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Enhancing Service Delivery Across the Continuum Lemmietta G. McNeilly ASHA Webinar 1630 / 1631 ASHA / Enhancing Service Delivery Across the Continuum . Lemmietta McNeilly, PhD, CCC-SLP, CAE ASHA / Speaker Disclosure Financial: • Employed by ASHA as Chief Staff Officer, Speech- Language Pathology Nonfinancial: • Member of Strategic Objective #4 Team
Transcript
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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

ASHA /

Enhancing Service Delivery Across the Continuum

.Lemmietta McNeilly, PhD, CCC-SLP, CAE

ASHA /

Speaker DisclosureFinancial:• Employed by ASHA as Chief Staff Officer, Speech-

Language Pathology

Nonfinancial:• Member of Strategic Objective #4 Team

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

ASHA /

After watching this presentation, you will be able to:

1. Identify ways to practice at the top of the license2. Write functional goals using the International

Classification of Functioning, Disability and Health (ICF) framework

3. Manage your workload by implementing alternative service delivery options, such as consultations or telepractice

Learning Outcomes

ASHA /

• ASHA’s envisioned future and pathway• Changing landscapes: health care and education• Reframing the SLP profession• Service delivery options

SLPAs, telepractice, IPE/IPP• ICF framework – writing functional goals• What do SLPs need to do now?

Topics

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

ASHA /

• Health Care• Schools• Early Intervention

What Challenges Do You Experience?

• Private Practice• Reimbursement• Documentation

ASHA /

ASHA’s Envisioned Future 2025 and

Strategic Plan

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

ASHA /

http://www.asha.org/About/ASHAs-Envisioned-Future/

ASHA /

http://www.asha.org/uploadedFiles/Strategic-Pathway-to-Excellence-Map.pdf

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

ASHA /

“Enhanced service delivery across the continuum of care to increase

value and access to services”

Strategic Objective #4

ASHA /

• Working with support personnel

• Preparing audiologists and speech-language pathologists for changes

• Supporting them in collaborative practice

Strategic Objective #4

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

ASHA /

• Supervising clinicians and students in training

• Practicing at the “top of the license”

• Promoting clinical education models of practice across the continuum of care, including clinical doctoral preparation

Strategic Objective #4

ASHA /

• Telepractice

• Demonstrate value of services and promote access to services

• Enhance members’ awareness of collaborative practice and multiple service delivery options

Strategic Objective #4

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

ASHA /

1. Number of members who report engagement in service delivery that involves practicing at the “top of the license” and using extenders to address functional patient/student outcomes”

2. Number of academic programs that infuse the concepts of varied continuum of service delivery options within the curriculum (e.g., practice at the “top of the license,” using assistants) that target functional patient/student outcomes

3. Number of members who report telepractice engagement

Performance Measures

ASHA /

1. Develop informational resources, including models, that define and explain the concepts of varied continuum of service delivery (e.g., support personnel, telepractice, practicing “at the top of the license,” etc.)

2. Disseminate customized resources and information to targeted audiences and showcase successful models that demonstrate the concepts of varied continuum of service delivery (e.g., academic programs, practitioners, members, etc.)

Strategic Initiatives

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

ASHA /

3. Maintain, enhance, and disseminate “state-of-the-art” resources on telepractice

4. Promote the use of telepractice among members working with select populations in disorder areas where funding/reimbursement is already in place

Strategic Initiatives

ASHA /

Changing Landscapes:Health Care and

Education

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

ASHA /

Health Care Landscape SummitOctober 2012

ASHA /

I n s t i t u t e f o r H e a l t h c a r e I m p r o v e m e n t , 2 0 0 7 ( w w w . i h i . o r g )

Framework

T R I P L EA I M

BetterCare

LowerCosts

ImproveHealth

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

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Purposes of the Summit• Provide forum for knowledge transfer, open

discussion about changing health care landscape

• Discern specific implications of health care reform including the professions of speech-language pathology and audiology

ASHA /

• Escalating costs

• Affordable Care Act

• Changing reimbursement models

• Quality outcome measures

Health Care Landscape

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ASHA /

TRENDS

ASHA /Medicare Trying To Limit Overutilization

• High documentation demands/increased denials/Department of Justice investigations

• Trend toward alternative payment models rather than fee for service

• Focus on value, outcomes, performance measures

Private Insurers Will Follow Similar Trends

Affordable Care Act, Impact Act, Etc.

Challenges In Hospitals• Staff reduction• Outcomes reporting• Cost-savings focus

TRENDS

Health Care

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

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.

Why Change Anything Now?

