The New Flexible Health Plans

You have accessThe ASHA LeaderFrom the President1 Nov 2009The Turn of a Phrase: “Habilitative/Rehabilitative Services” Is Heart of Health Reform Sue T. HaleMS, CCC-SLP Sue T. Hale Google Scholar More articles by this author , MS, CCC-SLP https://doi.org/10.1044/leader.FTP.14152009.20 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In As health care reform dominates the news and the attention of both houses of Congress, an inescapable truth confronts our professions. If a health reform bill passes—and it is likely that one will—audiology and speech-language pathology services will be embedded in the phrase “habilitative/rehabilitative services.” Much like the hopefuls on American Idol, with this phrase we are either “in” or “out” of the reform package. If this language is part of a bill that is enacted into law, we can celebrate a significant advocacy achievement. The key word is “habilitative.” Children born with communication disorders—those needing habilitative rather than rehabilitative services—have been left out of too many insurance plans for far too long. Many of us have experienced denials for children with communication disorders by insurers who refuse coverage for speech-language or audiology services. Particularly troubling is a growing trend in the insurance industry of dropping coverage for children who need habilitative services. Insurers claim that children born with disabilities are developmentally delayed and that their care should be addressed in educational settings rather than in the health care system. This approach is at odds with the evidence base of our discipline. We know that the best time for cochlear implantation, hearing aids, early intervention for autism and other disorders, or augmentative and alternative devices often predates a child’s eligibility for educational services. Children born with cognitive or communication disorders have the same needs as adults with pre-existing conditions—and, like those adults, should not be tossed aside by the insurance industry. It is indefensible to deny services to children born with cognitive or communication disorders but cover rehabilitation services for those who have acquired the same conditions. This predatory practice must end. Habilitative services must be a basic benefit, provided by all insurance plans. Never underestimate the impact of a single word in legislative language—or even basic punctuation—on our professions and the people we serve. After all, it was an inadvertent comma inserted by legislators in the Medicare law that placed speech-language pathology and physical therapy services under a single financial cap. As a result, ASHA has had to advocate tirelessly for successive overrides to the cap. So the power of a word or phrase can make a tremendous difference—and in the case of “habilitative/rehabilitative services,” a positive one. Children with congenital communication disorders have had no direct voice or vote in the recent congressional debate, but their concerns have been central to ASHA’s grassroots advocacy. Getting this language into all the proposed health reform bills was not easy. Many thanks to all of you who sent letters to members of the Senate Finance Committee when the committee’s proposal did not include that critical language. We must maintain our vigilance to ensure that it remains in the legislation and that we are able to respond immediately if the situation changes. Regardless of our feelings about specifics of the final bill or our personal politics, audiologists and speech-language pathologists and those whom we serve cannot risk being left out of any bill that goes to the White House for a presidential signature. On your behalf, I have communicated with Sens. Max Baucus and Charles Grassley to urge inclusion of habilitative services in health care bills. Along with ASHA’s governmental affairs staff, we pointed out that many communication disorders are medical in nature and caused by neurological injuries or dysfunction that affect acquisition of communication skills. We emphasized that early and appropriate intervention can mitigate the need for intensive services in the future, thereby reducing costs and improving the overall health and well-being of children and enhancing the opportunity for independence and success as adults. Federal health plans are embracing habilitative speech-language and audiology services. Beginning in January 2010, insurance companies under the Federal Employee Health Benefits Program will be required to provide these services. In the bigger health care reform debate, we should celebrate this recognition of the value of speech-language and audiology services and broadened coverage of habilitative services. I am hopeful that any health care reform decisions will assure that all children receive the same benefits that members of Congress enjoy and that we will be responsible stewards for the most vulnerable members of our society and give them a chance at a better life. A phrase or a word can make all the difference. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 14Issue 15November 2009 Get Permissions Add to your Mendeley library History Published in print: Nov 1, 2009 Metrics Downloaded 64 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2009 American Speech-Language-Hearing AssociationLoading ...

