What’s Happening in Health Care: 2011 Survey Results Speech-language pathologists in health care are treating more children with autism spectrum disorders, encountering fewer unfilled job openings in their workplaces, and treating fewer private-pay patients, according to the results of ASHA’s 2011 health care survey. More than 2,400 SLPs who work in six types of health care settings answered ... Features
Free
Features  |   October 01, 2011
What’s Happening in Health Care: 2011 Survey Results
Author Notes
  • Amy Hasselkus, associate director of health care services in speech-language pathology, can be reached at ahasselkus@asha.org.
    Amy Hasselkus, associate director of health care services in speech-language pathology, can be reached at ahasselkus@asha.org.×
Article Information
Healthcare Settings / Practice Management / Features
Features   |   October 01, 2011
What’s Happening in Health Care: 2011 Survey Results
The ASHA Leader, October 2011, Vol. 16, 22-23. doi:10.1044/leader.FTR3.16122011.22
The ASHA Leader, October 2011, Vol. 16, 22-23. doi:10.1044/leader.FTR3.16122011.22
Speech-language pathologists in health care are treating more children with autism spectrum disorders, encountering fewer unfilled job openings in their workplaces, and treating fewer private-pay patients, according to the results of ASHA’s 2011 health care survey.
More than 2,400 SLPs who work in six types of health care settings answered questions on issues such as productivity, salaries, patient caseload, and reimbursement. Data from the 2011 survey illustrate the current state of professional and clinical practice, and have been compared with data from previous studies (fielded in 2002, 2005, 2007, and 2009) to track trends. The survey results and special reports reveal the state of health care practice at a time of potential sweeping changes in health care delivery resulting from the recently enacted federal Affordable Care Act.
Workforce
ASHA has been tracking workforce issues for years to quantify the shortage of SLPs in all settings. Since 2005, the percentage of respondents indicating that job openings in their area were more plentiful than job-seekers has steadily decreased, from a high of 60% in 2005 to 37% in 2011. The percentage reporting any funded, unfilled positions at their facilities also has decreased, from 41% in 2005 to 24% in 2011. Although there are differences among geographic areas and setting types, these data reflect a positive trend and may indicate that SLP shortages in health care are diminishing.
Productivity
Despite anecdotal evidence suggesting productivity varies greatly among settings and facilities, survey data have remained fairly consistent, with reported productivity levels of about 75% (e.g., six hours of direct treatment in an eight-hour workday). In 2011, respondents were asked to further categorize time for individual and group treatment time, clinical documentation, and other activities.
Overall, SLPs reported productivity of about 75% for group and individual treatment together (71% individual and 4% group). Skilled nursing facilities and rehabilitation hospitals showed the highest use of group treatment (7% and 6%, respectively); general medical hospitals showed the least (1%). Across settings, respondents reported spending slightly less than 20% of their time on clinical documentation, leaving approximately 6% of their time for other activities (e.g., team meetings, phone calls or other conversations, family education, and working with payers).
Caseloads and Clinical Services
Children with autism spectrum disorders (ASDs)are a growing population on SLPs’ caseloads. In 2009, half the respondents indicated that children with ASDs totaled up to 6% of their caseloads. That number increased dramatically in 2011, with half of respondents indicating that children with autism equaled up to 20% of their caseloads.
Early intervention services continue to be a significant part of health care—27% of respondents indicated they provide such services. Early intervention was most often provided by home health agencies (63%), followed by outpatient clinics (31%) and pediatric hospitals (29%).
Adults comprise the largest proportion (60%) of typical health care caseloads. Adults are the majority of the caseload in skilled nursing facilities (98%), but a much smaller proportion of home health and outpatient clinic caseloads (30% and 23%, respectively). Clinicians treating adults spend a majority of their time on swallowing (42%), followed by aphasia (17%), dementia (13%), traumatic brain injury (8%), and dysarthria (7%). Those working with children reported that language was the most common area of treatment (38%), followed by articulation/phonology (26%), swallowing and feeding (14%), and cognitive communication (8%).
Professional Issues
Management of feeding and swallowing falls within the scopes of practice of several professions. SLPs, however, remain the primary provider of such services; only 12% report that a different professional provides swallowing services in their facility. Swallowing services provided by other professionals are most common in pediatric hospitals (44%) and least common in skilled nursing facilities (2%). These percentages have remained fairly stable for the past few years.
More than a third (37%) of SLPs indicated they work full- or part-time in a private practice. Of those who work part-time in private practice, slightly more than half work an additional job within the profession. Almost a quarter of private practitioners have taken advantage of the ability to enroll with Medicare as an independent provider.
Salaries and Reimbursement
Overall annual and hourly salaries did not change from those reported in 2009. However, median home health visit rates appear to have decreased from $65 in 2009 to $60 in 2011. The median per-visit rate dropped more for those working in outpatient clinics and offices than for those working in home health.
Patient private pay was the highest reported source of income, although the percentage of SLPs receiving private pay has dropped from 91% in 2009 to 79% in 2011. At the same time, the percentage that reported receiving payment from Medicare has increased from 10% in 2009 to 20%, reflecting SLPs’ ability to bill Medicare directly. Those who reported receiving private pay also may receive payment from other sources.
Payers sometimes restrict reimbursement for pediatric services, claiming that schools should provide them. These payers are not considering issues such as educational impact, as required under the Individuals With Disabilities Education Act, or medical necessity, required by health plans. Twenty-five percent of respondents indicated that they had received claim denials in 2010 because the health plans claimed that the public schools should provide the service. Twenty percent indicated that they had received more denials in 2010 than in previous years, 19% saw no change, and only 2% experienced a decrease in such denials.
The U.S. health care system is in flux, with many issues unresolved in the wake of new federal legislation, continued debate about reimbursement under Medicare and Medicaid, and increased pressure on health insurance companies to contain costs. SLPs’ participation in the biennial health care survey provides essential information on evolving practice patterns that can be used by researchers and ASHA to develop resources and professional development activities, such as the annual Health Care Conference/Business Institute, for members working in health care.
0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
October 2011
Volume 16, Issue 12