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The Future of Speech Language Pathology in Health Care

VIEWS: 459 PAGES: 45

									The Future of Speech-Language Pathology in Health Care
Session 411 Nov. 16, 2006
Janet Brown, MA CCC-SLP Director, Health Care Services ASHA

Overview
• Demographics of SLPs in health care
– Distribution across settings – Salaries – Supply and demand

• Career paths • Challenges
– Impact of shortages – Reimbursement
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Overview, continued
• • • • Recruitment/retention strategies ASHA‘s Focused Initiative Future trends Discussion

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Audience Scan
• • • • • • • Students Faculty Clinical supervisor Administrator/manager Clinician < 5 yrs Clinician > 5-10 yrs Clinician > 10-20 yrs
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Distribution of Certified SLPs
Schools - 55.4% - 47,390 Health Care - 35% - 30,367 College/Un - 3.1% - 2,651 Other - 5.4% - 4,619
Source: ASHA Dues notice: n=85,541 certified SLPs

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SLPs in Health Care (2005 Health Care Survey)
%
Hospitals Skilled Nursing Home Health SLP or Aud office Other nonresidential 14.1 6.6 4.5 3.8 2.9

# of SLPs
12,061 5,646 3,849 3,251 2,481

Speech & Hearing Center

2.2

1,948
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Salaries
• Average increase in annual salaries of $8,240 from 2002 to 2005 across all settings: 16% increase. • All settings showed an increase in annual salaries. • Largest annual salary increase was in SNFs (up $11,810 or 21%); the smallest increase was in clinics (up $6,250 or 13%).
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More About Salaries
• The highest paid setting: SNFs ($56,190 in 2002; $68,000 in 2005). • The lowest paid setting: home health ($41,950 in 2002; $52,000 in 2005). • The largest percent increase was in pediatric hospitals (25%); the lowest was in clinics (13%).
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Hourly Rates
• There was an average hourly salary increase of $7 (26%) across all settings. • All settings showed an hourly dollar increase. • Highest paid setting: home health ($50 in 2002; $57 in 2005).

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More About Hourly Rates
• Lowest paid settings: on an hourly basis in 2002 were pediatric hospitals and clinics ($24 each); pediatric hospitals were the lowest paid setting in 2005 ($29). • The largest increase in hourly payment was in clinics ($11 or 46%); the lowest was in home health ($7 or 14%).
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Comparing Schools and Health Care Settings
• Demographic profiles similar • Urban (health care) vs. suburban/rural (schools) • Salary vs. hourly rate (94% vs. 37%) • Significant difference in full time (schools) vs. part time (health care) • Salaries roughly equivalent on 10 month basis
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Challenges for Healthcare vs. Schools
• Top 3 challenges for Schools and Health Care:
– Paperwork (82% vs. 54%)

– Caseload/productivity (61% vs. 47%)
– Insufficient reimbursement for needed services in health care (53%)

12

Supply and Demand for SLPs
• Graduate Programs
– 244 programs surveyed in 2000-2001 – Master‘s degrees awarded in 1999-00: (5,692)
• In 1989-2000: 3,528 (61% increase)

– 4% decrease in enrollments between 1998-99 and 2000-01 – Awaiting updated survey data on grad programs
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Factors Affecting Supply
• Are people choosing other fields?
• Extended maternity leave • Reduce to part time • Change professions • Not seeking employment: 3.7% (3,000)

14

Attrition Data (1996-2003)
Years Experience
>5 5-9 10-16 17 +

Change from health care to schools 15%
14% 13% 7%

Change from schools to health care 8%
5% 3% 3%
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Attrition Data
• Approximately 70% stayed in health care, regardless of years of experience • PPS occurred during this time period • 2% of member with 17+ years experience retired within the 7-year period • Percentage of members not employed and not seeking work decreased with years of experience
– – – – Less than 5 years = 4% 5-9 = 3% 10-16 = 2% 17 + = 1%
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Demand
• Bureau of Labor Statistics‘ State Occupational Projections
– 27% growth anticipated from 2002 – 2012 – 119,250 jobs anticipated by 2012 – Average annual openings: 4,890

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Vacancies in Health Care
• Do you currently have funded, unfilled positions for SLPs at your facility?
– – – – – – Ped hospitals Rehab hospitals Home health Clinic Hospitals SNF 50% 41% 47% 40% 37% 37%

