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Health Care Reform, Telepractice, and A Look at the Future of Reimbursement for Audiologists and SLPs Janet Brown, MA CCC-SLP Director, Health Care Services—ASHA.

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Presentation on theme: "Health Care Reform, Telepractice, and A Look at the Future of Reimbursement for Audiologists and SLPs Janet Brown, MA CCC-SLP Director, Health Care Services—ASHA."— Presentation transcript:

1 Health Care Reform, Telepractice, and A Look at the Future of Reimbursement for Audiologists and SLPs Janet Brown, MA CCC-SLP Director, Health Care Services—ASHA MSHA Oct. 20, 2012

2 Speaker Disclosure Financial ASHA employee since 1997 Non-financial Ex officio for Business Practices,Telepractice Committees Member, American Telemedicine Association

3 “America’s health care is essentially a cottage industry of fragmented, dedicated artisans who eschew standardization. Care is frequently highly variable, and performance is, in large part, unmeasured.” Swenson, et al., 2012.The Mayo Clinic value creation system. AJMQ 27 (1),

4 What is the Problem? Health care spending has doubled as share of GDP in 30 years u 9.2 to 17.9 Medicare population will grow by 1/3 in the next 10 years Variation in spending by region without evidence of difference in outcomes Source: MedPAC report, March 2012: Executive Summary

5 Problems with Current System Fee-for-service creates incentives for unnecessary care Variability in payment across settings Fragmented care (ex:VFSS) No penalties for bad outcomes (e.g., rehospitalization)

6 Components of the Patient Protection and Affordable Care Act ( ) Expanded Coverage Dependents Medicaid eligibility Exchanges (Iowa Affordable Insurance Exchange) Individual mandate Payment Bundled Incentives for quality Adapted from Fabius, et al Vocabulary of Health Care Reform. Thomson Reuters Care Coordination Medical homes Accountable care organizations Delivery Innovations EHR Meaningful use Disease management

7 Essential Health Benefits—Medicaid and Exchanges 10 categories that must be included Ambulatory patient servicesPrescription Drugs Emergency ServicesRehabilitative and Habilitative Services and Devices HospitalizationLaboratory Services Maternity and Newborn CarePreventive and Wellness Services and Chronic Disease Management Mental Health and Substance Use Disorder Services Pediatric Services, Including Oral and Vision Care

8 SLPs and Pediatric Services % of SLPs in health care providing services u 17% to infants and toddlers u 13% to preschoolers u 11% to school-age children 27% provide Early Intervention services 20% of SLP caseload in autism up considerably from 6% in 2009 Source: 2011 ASHA SLP Health Care Survey

9 Medicare Medicare Part A—hospitals, SNFs u May join ACOs u Bundled care Medicare Part B—outpatient u Alternative to therapy caps— u Documentation of outcomes u Bundled care, ACOs u Episodic payment?

10 The New Order in Health Care— Public and Private Pay Value

11 Transition to Measures Accountability through programs involving measures Quality reporting systems affect reimbursement u Under Medicare Hospital value-based purchasing Physician Quality Reporting System

12 Outcome Measures National Outcomes Measurement System (NOMS) developed by ASHA u Data collection system that illustrates the value of SLP services u Uses Functional Communication Measures (FCMs), a series of disorder-specific, seven- point rating scales to describe the change in an individual's functional communication and/or swallowing ability over time

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15 ASHA NOMS SLPs register to become a NOMS user (free) Submit FCM scores at admission and discharge (online database) Submit data on diagnosis, tx frequency, etc. Receive standard reports and national benchmarking data More information at

16 NOMS In 2008, eight of the 15 adult FCMs were endorsed by the National Quality Forum (NQF) as quality measures NOMS can be used as an objective measurement tool for home health reassessments or Part B documentation

17 How Will Life Change Billing for services u Fee for service to episode of care u Bundling/ACO Documentation systems u EMR u ICD 10 Documentation/Justification of services u Value/outcomes u Medical Necessity

18 What We May See More Of Different levels of care within episode u Support personnel u Community u Family/caregivers Use of technology u Telepractice/videoconferencing u Technology apps/tools for independent practice

19 What You Can Do Look at your practice u How can you be more efficient? Process, documentation, practice u How do you measure your outcomes? u Are you diversified? u What are your competitors doing? u Reach out to potential referral sources, ACOs

20 What You Can Do Be informed u ASHA Leader u ASHA web site: Health care reform page u ASHA Healthcare Landscape Summit recommendations

21 What You Can Do ADVOCATE! u Respond to Take Action—ASHA Grassroots network u Contact your representatives at home u Capitol Hill visits