• Costs too high

• Government can’t continue to fund Medicare

• Affordable Care Act

• Necessity for functional patient outcomes

• Need for quality service delivery models

ASHA /

Identified a set of options and gained consensusrecommendations for strategic actions that respond to health care challenges and opportunities in the areas of:• Professional practice• Research and data needs• Professional preparation• Member education and interprofessional education• Information dissemination to energize change

Outcomes of the Summit

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ASHA Webinar 1630 / 1631

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Determine ASHA’s role in proactively safeguardingthe professions in light of the changing landscape of health care

Summit Summary

http://www.asha.org/uploadedFiles/ASHA/Practice/Health-Care-Reform/Healthcare-Summit-Executive-Summary-2012.pdf

ASHA /

Ad Hoc Committee on Reframing the Professions

December 2013

December 2013

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Roles and Responsibilities of SLPs in Schools – Reframing for School Practice

http://www.asha.org/uploadedFiles/Roles-Responsibilities-SLPs-Schools-Poster.pdf

ASHA /

Education Landscape

.

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

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TRENDSSchool

• Teacher accountability

• State standards

• Medicaid/budget constraints

• SLPAs

• Collaboration

• Shortages and expanding workload

• Every Student Succeeds Act (ESSA)

ASHA /

• Goals are tied to the state standards and district curriculum

• Goals are designed to improve the student’s academic, social, and emotional functioning

• Goals promote improved communication in various school and community settings

What Are Functional Outcomes in the School Setting?

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

ASHA /

The roles and responsibilities of SLPs listed below should provide the basis for speech-language services in schools to promote efficient and effective outcomes for students• Critical roles – SLPs have integral roles in education and are

essential members of school faculties• Range of responsibilities – SLPs help students meet the

performance standards of a particular school district and state• Collaboration – SLPs work in partnership with others to meet

students' needs• Leadership – SLPs provide direction in defining their roles and

responsibilities and in ensuring delivery of appropriate services to students

Roles and Responsibilities of SLPs in Schools – Reframing for Schools

ASHA /

TRENDSAudiology

• Unbundling of services

• Direct-to-consumer hearing tests and hearing aid sales

• Personal sound amplification products (PSAP)

• Audiology assistants

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

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TRENDSPrivate Practice

• Expenses increasing and reimbursement decreasing

• Health plans and Medicaid– Increased denials– Fewer sessions approved– Demand for measurable

outcomes, functional improvement, cost savings

ASHA /

How Is the Clinical Paradigm Changing?

• Move from deficits/impairments to functional effectiveness

• Move from silos to interprofessional collaborative practice

• Include consultations with other professionals that enhance care coordination within and across settings

• Expand beyond traditional service models• Consider the social determinants of health

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ASHA Webinar 1630 / 1631

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• IDEA• ESSA• EHDI• Medicaid• State licensure • Reimbursement

• FERPA• HIPAA

Regulations

ASHA /

FACINGTHE

CHALLENGES

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ASHA Webinar 1630 / 1631

ASHA /

.

Speech-Language Pathology • Expand the clinical paradigm• Reframe the profession • Outcomes, databases, and quality • Professional preparation• Member education • Widespread dissemination of information

ASHA /

RESPONDINGTO THE

CLINICALPARADIGMCHANGES

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

ASHA /

• SLPs need guidance documents for optimal practice (e.g., pathways, protocols)

• Update National Outcomes Measurement System (NOMS)

• Outcomes focused on patient/student functional measures

• Patient-reported outcomes• Consider cross-professional outcomes tool

Quality and Outcomes Measurement Needs

ASHA /

• Adhere to best practices (e.g., Practice Portal, institutional protocols and procedures, EBP)

• Participate in ASHA’s National Outcomes Measurement System (NOMS)

• A new audiology registry is being developed

Demonstrating Value and Outcomes

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

ASHA /

.

How To Be Trustworthy?

(McCarthy & Klein, 2011; Marx, 2001)

• Demonstrate safe care• Use standard practice guidelines• Be accountable for our behavior• Manage knowledge• Utilize a value creation system

ASHA /

• Clinical practicum “active” approaches (e.g., simulation, case-based or problem-based learning)

• Interprofessional education (IPE)• Supervision training of support personnel• Documentation, billing, and coding

Innovative Approaches to Pre-Professional Education

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

ASHA /

• Interprofessional collaborative practice

• Professional learning communities (PLCs)

• Supervision training

• Leadership development• Advocacy education• Specialty certification• SLP clinical doctoral

programs

Innovative Approachesto Professional Education

– Support personnel– Graduate students– CFs– SLPs– Other professionals

ASHA /

May require new ways of thinking/working by:• Delegating responsibilities that do not require

professional interpretation and judgment• Enhancing supervision and management skills• Demonstrating and articulating our own unique

knowledge and skills (value) and how we can contribute to teams

Practicing at the “Top of the License”

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

ASHA /

Practicing at the “Top of the License”

“Audiologists and SLPs should engage in ONLY

those patient/student/client care activities

that require their level of expertise and skill.”