• Average= 40% (2005 ASHA Health Care Survey) • Up from 25% in 2002

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Career Paths for SLPs in Health Care
• • • • • • • • Clinician Specialist Supervisor Private Practitioner Facility Administrator Government Agency Administration Insurance companies/claims review Materials and CE development/sales
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Issues in Health Care
• • • • • Encroachment Hiring less qualified professionals Unreasonable employer demands Ethical dilemmas Burnout

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Encroachment
• In all settings: schools, health care, early intervention • All age groups—NICU to EI to geriatrics • All disorders—swallowing, language, speech, cognition, AAC

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Hiring Less Qualified Professionals
• Schools: potential reduction of qualifications under IDEA • Role of SLP Assistants
– Reimbursement – Supervision

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Unreasonable Employer Demands
• Expectations of non-SLP managers:
– Groups, multiple timed codes

• Caseloads; productivity • Weekend coverage • Broad range of competencies

23

Competencies
• Speech, language, cognitive-communication, swallowing
– Instrumental evaluations (voice and swallowing) – Trachs and vents – Laryngectomy – Pediatrics vs. adults – NICU
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Achieving New Competencies
• • • • Reading Continuing education courses Practicum/mentoring Facility policies/competency checklists
– ASHA knowledge and skills documents – http://www.asha.org/members/deskrefjournals/deskref/DRVol3
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Ethical Challenges
• Inappropriate patients or inappropriate frequency and duration of services • Documentation that misrepresents need for treatment • Practicing outside personal scope of practice • Patient well-being vs. insurance requirements (e.g., feeding)
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Burnout

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Impact of Reimbursement on Personnel
• SNFs rebounding from PPS • Medicare Fee Schedule • Private health plans
– Developmental problems excluded – Cognitive-communication denials by BC/BS – Limits on sessions or dollars

28

ASHA’s Focused Initiatives

• Personnel Issues in Health Care and Education

• Reimbursement
• Doctoral shortage • Evidence-based practice
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Outcomes of Focused InitiativePersonnel Shortages
• • • • • • Recruitment/retention packets Career in Health Care brochure Incentives for recruitment presentations Publications in other journals Forum on innovative solutions Survey of state Labor, Health Depts, and state hospital associations
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What can you do?

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Get Involved with Students!
• Be a practicum supervisor • Connect with university programs to give a lecture, engage in research • Create student volunteer programs
– High school, undergrad

• Recruit the next generation of SLPs
– ASHA‘s recruitment kit for presentations at schools (Kundergrads) – $50 incentive program
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What’s Everyone Else Doing?
• Forum on Innovative Strategies – Sept. ‗06
– Multiple stakeholders
• Health care, schools, universities

• Forum presentations and related information:
– www.asha.org – Search on ―Forum 06‖
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Potential Future Trends
• • • • • Health care reimbursement changes Independent billing status for SLPs Electronic medical record More private practice Telepractice/telehealth

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Medicare Reimbursement Issues
• Medicare‘s modification of $1500 cap
– Exceptions process

• Alternative to cap in 2007

35

Alternative to Cap
• Pay for performance
• Universal assessment tool • ASHA National Outcomes Measurement System
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Independent Billing Status for SLPs under Medicare
• Success may be tied to process for alternatives to cap • May lead to greater interest in private practice

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Other Reimbursement Issues
• Limited Medicaid funding • Health Savings Accounts • Private insurance

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Electronic Medical Record
• Major push from the Bush Administration • Could streamline documentation time and capture outcomes information • Challenge: to adopt a system that is customized for SLP practice • National Provider Identifier
– Info at: www.cms.hhs.gov/NationalProvidentStand/
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More Private Practice
• Increased interest—Gen X • Personnel shortages and low insurance reimbursement

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Telepractice/Telehealth
• Potential to expand access to underserved populations and areas • Currently not recognized by Medicare for SLP/Aud services—application pending • Contract services to schools in Oklahoma, North Dakota via telepractice • Limited by state licensure
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Telepractice/Telehealth
• ASHA policy documents
– Position statement – Technical report – Knowledge and skills

• Policies and resources
– www.asha.org/telepractice

42

Resources on ASHA Web site
• 2005 ASHA Health Care Survey
– Briefs on salaries, vacancies, workload – Search on ―health care survey‖

• Recruitment/retention information
– http://www.asha.org/members/slp/healthcare/ recruitment/default.htm

• Focused Initiative on Personnel Issues
– Search on ―2006 Focused Initiative‖
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Brochures
• Reward Yourself with a Career in Health Care • Adult Health Care

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Contact Me:
Janet Brown, MA CCC-SLP jbrown@asha.org 301-897-0136 800-498-5700 x 4136

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