ABSTRACTPurpose: As the number of children entering into Out Of Home Care (OOHC) increase, an increasing body of evidence is emerging, exploring the impact of maltreatment on a range of child development domains, for example, communication, behaviour, and cognition. Current research identifies the negative impacts of maltreatment on communication development, however to date, there is limited research relating to speech-language pathology (SLP) services with children in OOHC, including implementation and recommendation of modifications in SLP intervention.Method: A retrospective clinical audit of eight clients in OOHC who had accessed SLP services was conducted. The medical files were reviewed and general demographic data and clinical information was gathered. The files were reviewed for specific strategies that had been used or modified based on considerations of the child’s situation. These strategies were analysed across the cases by the authors in regards to patterns that emerged for successful implementation.Results: These children were more likely to present with a language delay, with improvements evident once the child had been in a stable language environment for 6 months. Careful selection of assessment tools and therapy resources by the speech-language pathologist along with the benefits of working with Foster Carers is discussed.Discussion: This paper builds upon previously identified challenges and strategies for working with children in OOHC and provides case examples of the journey through a SLP service. It provides preliminary discussions relating to the implementation of trauma-informed practice into the SLP therapeutic context, whilst also offering the learning and experiences of a specific SLP service as knowledge transfer. Finally, it also aims to promote further discussion and potential research into effective trauma-informed speech pathology practice for this vulnerable group of children.

Purpose: This study explored experiences of bulbar (speech, voice and swallowing) symptoms in Australian adults with Myasthenia Gravis (MG), and the relationship between these symptoms and community participation and quality-of-life. Further, it examined access to and experiences with speech-language pathology (SLP) services, and awareness and perceptions of the SLP’s role. Method: A cross-sectional mixed methods online survey collected data using researcher-designed questions and patient-reported outcome measures (PROMs) including the Dysarthria Impact Profile (DIP), Voice Handicap Index (VHI), Dysphagia Handicap Index (DHI), Community Integration Questionnaire–Revised (CIQ-R), and Myasthenia Gravis Quality of Life–Revised 15 (MG-QOL15r). Analyses included descriptive and non-parametric statistics, and content analysis. Result: Participants were 111 adults with MG living in Australia. 74% of respondents reported experiencing symptoms of speech difficulties but only 20% of those were referred to SLP services. Similarly, 85% of respondents reported experiencing swallowing difficulties, but only 26% were referred to SLP. Voice handicap (VHI) was strongly correlated with the psychosocial impact of dysarthria (DIP) and dysphagia handicap (DHI). Increased voice and dysphagia handicap were moderately correlated with worse quality-of-life. There was generally poor awareness of the SLP’s role and many were reluctant to attend SLP appointments. Conclusion: These findings highlight unmet consumer needs for MG-related bulbar symptoms, and a lack of awareness of SLP services. It is suggested that, in addition to other strategies, consumer education and increased awareness are required to address these unmet needs.

Provision of speech-language pathology services for the treatment of speech and language disorders in children during the COVID-19 pandemic: Problems, concerns, and solutions

This study is intended to identify current perceptions about artificial intelligence among speech-language pathology practices and services in children and adults. Focus group data from 9 speech-language pathologists – clinical supervisors (SLPs) in Greece and Cyprus services were used. The focus group answered a 9-item questionnaire, and the data were analyzed using qualitative thematic analysis to understand better perceptions of Artificial Intelligence among SLPs professionals. The findings revealed the primary themes of the SLPs who participated in the focus group. Specifically, it was reported that participants showed a positive attitude toward AI, recognizing its potential to enhance speech-language pathology services with accurate and efficient diagnostics and treatment. Concerns about the lack of human touch and data privacy/security were significant among them. Most participants agreed that SLPs should acquire knowledge of AI, data analysis, and technical skills to integrate AI effectively into their practice. This study revealed critical clinical implications derived from participants’ reports. It discusses the importance of rethinking the scope of practice of using AI when working with vulnerable populations.

