Getting Started as an SLP in Health Care

Speech-language pathologists (SLPs) in health care see patients in many different settings, including

  • acute-care hospitals,
  • long-term acute-care hospitals (LTACH),
  • inpatient rehabilitation facilities (IRFs),
  • skilled nursing facilities (SNFs),
  • long-term care facilities,
  • outpatient clinics, and
  • home health services.

In each of these settings, SLPs work with children and adults, as well as their care partners, in the context of larger medical teams. Each setting has unique employment and service delivery considerations, which are discussed here.

Roles and Responsibilities

SLPs in health care settings

  • provide screening, assessment, and treatment services to individuals with a range of medical diagnoses that impact communication, cognition, and swallowing;

  • play a critical role in health literacy, patient safety, communication access, and prevention and wellness initiatives within their organization; and

  • may also participate in related patient care activities (multiskilling), advocacy, supervision, research, and administration.

Salary Information

Salaries in health care vary by geographical location, health care setting, and years of experience (among other factors). ASHA’s biannual health care survey provides salary data and related trends.

Referral Process

Patients may be referred to an SLP in a health care setting via one of the following ways:

  1. The patient’s physician or another member of the care team, such as a nurse. They initiate the referral or “consult” based on their own assessment or screening. The patient may be screened either (a) at admission—in follow-up to a specific referral of another staff or family member—or (b) periodically to coincide with the facility’s care plan schedule.

  2. “Critical pathways” based on the admitting diagnosis. A critical pathway is when the facility has an established set of organizational protocols that automatically initiate the SLP referral (e.g., a facility’s critical pathway for stroke may include an SLP consult for a swallowing evaluation within the first 24 hours).

  3. Staff/family referrals or patient self-referrals.

Service Delivery Considerations

There are several factors related to the business of health care that impact service delivery. The factors are not unique to speech-language pathology, but the impacts often are.  

  • Reimbursement: Reimbursement drives service delivery in health care settings. Reimbursement for SLP services in health care can come from various payers—such as Medicare, Medicaid, private insurance, and state funding programs. In some cases, patients are self-pay.

Some important reimbursement-related concepts for successful service delivery include the following methods and models:

  • Prospective Payment System (PPS): This is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount driven by a classification system unique to the setting. The Centers for Medicare and Medicaid Services (CMS) uses separate PPSs for reimbursement under Medicare Part A to acute-care inpatient hospitals (Diagnostic Related Group [DRG]), home health agencies (Patient-Driven Groupings Model [PDGM]), hospital outpatient facilities, hospital inpatient rehabilitation facilities (Inpatient Rehabilitation Facility Prospective Payment System [IRF PPS]), and skilled nursing facilities (Patient-Driven Payment Model [PDPM]). Under a PPS, the facilities are reimbursed a lump sum based on the patient’s diagnosis.

  • Fee for Service (FFS) versus Value-Based Care (VBC): Fee-for-service is a traditional payment model where health care providers like SLPs are reimbursed for each service they deliver to a patient. The reimbursement is based on the fee schedule set by the provider and the payer—typically a government program (e.g., Medicare Part B) or an insurance company. Private insurance companies may negotiate a rate with the clinic for services provided, and payment may differ if the clinic is an “in-network” or “out-of-network” provider. FFS rates may also be negotiated as per-visit or per-session reimbursement rates. Alternately, value-based care is the approach that incentivizes providers to focus on quality outcomes rather than the quantity of services rendered.

  • Impact of Reimbursement on Clinicians: Payers often set limits on the amount that they will pay for services or on the length of time that they will pay for them. Documentation needs to support the medical necessity of the services, and claims are sometimes denied payment if the patient’s needs do not meet the requirements set forth by the payer. Productivity requirements may be in place to maximize reimbursement and keep the clinic running.

  • Productivity: This is the ratio between the SLP’s time in patient care and the number of hours worked. Patient care includes direct billable services as well as indirect services that are components of comprehensive, holistic care. Productivity standards are not developed or required by payers and do not affect reimbursement. Employers determine the direct and indirect activities that count toward patient care time. ASHA encourages employers that establish a productivity standard to include any activity required for patient care—such as patient care coordination meetings, family training, and documentation. However, many employers consider “activity” to be only billable time. Productivity targets and how they are measured vary across settings. ASHA’s biannual health care survey provides productivity data and related trends.

  • Interprofessional Practice: Because patients with chronic or complex conditions have multiple medical and treatment needs, it is important for the SLP to take an interprofessional approach to care. Depending on the patient’s diagnosis, functional skills, current needs, and age level, the SLP may collaborate with any of the following professionals: audiologists, aural rehabilitation specialists, dieticians, nurses, physicians, social workers, occupational therapists, physical therapists, psychologists, recreation therapists, teachers, and others. SLPs may participate in specialized teams within the facility, such as a craniofacial or feeding team. The interprofessional treatment team works together to develop an integrated, person-centered treatment plan.

  • Documentation: Documentation of services is critical to reimbursement and is consistent with quality care as outlined in the ASHA Code of Ethics. Documentation is patient-centered, is skilled, and focuses on medical necessity of services rendered.

  • Models of service delivery: Patients benefit from varied service delivery models that include changing treatment, frequency, intensity, and duration consistent with their individualized plan of care. Services may be provided via many modes of service delivery (e.g., individual, group, etc.).

Related Resources

Working at a SNF: Is It Right for You?

Getting Started in Pediatric Hospitals

Pondering a Move to Home Health? Some Considerations

Is Home Health Care for You?

My Crash Course in Cultural Differences in Home Health