Health Care SLPs Face Productivity Pressures, Fewer Full-Time Positions ASHA’s survey of speech-language pathologists in health care highlights trends in salary and job structures and confirms productivity concerns. On the Pulse
Free
On the Pulse  |   September 01, 2015
Health Care SLPs Face Productivity Pressures, Fewer Full-Time Positions
Author Notes
  • Janet Brown, MA, CCC-SLP, is ASHA director of health care services in speech-language pathology. jbrown@asha.org
    Janet Brown, MA, CCC-SLP, is ASHA director of health care services in speech-language pathology. jbrown@asha.org×
Article Information
Healthcare Settings / Professional Issues & Training / ASHA News & Member Stories / On the Pulse
On the Pulse   |   September 01, 2015
Health Care SLPs Face Productivity Pressures, Fewer Full-Time Positions
The ASHA Leader, September 2015, Vol. 20, 34-35. doi:10.1044/leader.OTP.20092015.34
The ASHA Leader, September 2015, Vol. 20, 34-35. doi:10.1044/leader.OTP.20092015.34
Fewer speech-language pathologists in health care settings have full-time employment than two years ago, according to ASHA’s 2015 health care survey, and the number of full-time workers who get paid a salary—rather than hourly—is falling.
This squeeze may be related to cost-cutting measures in health care settings, which include hospitals (long-term care, acute care and rehabilitation), private practices, home health care agencies and skilled nursing facilities.
Fielded every two years, the survey explores caseloads, salaries and wages, practice issues, and demographics of SLPs working in health care settings. Survey results—as well as previous surveys and trend reports that help put the information in context—are available on ASHA’s website.
In 2013, 67 percent of health care SLPs worked full time, a number that fell to 62 percent in 2015. At the same time, the number of salaried survey respondents dropped from 33 percent to 30 percent. The figures indicate that just over half of full-time employees are paid hourly.
The situation is even more pronounced in skilled nursing facilities (SNFs). The number of SLPs working full time in SNFs fell from 81 percent in 2013 to 63 percent in 2015, and the percentage on salary fell from 19 percent to 16 percent.
Cost-cutting and revenue-enhancing measures that affect clinicians and their patients are a growing concern across the health care community. Facilities often use a productivity percentage as one target measure for rehabilitation providers, including SLPs and occupational and physical therapists. The 2015 survey included new questions about productivity and related issues.
Productivity
In 2015, 60 percent of all SLPs in health care reported having an employer-established productivity requirement. SNF workers had the highest mean productivity requirement—86 percent. The lowest mean requirement was in pediatric hospitals—68 percent.
Further analysis of the data, however, shows that about 18 percent of SNF respondents reported productivity requirements of 90 percent or greater. Fifty-nine percent in SNFs said meeting productivity requirements was extremely important, compared to 29 percent in outpatient clinics.
Employers calculate productivity in many different ways. Some may include only “billable” therapy time with the patient; other employers may include team meetings, staff training, documentation, care coordination and other clinical activities in the productivity calculation. Although 64 percent of all survey respondents said that their productivity included none of these activities, clinicians in SNFs included at least some of them more often than clinicians in the other settings.
Documentation
The survey asked about “point-of-service” documentation (during treatment with the patient present), a practice encouraged by administrators in all rehabilitation professions as a way to maximize productivity. Many SLPs, however, report they cannot document during treatment with many of their patients. Only 13 percent report always completing documentation at the point of service; home health clinicians reported the highest (23 percent) rate and acute care hospitals the lowest (3 percent). Twenty percent of clinicians in SNFs and outpatient settings said they never complete point-of-service documentation.
Off-the-clock work
Hourly employees report working “off the clock”—for example, finishing documentation not completed at point of service after clocking out for the day. About a third of hourly employees reported that they typically worked “off the clock” daily; 29 percent reported they never did.

About a third of hourly employees reported that they typically worked “off the clock” daily; 29 percent reported they never did.

Patient care pressures
Many SLPs in health care report feeling employer pressure to make decisions about patient care that contradict their own clinical judgment. The 2015 survey asked about supervisory pressure in five specific areas. In four of the areas, clinicians in SNFs reported feeling these pressures the most. They reported the most pressure to:
  • Provide inappropriate frequency or intensity of services (41 percent), compared with the second-highest amount—24 percent—in rehabilitation hospitals.

  • Discharge inappropriately (delay or advance discharge for reasons unrelated to the patient’s progress or condition), 43 percent. Rehabilitation hospital clinicians reported the second-highest level, 16 percent.

  • Provide evaluation and treatment that were not clinically appropriate (37 percent); rehab hospital staff reported the second-highest (26 percent).

  • Alter documentation for reimbursement (15 percent), compared with the second-highest, 11 percent, in rehab hospitals.

However, only 5 percent of SNF clinicians reported pressure to provide services for which they had inadequate training and/or experience, compared with 11 percent in acute care, Veterans Affairs or long-term acute-care hospitals.
Since the 2013 survey, ASHA has initiated discussions with leaders of the skilled nursing industry to discuss employer pressures (on.asha.org/clinical-SLP, on.asha.org/uneth-demands, on.asha.org/leader-under-pressure). A task force of industry leaders and staff from ASHA, the American Occupational Therapy Association and American Physical Therapy Association is working to address these challenges, including dissemination of information to employers and employees about appropriate practices and how clinicians can report concerns.
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
September 2015
Volume 20, Issue 9