Ad Hoc Committee on Refreshing the Professions

ASHA /

Practicing at the “Top of the License”

• Assessment• Skilled intervention• Consultations (with

colleagues regarding functional goals and treatment option)

• Delegation (supervision/mentoring)– Clinical fellows– Students– Support personnel (speech-

language pathology/ audiology assistants)

– Technicians, family members, volunteers

Includes:

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TO PERSON-CENTERED CARE

Using the ICF framework to developindividual functional goals

ASHA /

Overview of ICFhttps://youtu.be/p_WvTrr_yPc

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

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Developed by the

World Health Organization (WHO) in 2001

Provides a framework for an individual’s functioning and disability within the context of his/her activities

and social roles in everyday life

Overview of ICF

ASHA /

A P P L I C A T I O N S O F F R A M E W O R Kof Heal th and D isab i l i t y ( W H O , 2 0 11 )

Bio-psycho-social-spiritual approach in the context of ethics,human rights, and legal framework

INDIVIDUALLEVEL

INSTITUTIONALLEVEL

SOCIALLEVEL

Environmentalfactors

Personalfactors

Participation(Restriction)

Activities(Limitation)

Body functions andstructures (impairment)

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ICF Online

http://apps.who.int/classifications/icfbrowser/

ASHA /

• Addresses functioning• Is not based on etiology or “consequence of disease” but

as a component of health• The World Health Organization defines health as “the

complete physical, mental, and social functioning of a person and not merely the absence of disease.”

• In this definition, functioning, as classified in the ICF, is an essential component of health

ICF

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

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Describes health and health-related domains using standard language

The purposes of the ICF include:– Collection of statistical data– Clinical research– Clinical use– Social policy use

ICF

ASHA /

ICF

Functional Goal Writing

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

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Functional Goals

Target individually meaningful activities or roles that a person cannot perform or avoids performing as a result of a health condition

ASHA /

• To maximize outcomes, because treatment of impairments alone may not lead to functional improvement or be meaningful to the individual

• To optimize the individual’s potential to engage in meaningful activities following discharge

• To increase engagement with clients and their families • To demonstrate the value of skilled services to payers

Why Target Functional Goals?

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

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Acquired Apraxia of SpeechAphasiaCleft Lip and Cleft PalateDementiaDysarthriaPermanent Childhood Hearing LossSevere Hearing Loss and FallsSpecific Language ImpairmentSpeech Sound DisorderSwallowingTinnitus ManagementTraumatic Brain InjuryVoice

Acquired Apraxia of SpeechAphasiaCleft Lip and Cleft PalateDementiaDysarthriaPermanent Childhood Hearing LossSevere Hearing Loss and FallsSpecific Language ImpairmentSpeech Sound DisorderSwallowingTinnitus ManagementTraumatic Brain InjuryVoice

Functional Goals Using ICFClick below for more information…

ASHA /

ICF Case Study: SLPhttps://youtu.be/r2Gcy3EwcCE

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

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Specific Language Impairmenthttp://www.asha.org/uploadedFiles/ICF-Specific-Language-Impairment.pdf

ASHA /

• .

Swallowinghttp://www.asha.org/uploadedFiles/ICF-Swallowing.pdf

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ASHA Webinar 1630 / 1631

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Service Delivery• Extenders• Consultations• Intensive treatment• Service delivery models• Telepractice

ASHA /

Continuum of Service Delivery

Using extenders• Rehab technicians• Family members• Community workers• SLPAs

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

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Consultations• Other professionals• Individuals and families• Self management

Continuum of Service Delivery

ASHA /

Continuum of Service Delivery

Intensive treatment• More frequent sessions scheduled in blocks

Service delivery models• Varying location, frequency, length of

sessions

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

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Continuum of Service Delivery

Telepractice• State laws• Equipment and software • Requirements at both locations

ASHA /

• Provide resources for SLPs and audiologists who are interested in provision of services through telepractice

• Promote legislative and regulatory changes to: a) Allow the use of and reimbursement for

telepractice in the provision of services, even across state lines

b) Allow for telepractice for supervision, mentoring, and professional consultation

Telepractice

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Interprofessional Collaborative Practice (IPP)

.

ASHA /

Interprofessional Education (IPE)

“…two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes.”

Framework for Action on Interprofessional Education and Collaborative Practice, WHO, 2010

World Health Organization Definitions

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

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Interprofessional (or Collaborative) Practice (IPP)

“…multiple health workers from different professional backgrounds provide comprehensive health services by working with patients, their families, caregivers, and communities to deliver the highest quality of care across settings.”

