What I Learned at ASHA19

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What I Learned at #ASHA2019

Kelly Cooney, CCC-SLP, CHC

NARA President


We are in a time of significant change in post -acute care. With this type of significant change can come fear and distrust, as well as opportunity. At ASHA 2019 in Orlando this week I saw that our SLP colleagues are hopeful. They are looking for resources.  They are engaged. They are interested in tools to help them navigate PDPM and PDGM.  

Many are embracing change but have fears of what their futures may look like or feel uncomfortable with lack of input in care planning. Some are encountering schedules or non-patient centered decisions that they feel create significant ethical concerns. Some in home health are being asked to expand the services provided in their visits to include unfamiliar tasks that they may feel uncomfortable with.

How is My Staff Doing?

  • We as providers need to know what’s happening at the ground level in our businesses.
  • Did that CMG that was loaded into the software to help assess cost at an administrative level give a rehab manager the impression that a daily eight-minute treatment for speech was appropriate and all that that resident could receive?
  • Do our teams and clinicians feel supported in their choices of group and concurrent therapy?
  • Do they know how to schedule it appropriately and are there clear communication channels within the department and IDT to make this work?  

I heard a lot of questions about group therapy for Dysphagia- which can be very region specific.

  • What has your organization determined is billable?
  • Do they have resources to provide meaningful group interactions?
  • Did some well-meaning person ask the SLP to provide wound care in home health?  

For those unfamiliar with different treatment modalities, are we as employers modeling and improving skills? Do we know what our staff on the ground is hearing from our managers or are we playing a bad “game of telephone” where our message of quality or our well thought out resources are lost to the field clinician in the rush to productivity? Click here to listen to some personal stories from SLP’s.

What can we do to support our Speech Language Pathologists and other staff?

  • Create opportunities for interdisciplinary collaboration to capture the value of the Rehabilitation team.
  • Ask staff how they are experiencing these changes. What do they need? What do they need to know?
  • Ask our managers to articulate the messages to us that they are delivering to staff. Are they in alignment with our messaging? Our culture?
  • Provide transparent and ongoing evidence and trends gathered for best practices.
  • Expand practice: For example, while at ASHA I gathered some incredible resources for my team for speech language pathology evidence-based practice for interventions for behaviors related to dementia and mental health issues. We know our Medicare recipients are coming to us more and more with these types of diagnoses and it was incredible to see ASHA supporting the SLP role with this difficult and often underserved population.

Many of us as operators have been very focused on downward communication and education as we prepared for payment changes. That will need to continue but now we need to listen. Listen to our teams. Hear them. Help them problem solve. There are loud voices that are sharing concerns about practice change. We need to hear those voices and help provide answers that support our clinical interventions. They speak for many. They call attention to our issues and our opportunities to improve. We also need to hear the quiet ones in the trenches that are working hard and can give us equally or even more valuable feedback and incredible ideas and solutions. They are the heart in what we do. They will move us through these changes in payment and bring excellent outcomes to the people they treat and the organizations they represent.

We are less than 2 months into PDPM, and less than 2 months away from PDGM.  It’s all new. We planned, we practiced, we projected. But- now we are in it.

So, what should we do now?

  • We should ask.
  • We should listen.
  • We should learn.
  • We should assess.
  • We should model.

I know we are all in the thick of change but we need to ensure our focus does not stray from our most valuable asset, the associates that work for us and for our customers.  Please share with NARA some ways that you are working with your organization to support your teams. NARA is about sharing and collaborating and are all most successful when we work together!

Some additional resources for your SLP’s can be found at:

ASHA - Demonstrating Value of SLP Services

ASHA – Compliance Reporting

ASHA - Home Health Prospective Payment System

AOTA/APTA/ASHA Consensus Statement

NARA Webinar:  Multidisciplinary Approach to Quality Care in Skilled Facilities

NARA Webinar:  Modes of Treatment – Recorded Webinar for Purchase