You have accessThe ASHA LeaderASHA News1 Mar 2005One New Year’s Resolution to Keep: Advocate for Fair Reimbursement Through the STAR Network Cynthia Jacobsen and Maureen Thompson Cynthia Jacobsen Google Scholar More articles by this author and Maureen Thompson Google Scholar More articles by this author https://doi.org/10.1044/leader.AN1.10032005.2 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In For some of you, those personal New Year’s resolutions have already been forgotten. While goals to lose weight, quit smoking, or spend less may have fallen by the wayside, you can’t afford to forget about your professional resolutions because they can make a positive difference to a lot of people. What are your professional goals this year? Do you want to increase the visibility of your profession? Enhance reimbursement advocacy in your state? Enjoy enhanced professional recognition and satisfaction? If the answer is yes, lend a helping hand to ASHA’s State Advocates for Reimbursement (STAR) network. The STAR network is ASHA-member audiologists and speech-language pathologists who are willing to advocate locally with legislators, state insurance commissioners, health plans, unions, and employers on matters related to private health plan reimbursement. They share their advocacy skills and help create coverage and reimbursement strategies with state associations. They are the link between your state and ASHA. STAR members are a network in the true sense of the word-they are eager and willing to offer assistance, share information, and seek solutions to the reimbursement issues that challenge the financial viability of our professions. So what does STAR hope to achieve? Our mission is to advocate for consistent coverage and equitable reimbursement rates by private payers for speech-language pathology and audiology services. Forty-four states are represented in the network and STAR representatives must be able to count on you-our colleagues-to work with us to effect change in the private health plan system. We can’t do it alone. Regardless of where your private health plan concerns lie-with developing contracts, calculating appropriate fees, or obtaining “qualified provider” status, when you join forces with your STAR rep and other state association colleagues you will facilitate positive change. Teamwork is essential. Each of you knows how to communicate effectively. You are uniquely positioned to take on this challenge, improve reimbursement for our services, and work with your patients and families to ensure that, on a state level, decision-makers value the professions. You may ask, “How can I possibly make a difference?” To begin with, you can share stories of positive patient outcomes with legislators and decision makers or educate payers as to the cost effectiveness of speech, language, and hearing services. Your stories will demonstrate that speech, language, and hearing treatment leads to positive outcomes. You owe it to yourself, your patients, and your profession to make a long-lasting commitment. Meet with your STAR representative and select one issue to focus on-coverage of speech and language treatment for apraxia for example, or pediatric hearing aid coverage by a large employer in your state. The next step is gathering consumer education materials available from ASHA. Provide families with step-by-step instructions on contacting key decision-makers in your state. Meet with these key people on the state level and offer to be a resource regarding the needs of their constituents with communication disorders. If several of your patients contacted key decision makers in your state each week, administrators and legislators would pay close attention. After all, America’s historic civil rights movement began with a small nucleus of committed people. Their members set goals, developed plans, stayed flexible, and kept their eyes “on the prize.” In the beginning, goals were limited and grew with each success. While at times we may question the most effective methods for achieving comprehensive coverage of and reimbursement for our services; as we each work in our states to achieve change and share our successful strategies, we will find ways to achieve real and lasting results. Author Notes Cynthia Jacobsen, is the Kansas STAR representative and director of the Hearing and Speech Clinic, Children’s Mercy Hospitals and Clinics in Kansas City). Contact her at [email protected]. Maureen Thompson, is ASHA’s director of private health plan advocacy and coordinator of the STAR Network. Contact her at [email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 10Issue 3March 2005 Get Permissions Add to your Mendeley library History Published in print: Mar 1, 2005 Metrics Downloaded 60 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2005 American Speech-Language-Hearing AssociationLoading ...