Framework for Action on Interprofessional Education and Collaborative Practice, WHO, 2010

World Health Organization Definitions

ASHA /

InterprofessionalEducation/Learning

Interprofessional Collaborative Practice

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Why IPE/IPP?

ASHA /

PharmacistAUD

SLP

Patient Nurse

Soc. Worker

PT

Doctor

OT

Psychologist

Dentist

Family Member

Patient

Why IPP in the Health Care Setting?

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

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SpecialEducator

AudiologistSLP

Parent Nurse

Resource Teacher

PT

Teacher

OT

SchoolPsychologist

ESL Teacher

Student

Student / Family

Why IPP in a School Setting?

ASHA /

• Patient/student/family is part of the team • Shared responsibility/accountability• Role clarification • Non-hierarchical/non-territorial• Transparency • Integrated evaluation, service provision,

professional development• Continuous, seamless, dynamic communication

How Is IPP Different From Multidisciplinary/Interdisciplinary

Collaboration?

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

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IP Competencies: Four Domains

Values and Ethics

Roles &Responsibilities

Teams &Teamwork

InterprofessionalCommunication

ASHA /

Values and Ethics• Act with honesty and integrity in

relationships with patients/students, families, and other team members

• Respect the dignity and privacy of patients/ students while maintaining confidentiality of the delivery of team-based care

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

ASHA /

Roles and Responsibilities• Communicate one’s role and

responsibilities clearly to patients, students, families, and other professionals

• Explain the roles and responsibilities of other care providers and how the team works together to provide care

ASHA /

• Choose effective communication tools and techniques, including information systems and communication technologies for facilitating discussions and interactions that enhance team function

• Give timely, sensitive, instructive feedback to others about their performance on the team and respond respectfully as a team member to feedback from others

Interprofessional Communication

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

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• Engage other health/education professionals – appropriate to the specific care situation – in shared patient/student-centered problem-solving

• Reflect on both individual and team performance improvement

Teams and Teamwork

ASHA /

What Is ASHA Doing?• Presenting at 10 state association

conventions• Presented at ASHA Convention • Providing professional development

opportunities• Developing resource pages and info for

Practice Portal

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

ASHA /

http://www.asha.org/practice-portal/

ASHA /

http://www.asha.org/Practice-Portal/Clinical-Topics/Aphasia/

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

ASHA /

http://www.asha.org/Practice-Portal/Clinical-Topics/Pediatric-Dysphagia/

ASHA /

http://www.asha.org/Practice-Portal/Professional-Issues/Speech-Language-Pathology-Assistants/

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

ASHA /

http://www.asha.org/Practice-Portal/Professional-Issues/Clinical-Education-and-Supervision/

ASHA /

• Changes in health care, schools, and communities are creating opportunities for audiologists and speech-language pathologists to use different service delivery options

• These options enhance service delivery across the continuum and demonstrate value and functional outcomes for individuals

• Options include “top of the license” practice, using support personnel, and telepractice

Summary

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

ASHA /

• SLPs practicing collaboratively across the continuum of care (e.g., acute care, inpatient rehabilitation, skilled nursing, home health, outpatient, early intervention, schools, and private practice)

• Determine which services are most beneficial and valuable to the individual’s functioning

• Variations in payment methodologies across settings will impact service delivery options

Summary

ASHA /

• How can I practice differently?• How does the patient’s/student’s

environment impact his/her goals?• How do I work with other health care and

education providers?• What changes are needed to support a

value-based approach?

Ask Yourself

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

ASHA /

• Continue to educate yourself– ASHA Web site, articles, podcasts, webinars,

and other resources• Provide clear evidence of the value of your

services • Think “out of the box” regarding treatment

models• Share information with your colleagues

What Can I Do Monday?

ASHA /

• I Can Function mobile app http://icfmobile.org/

• ASHA ICF Resourceshttp://www.asha.org/slp/icf

• SLP Case Study – Vickers https://www.youtube.com/watch?v=r2Gcy3EwcCE&feature=youtu.be

Resources

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Enhancing Service Delivery Across the ContinuumLemmietta G. McNeilly

ASHA Webinar 1630 / 1631

ASHA /

.

Resources• The Practice Portal - Documentation in Health Care and Schools

http://www.asha.org/practice-portal/

• Reframing the Professions of Speech-Language Pathology and Audiologyhttp://www.asha.org/uploadedFiles/Reframing-the-Professions-Report.pdf

• ASHA Code of Ethicshttp://www.asha.org/Code-of-Ethics/

ASHA /

Questions and Answers

Thank you!!!


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