Survey Probes Practice Trends for SLPs in Health Care In a year marked by significant change in the national economy, ASHA’s 2009 Health Care Survey offers a snapshot of issues that affect speech-language pathologists working in health care. The biennial survey probes current issues and tracks trends in shortages, salaries, caseload, and productivity. Received from 2,064 SLPs (a 54.6% ... ASHA News
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ASHA News  |   November 01, 2009
Survey Probes Practice Trends for SLPs in Health Care
Author Notes
  • Janet Brown, MA, CCC-SLP, is the director of health care services in speech-language pathology, and can be contacted at jbrown@asha.org.
    Janet Brown, MA, CCC-SLP, is the director of health care services in speech-language pathology, and can be contacted at jbrown@asha.org.×
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Speech, Voice & Prosodic Disorders / Special Populations / Older Adults & Aging / Healthcare Settings / Practice Management / Professional Issues & Training / ASHA News & Member Stories / ASHA News
ASHA News   |   November 01, 2009
Survey Probes Practice Trends for SLPs in Health Care
The ASHA Leader, November 2009, Vol. 14, 18. doi:10.1044/leader.AN.14142009.18
The ASHA Leader, November 2009, Vol. 14, 18. doi:10.1044/leader.AN.14142009.18
In a year marked by significant change in the national economy, ASHA’s 2009 Health Care Survey offers a snapshot of issues that affect speech-language pathologists working in health care. The biennial survey probes current issues and tracks trends in shortages, salaries, caseload, and productivity.
Received from 2,064 SLPs (a 54.6% response rate), responses are divided among six practice settings: general medical hospitals, rehabilitation hospitals, pediatric hospitals, skilled nursing facilities (SNFs), home health providers, and clinics/offices.
In 2009, SLPs were allowed to enroll as Medicare providers for the first time (beginning July 1). More than 15% of respondents indicated plans to enroll as Medicare providers.
Applying this figure to the total number of SLPs working in health care suggests that as many as 5,000 SLPs will enroll.
The survey explored changes in staffing and salaries that might reflect the impact of current economic pressures. Although 42% of respondents reported no changes, 26% reported an increase in caseload/ workload/productivity, and 14% reported a reduction in salary or benefits. However, overall productivity levels have remained stable (75%–77%) from 2005 to 2009. The percentage of respondents in facilities that provide SLP services on weekends decreased from 48% in 2007 to 44% in 2009, suggesting that facilities may be spending less on contract weekend staff.
Despite the number of respondents who said they work full time (61%), only 35% were paid a salary rather than an hourly or per-visit rate. Annual salaries increased from a median of $65,000 in 2007 to $70,000 in 2009.
The median hourly wage in 2009 was $36 for those who worked 31 or more hours weekly and $45 for those who worked fewer. In 2007, the figures were $34 for SLPs who worked 26 or more hours and $41 for those who worked fewer hours. The median per-visit wage in 2009 was $64.
Tracking the activities of SLPs who provide early intervention (EI) services has been difficult because several settings deliver EI services. Survey results indicate that 26% of respondents provide EI services; their primary settings are home health (63%), pediatric hospitals (35%), and clinic/ office (30%). For all survey respondents, children with autism accounted for 16% of their caseloads.
Several practice trends that have been sampled repeatedly are SLP shortages and service delivery to patients with dysphagia. Overall, SLPs reporting vacancies declined from 38% in 2007 to 26% in 2009; the highest vacancy rates of were reported in pediatric hospitals and home health. The use of teams to deliver dysphagia services remains high in pediatric hospitals (47%), but a consistent decline has been noted by other professionals delivering dysphagia services in other settings (10% overall, down from 12%).
Speech-language pathology assistants (SLPAs) are used infrequently in health care settings because their services are not reimbursable by Medicare. More than half (59%) of the respondents would not support the use of SLPAs if their services were covered; 41% would support their use.
For more information about the clinical implications of the survey, contactJanet Brown, MA, CCC-SLP, director of health care services in speech-language pathology, atahasselkus@asha.org. For more information about the survey analysis, contactJeanette Janota, senior research assistant/statistician, atjjanota@asha.org.
Health Care Survey Reveals Ethical Pressures on SLPS

The current economic downturn may play a role in the high percentage of SLPs reporting ethical challenges in health care settings. More than a quarter (26%) of respondents across all settings felt pressured by an employer to engage in unethical practice in the previous 12 months. The highest number of affirmative responses (41%) came from SLPs in skilled nursing facilities, who most often cited providing inappropriate frequency or intensity of services (11%) and providing services that are not clinically appropriate (6%).

In 2007, 11% of SLPs reported that they had experienced ethical challenges within the past three years; in skilled nursing facilities, the percentage was 21%.

The current reimbursement system for Medicare Part B and other insurers is based on the number of sessions or codes that are billed. To reach budget projections, administrators may impose arbitrary caseload or productivity requirements on clinicians that create ethical conflicts when treatment or a particular intensity of services is not appropriate for some patients. In some cases SLPs have faced termination or disciplinary action for failing to comply with policies that conflict with their clinical judgment.

In other scenarios, SLPs may encounter pressure to engage in illegal practices such as altering or backdating documentation to meet reimbursement requirements.

All certified ASHA members must abide by ASHA’s Code of Ethics, the cardinal document for guiding ethical practice. The “Issues in Ethics: Prescription” statement specifically affirms that clinicians must use their independent judgment in developing or implementing services.

—Janet Brown

The Code of Ethics is available online as is the statement on prescription. For more information, contact Janet Brown, MA, CCC-SLP, director of health care services in speech-language pathology, at jbrown@asha.org , or David Denton, JD, CCC-SLP, director of ethics, at ddenton@asha.org.

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November 2009
Volume 14, Issue 14