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Health Care Reform and Speech-Language Pathology Practice

Congress and presidential administrations over the last 20 years have slowly moved forward with Medicare value-based health care purchasing initiatives (that is, paying for results, not volume of tests, procedures, or services, regardless of quality or outcomes achieved). These initiatives were bolstered and extended with the recent passage of major health care reform legislation: the Patient Protection and Affordable Care Act (PPACA, P.L. 111–148) and the Health Care and Education Reconciliation Act (P.L. 111–152). As sections of the law and accompanying regulations are implemented during the next few years, the ways in which hospitals, physicians, and non-physician health care professionals operate and practice will change in fundamental ways. The chief research officer (Roades, 2009) of the Advisory Board Company, a provider of comprehensive performance improvement services to the health care and education sectors, outlines common areas of change in health care reform: Hospitals and other health care providers will see increased risk to revenue growth as the system transitions to outcomes-focused payment and an emphasis on operating efficiency.

Bundled payments will reduce specialty care.

Rewards in primary care practice will focus on coordination, chronic disease management, and population health.

Total cost management will supplant fee-for-service incentives.

New regulatory frameworks and entities will emerge.

Milliman’s Health Care Reform Briefing further contends that “restructuring the payment system can motivate providers to perform, and payers and patients to pay for, only those procedures consistent with the best evidence and the needs of the patient. A system driven by results allows clinicians time to focus on the treatment delivered rather than the quantity of services provided” (Shreve, 2009, p. 2). For many years, the Centers for Medicare and Medicaid Services (CMS) has indicated that rehabilitation goals must focus on “functional” outcomes, and that “there must be an expectation that the patient’s condition will improve significantly in a reasonable and generally predictable period of time.

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