ABSTRACTBackground: Recent evidence suggests racial disparities exist in post-stroke conditions such as aphasia, yet the underlying cause of such disparities is unclear. Disparities in rehabilitation service utilisation have been previously proposed as a contributor to racial disparities in post-stroke outcomes.Aim: To examine racial differences in speech–language pathology (SLP) service utilisation and costs among persons with aphasia being treated in acute care hospitals in North Carolina.Methods & Procedures: The North Carolina Healthcare Cost and Utilization Project data from 2011 to 2012 were analysed to examine SLP service utilisation and costs for stroke patients with aphasia. Analyses included length of stay (LOS) and charges/costs of SLP services. Generalised linear models were constructed to determine the impact of demographic characteristics, stroke severity, residence, and hospital fixed effects (variability of hospital management practices) on SLP utilisation and costs.Outcomes & Results: Approximately 5% more Blacks with aphasia were seen for SLP services than Whites with aphasia. LOSs were 2.1 days longer in acute care at 17% greater cost. Generalised linear models showed that Blacks with aphasia were seen for approximately 0.416 more visits than Whites after controlling for demographic characteristics, stroke/illness severity and residence and 0.25 more visits after controlling for hospital fixed effects. The slight increase in visits occurred at a cost of $57 when controlling for demographic characteristics, $63 when controlling for stroke/illness severity, $50 when controlling for residence, and $23 when controlling for hospital fixed effects.Conclusions: Blacks with aphasia utilise more SLP services during longer LOSs and with greater costs when compared to Whites with aphasia.

You have accessThe ASHA LeaderPolicy Analysis1 Nov 2011Rules Issued for Accountable Care Organizations Mark Kander Mark Kander Google Scholar More articles by this author https://doi.org/10.1044/leader.PA1.16152011.7 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In ASHA’s concerns about telepractice, access to speech-language and hearing services, and shared savings for speech-language and hearing professionals were not resolved in the Centers for Medicare and Medicaid Services’ (CMS) final rules for accountable care organizations (ACOs), a new model for providing health care services to Medicare beneficiaries under national health care reform law. An ACO is a network of physician group practices, hospitals, and others involved in patient care that share responsibility for providing care to Medicare patients. Much like health maintenance organizations, ACOs would bring together various health care components—primary care, specialists, hospitals, home health care, rehabilitation services—and offer providers and hospitals financial incentives (“shared savings”) for controlling costs and improving quality. However, Medicare patients will continue to have the ability to choose any provider inside or outside the ACO. ACOs are expected to create closer ties between hospitals and physicians and to be attractive to rehabilitation providers. CMS expects that ACOs typically will include primary care physicians, specialists, and a hospital. Rehabilitation services could be provided by in-house staff or by contracted rehabilitation provider organizations. ACOs would most likely contract with a single rehabilitation organization rather than increase administrative burdens by contracting separately with speech-language pathology, physical therapy, and occupational therapy providers. Audiology services could be incorporated into rehabilitation contracts through independent audiology contracts or ACO-participating otolaryngology practices. Shared savings payments would be distributed to physicians and hospitals participating in the ACO and to other providers based on individual contracts and the ACO’s determination of “how to equitably distribute shared savings or use the shared savings to meet the goals of the program,” according to the regulations. The ACO concept can be compared to a construction contract, with the ACO as general contractor and the providers as subcontractors. The final regulations released in October are less stringent than the proposed version. For example, prospective ACOs will not be required to assume financial risk during the first three years. Also, ACOs will be assessed on 33 quality measures (half the number initially proposed) divided into four domains: patient/caregiver experience, care coordination and patient safety, preventive health, and caring for at-risk populations. (Speech-language pathologists and audiologists already participate in the Medicare quality reporting process.) According to CMS, higher quality care will result in greater shared savings payments. Establishing an ACO typically will cost more than $3 million. The regulations create an assistance program—$170 million for up to 50 ACOs—for physicians and small hospitals that lack the requisite capital. In response to proposed ACO regulations issued in April, ASHA submitted comments suggesting that ACOs be required to: Ensure that speech-language pathology and audiology services are accessible to patients. CMS responded that market forces will determine the need for the range of services offered. Allocate an equitable portion of shared savings to speech-language pathologists and audiologists. CMS stated that it lacks legal authority to dictate this distribution. Encourage the use of telepractice services provided by audiologists and speech-language pathologists. In response, CMS announced that it is preparing a separate incentive package, not limited to ACOs, that expands Medicare-reimbursable telepractice services. ASHA will continue to analyze the impact and restrictions of ACOs, which are scheduled to begin operating in 2012. Author Notes Mark Kander, director of health care regulatory analysis, can be reached at[email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 16Issue 15November 2011 Get Permissions Add to your Mendeley library History Published in print: Nov 1, 2011 Metrics Downloaded 48 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2011 American Speech-Language-Hearing AssociationLoading ...

