions scheduled for ASHA’s 2015 Health Care and Business Institute, July 10–12 in Phoenix.

Designed to help health care and private practice clinicians focus on the latest changes in health care, clinical approaches and business issues, the three-day conference offers sessions in pediatric care, adult care, swallowing, business management and business leadership.

Sessions will address diverse topics, including the power of social media, coding for reimbursement, planning for business success, decision-making in hospice care, dysphagia and dementia, stuttering treatment for children, voice banking, pediatric reflux, and dysarthria. The list of presenters includes leading experts in business and clinical issues.

Click here for the full schedule and registration information.

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April 2015
Volume 20, Issue 4