22 Role of Telepractice in Health Care Increasing access u to providers u to specialists u to equipment Savings costs u travel u Complications from delayed treatment

23 Role of Telepractice in Schools Respond to shortages Efficiencies in reducing driving time

24 ASHA’s Definition Telepractice is the application of telecommunications technology at a distance by linking clinician to client, or clinician to clinician for assessment, intervention, and/or consultation. ASHA, 2005 Speech-Language Pathologists Providing Clinical Services via Telepractice: Position Statement

25 Terminology Makes a Difference Using telepractice as a means of direct service delivery u Telespeech, telehealth, telemedicine, telerehab, teletherapy u Typically via teleconferencing (“face-to-face,” but not “in person” NOT distance education NOT distance supervision

26 Why This Can Be Confusing Telepractice: students delivering services via teleconferencing with supervisor sitting with them Telesupervision: Clinical Fellow delivering services face-to-face with supervisor observing via teleconferencing

27 And In Education… Distance learning may incorporate interactive videoconferencing, virtual classrooms May be used to teach SLPs Not used to describe SLP services

28 Quality Qualifier 2005 Position Statement "The use of telepractice does not remove any existing responsibilities in delivering services, including adherence to the Code of Ethics, Scope of Practice, state and federal laws (e.g., licensure, HIPAA, etc.), and ASHA policy documents on professional practices." “Therefore, the quality of services delivered via telepractice must be consistent with the quality of services delivered face-to-face." Position Statement, 2005

29 Challenges of Developing “Standards” Rapid advance of technology Lack of comparative effectiveness research on different types of technology Scope of the professions: broad range in u age u disorders u assessment and treatment procedures

30 Quality Components Provider competence Patient selection Technology selection Transmission quality Efficiency, effectiveness of service Patient, caregiver, provider satisfaction

31 ASHA’s Telepractice Resources tice u Video clip u Policy documents u Articles u Model licensure regulations u Reimbursement information u Bibliography

32 Types of Telehealth Synchronous (real time) Asynchronous (store and forward) Self-monitoring (not typically used in SLP)

33 Technology Is Used To… Capture Transmit Display Camera, microphone, peripheral devices Bandwidth Computer,videoconfer encing equipment

34 Technology Equipment u Hardware Dedicated system, computer Camera, monitor, microphone, multisite capability u Software u Peripheral devices Document camera, videoendoscope

35 Collaboration Whiteboards Chat Screen sharing

36 Technology Connectivity u Connection speed (bandwidth) u Minimum cited in research: 384 kps u Standard definition vs high definition u Influenced by others using same bandwidth u Quality consequences Delays, jitter, loss of data, turntaking

37 Licensure What is licensure for? Current status—full licensure in state where client resides What are other disciplines doing? ASHA model regulations: general and interstate practice

38 Privacy & Protections FERPA u School records HIPAA u Privacy of protected health information for providers and their business associates Notification/Consent Secure transmission via virtual private networks, firewalls, encryption

39 Reimbursement--Medicare Physicians, nurses, CSWs, psychologists, dietitians for selected CPT codes Designated originating sites u Rural health professional shortage area u Outside Metropolitan Statistical Area ASHA and ATA advocacy u Search Telehealth Services Fact Sheet

40 Reimbursement--Medicaid Varies from state to state Need approved CPT codes to receive payment for using modifier Oklahoma has established Medicaid payments with schools receiving origination fee Missouri, but not for schools Kentucky and Virginia are pending

41 Reimbursement--Private Insurance Trend for state legislation to mandate payment for approved services CareFirst Blue Cross/Blue Shield (see ASHA Leader story)

42 Reimbursement--Schools Largest area for reimbursed telepractice Within-district or contractor services Virtual schools—some providing special ed and related services u e.g., North Carolina, Idaho, Colorado, PA

43 “It’s Not the Technology” Planning, stakeholder support, training u Business plan u Who are the stakeholders Licensure, school boards Administrators at all levels Teachers, facilitators Parents, clients u Training and information: managing expectations

44 Technology Available bandwidth, firewalls Ongoing tech support Other means of connection when there is a problem

45 Research More articles being published on comparability, esp. from Australia u Tests for dysarthria, CELF u LSVT, Lidcombe, voice, post-laryngectomy, aphasia, apraxia, swallowing, fluency, early intervention Telehealth Journals: u Telemedicine and e-Health u Journal of Telemedicine and Telecare Bibliography at

46 Other Telehealth Groups American Telemedicine Association Center for Telemedicine and e-Health Association of Telehealth Service Providers u Telemedicine Information Exchange Office for Advancement of Telehealth (HRSA)

47 Questions? Janet Brown Director, Health Care Services


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