THE MOTIVATION AND POTENTIAL BENEFITS OF MEDICAL SAVINGS ACCOUNTS Medical savings accounts (MSAs) were implemented in die United States as a pilot programme. The primary motivation for implementing MSAs, which are privately invested healthcare accounts, is die consistently rising cost of healthcare in traditional medical insurance plans due to moral hazard. Moral hazard is die phenomenon that occurs when consumers utilise more of a service or product when cost is shared than when the consumer is responsible for the entirety of the cost.' The consumer would dierefore use more of a service when they are not or are only partially responsible for the payment than when they pay for the service diemselves. Moral hazard has been shown to increase the costs of existing traditional health plans. MSAs seek to reduce moral hazard and thereby make health coverage both accessible and affordable. By forcing consumers to become the executors of die bulk of their healthcare expenditures, moral hazard is reduced, as are healthcare costs. A secondary benefit realised by MSAs is the increase of health insurance coverage for the previously uninsured. Currently, 25 million people who work for businesses with 50 or fewer employees in the USA are uninsured. Of self-employed people another 9.7 million are uninsured. A total of 35.7 million are therefore eligible for MSAs. Golden Rule an MSA administrator reported that 15 to 20% of the MSA policyholders were previously uninsured. MSAs represent a viable solution to alleviating a part of the uninsured population.'' An MSA is composed of two components. The first part is a personal savings interest-bearing account where the consumer deposits monthly premiums or payments. (Under the US tax system the payments—up to $ 1462.50 for individuals and $3,375 for families—are not taxed.) The money in the account is used to pay for routine and preventative care. When die money in die account is exhausted or an expensive medical procedure is necessary, the consumer can invoke the second part of die MSA. In this situation, the consumer first pays for a fixed portion of the medical fees (known as a deductible); afterwards,

Background and Aim: There is a literature gap addressing the Saudi general public’s understanding of audiology and speech-language pathology (SLP). This study aimed to examine the public awareness of audiology and SLP professions in Saudi Arabia. Methods: This was a cross-sectional study design consisted of two parts. The pre-test part aimed to provide content validation for the major questionnaire study. The full- scale study addressed the aim. An electronic questionnaire was prepared and distributed. The questionnaire contained three sections: demographics, experience with hearing and communication disorders, and audiology and SLP knowledge. Results: A total of 50 and 512 participants completed the questionnaires for both parts, respectively. Most of participants were Saudi citizens (98.8%), aged 18–30 years, and lived in Riyadh. The questions with the most correct response rates were mostly inductive (e.g., work- place), but some audiology and SLP services (e.g., diagnosis and management of tinnitus, vestibular and swallowing disorders) were not well-identified by the participants. Of the total, 78.7% and 87.5% of participants correctly identified that the work of audiologists and speech-language pathologists (SLPs) was not like the work of teachers of deaf and hard of hearing and special education teachers, respectively. Conclusions: A reasonable level of public awareness of audiology and SLP in Saudi Arabia was identified. Still, more public awareness campaigns and educational materials about audiology and SLP are needed. Stakeholders are advised to strengthen public awareness efforts at the national level.

Compared to national averages, the Gold Coast, Australia, has a proportionately higher number of children entering their first year of primary school with 'at risk' or 'vulnerable' language skills. This paper investigates the distribution of paediatric speech-language pathology (SLP) services on the Gold Coast, relative to children's language and cognitive skills, and socioeconomic status (SES). SLP service locations were identified through national association data and a manual search and mapped against SES and Australian Early Development Census data, for language and cognitive skills. Data for 7595 children was included, with 943 (12.4%) at risk and 780 (12.6%) vulnerable for language and cognitive skills. A total of 75 SLPs were identified (85.3% private, 14.6% public), which is 1 SLP to every 23 children who might have current or impending speech, language and communication needs. Fewer services were available in areas where vulnerable children were located and most were private providers, leading to further potential barriers to service access. The number of SLP services located on the Gold Coast is inadequate to meet the needs of children with language and cognitive skill vulnerabilities. Consideration of how services might be distributed is explored and warrants further consideration.

