The Affordable Care Act will shake up insurance reimbursement, and audiologists and speech-language pathologists will feel the effects.
The current practices of measuring time units of service delivery or of counting procedures, though directly tied to the cost of care, will continue only insofar as these costs add value. Instead, reimbursement will be more patient-centered—tied to patient outcomes and evidence-based treatment. Thus, the ability of our discipline to hold its rightful place in service delivery depends on us clearly and consistently demonstrating value.
Meeting these new demands requires that we strengthen our model of graduate education in communication sciences and disorders. We should be teaching our students to provide the most help to patients and to the health system, while preventing unnecessary costs and complications. It is critical that future providers learn the difficult science of measuring value in ways understood clearly by those outside the discipline. Rational, evidence-based education is more relevant than ever before.
So how do we get there? I offer some recommendations:
- Bring together classroom and clinic. Focus class time on content that cannot be acquired elsewhere. Require students to acquire information from a variety of sources before coming to class and then have them practice applying this new information in the classroom for rapid integration and critical thinking. In addition to the traditional lecture approach, instructors can use case-based and problem-based learning to develop competency in self-assessment, critical thinking and patient-focused decision making. They can also use interactive video technologies to expose students to "real-world" patients and situations.
- Use competencies and outcomes to guide content. Determine the level of competency (outcome) required for a beginning practitioner and then work backward in designing the course or the curriculum. Ensure that the required competencies are clear to everyone: faculty members, students and clinical instructors. Provide multiple opportunities for each student to learn these competencies. To the degree possible, integrate competencies across the entire professional curriculum. The need for constant updates, content currency and academic freedom needs to be aligned with overall curricular goals. Major areas of the curriculum need to be guided by a balance of faculty expertise, the scope of the discipline and agreement on future practitioner needs.
- Require students to master interprofessional abilities and team-based practices early. Programs should add the widely distributed interprofessional competencies outlined by the Interprofessional Education Collaborative Expert Panel [PDF] in 2011 to the required skills for every health professional. Students should learn to function on teams of professionals, especially those with whom they are most likely to work in the future. Where possible, programs should ensure that arrangements are made for interprofessional observation and real-time experience, with health and rehabilitation professionals in simulated and actual clinical settings. Academic leaders need to be deliberate in preparing students for the most common or high-risk interprofessional interactions. The Institute for Health Improvement has created several resources for the development of these skills.
- Consider the relationship of communication and swallowing abilities in the primary care of all patients. Primary care practitioners have an expanded role in health reform. In addition to physicians, an increasing number of PCPs are nurse practitioners and physician assistants. Including information about primary care considerations throughout the communication sciences and disorders curriculum is likely to help graduate students bridge their disciplinary knowledge to the interest and concern of the PCP. Health literacy and patient compliance frequently are identified as key factors in poor health outcomes—and by bolstering patients’ communication abilities, our professions can help PCPs improve such outcomes. We need to prepare our future practitioners to communicate this message effectively.