You have accessThe ASHA LeaderASHA News1 May 2002Better Hearing and Speech Month Celebrated on Capitol Hill Mary M. Annett Mary M. Annett Google Scholar More articles by this author https://doi.org/10.1044/leader.AN.07102002.1 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In As May—Better Hearing and Speech Month (BHSM)—comes to an end, ASHA and its members can look back on a successful public awareness campaign touting the value of audiology and speech-language pathology services. Members across the country have been promoting better hearing and speech, as well as their services, through a variety of creative projects. And, through congressional testimony and a Capitol Hill health fair, ASHA has taken the message to Congress, where the U.S. House of Representatives and Senate passed concurrent resolutions supporting National Better Hearing and Speech Month. In recognition of the approximately 42 million people in the United States who have speech, language, or hearing disorders, both chambers of Congress resolved to support the goals and ideals of BHSM. The concurrent resolutions commend the 41 states that have implemented routine hearing screenings for all newborns, support the efforts of speech and hearing professionals in their efforts to improve the speech and hearing development of children, and encourage Americans to avoid harmful environmental noise and have their hearing checked regularly. Rep. Jim Ryun (R-KS) introduced H.Con. Res. 358, which passed the House on April 30. In addition to Ryun, Reps. Jim Walsh (R-NY), Mike Bilirakis (R-FL), and Sherrod Brown (D-OH) spoke on the House floor on behalf of the resolution, hearing and speech issues, and ASHA’s BHSM activities. On May 1, the Senate passed S.Con.Res. 103, which was introduced by Sen. Hillary Rodham Clinton (D-NY). The resolutions are available on ASHA’s Web site. To view the list of the resolutions’ co-sponsors, visit ASHA’s Political Action Center site. EHDI and IDEA Funding On May 2, ASHA President Nancy Creaghead testified before the House Labor, Health and Human Services, and Education Appropriations Subcommittee, requesting increased funding—$23 million—for the federal early hearing detection and intervention (EHDI) program in fiscal year 2003. Specifically, she requested $11 million for the Health Resources and Services Administration and $12 million for the Centers for Disease Control and Prevention. “This level of funding is needed in order to continue assisting states with the development of newborn hearing screening, diagnosis, tracking and intervention programs, as well as the applied research component related to these EHDI programs,” explained Creaghead. “Today, we currently screen about two-thirds of the babies in this country. Nevertheless, every day at least 11 babies with hearing loss still leave the hospital and their parents have no idea. These results validate the need for continued federal participation to help ensure that all states and U.S. territories are given the opportunity to successfully put in place comprehensive EHDI programs so that no child is left behind.” ASHA coordinated a letter to all members of Congress reiterating the need for increased EHDI funding in the FY 2003 budget. Thirty national consumer and professional organizations from the health care and education fields signed the letter. Creaghead also requested a 12% increase in funding for both Part C, Early Intervention Services for Infants and Families, and Part D, Personnel Preparation, of the Individuals with Disabilities Education Act (IDEA). “A commitment to achieving the early diagnosis and intervention for hearing loss for our nation’s children will also require cooperation and coordination among federal agencies, professional and consumer organizations,” she said. “While ASHA is actively working with the administration on ways to best reform IDEA through its upcoming reauthorization process, the need for services greatly outstrips the resources available to deliver adequate early intervention services to children with hearing loss.” The full text of Creaghead’s testimony is available online. Capitol Hill Health Fair In conjunction with the Congressional Hearing Health Caucus, ASHA sponsored a Capitol Hill health fair for BHSM on May 8, giving members of Congress and their staff the chance to gather information about hearing and speech issues. Fifteen organizations—including consumer and professional groups, as well as federal agencies—participated in the event, as did members of Congress, actor Taro Alexander, and Creaghead. The four co-chairs of the Congressional Hearing Health Caucus—Reps. Lois Capps (D-CA), Carolyn McCarthy (D-NY), Ryun, and Walsh—participated in a kickoff event with Creaghead, and over 100 congressional staff members visited the displays during the fair. Alexander—who performs in the off-Broadway show “Stomp!“—has stuttered since he was 5. Last year he founded the Our Time Theatre Company in New York, “an artistic home for people who stutter,” and in March he received the Charles VanRiper Award at the 20th Annual Communication Awards. At the health fair, he shared his experiences with stuttering, working with speech-language pathologists, and the outreach he is now, in turn, doing for others who stutter. For more information about the BHSM congressional activities, contact Neil Snyder by email at [email protected] or through the Action Center at 800-498-2071, ext. 4257. For more information on BHSM and related resources, visit ASHA’s Web site. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 7Issue 10May 2002 Get Permissions Add to your Mendeley library History Published in print: May 1, 2002 Metrics Downloaded 63 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2002 American Speech-Language-Hearing AssociationLoading ...

The World Health Organization's equity objective states that there should be equal access to healthcare for equal need, regardless of location. Disparities between health services and challenges to achieving the equity objective have been documented both in Australia and around the world. However, little is known about the extent to which this objective has been met in the field of speech-language pathology in Australia. This study used structured interviews with 74 speech-language pathologists working in rural areas of New South Wales and Victoria. The data obtained were used to develop maps to describe the availability of paediatric speech-language pathology services through consideration of location and frequency. The findings show that 98.60% of localities are unserviced at the ideal frequency of weekly or more often. It is important to note that these percentages include all localities in the represented rural areas of New South Wales and Victoria, some of which are minimally populated. The maps also depict travel and distance as barriers to the accessibility of services and have been used to suggest a critical maximum distance for paediatric outpatient speech-language pathology services in rural New South Wales and Victoria. From the data collected, 50 kilometres was suggested as the critical maximum distance past which consumers become unable or unwilling to travel to access weekly rural speech-language pathology services in rural New South Wales and Victoria. Thus, people living in almost one third of rural localities in rural New South Wales and Victoria lie beyond what is considered by rural speech-language pathologists to be a reasonable travel distance to weekly speech-language pathology services. These results highlight barriers to the achievement of equitable services in rural areas. The results also provide an essential foundation to inform policy development and assist health service planning to meet the needs of rural consumers.

Tax-preferred health savings devices such as Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) offer employees potentially valuable financial instruments for directing pre-tax earnings to eligible medical expenses. Despite their increasing popularity as an employee benefit, however, there is little causal evidence around individual demand for these accounts. This paper seeks to address this gap in the literature, reporting on a randomized controlled field experiment conducted with over 11,000U. S federal employees in 2017 in order to evaluate the effectiveness of targeted messages designed to increase FSA contributions. Our results suggest that the provision of basic information about FSAs delivered via an emailed employee newsletter did not affect the likelihood of contribution or the contribution level. The addition of statements about the absolute returns or relative returns offered by the accounts similarly had no significant effects, and these null effects are observed despite relatively high email open rates. We discuss explanations for the null results and the policy implications of findings from what appears to be the first health economics experiment analyzing tax incentives around health care savings.

Background: Early detection of dysphagia can reduce associated medical sequelae and subsequent burden of care. As most patients admitted to acute care services present first via the emergency department (ED), timely speech-language pathology (SLP) involvement in ED services may improve patient and service outcomes. To date, however, there is limited knowledge of the nature of current dysphagia management practices within EDs. Methods and procedures: A national online survey was utilized to explore SLP service provision, referral patterns, dysphagia assessment/management practices and perceptions of SLP services within the Australian ED setting. Respondents represented 68 clinical facilities across Australia. Outcomes and results: Almost all (97%) reported providing SLP-led dysphagia services in the ED, though occasions of service were low (<10 referrals per week). Additionally, 76% of services utilized nursing-led dysphagia screening. Dysphagia services were primarily focused on patients admitted post-stroke (84%), with clinical pathways reportedly less consistent for other clinical populations. Most respondents (95%) perceived the provision of SLP services in ED as valuable, however, identified funding and resource issues, limited recognition of the role of SLP in ED, and patient flow as key challenges to dysphagia service provision in EDs. Conclusions: This study highlights that current clinical models of ED dysphagia management are largely dependent on nursing-led screening which are predominantly only applied for patients admitted post-stroke. Further research into dysphagia risk identification beyond the stroke population is needed to determine optimal clinical service models for dysphagia management within the ED setting.