Accountability and the RAC teams:

BY: Karlene Stefanakos, M.A., CCC-SLP on Sunday, 10 June 2012. Posted in All, Dementia, Speech Evaluation, Speech Pathology

As we have entered into the Medicare reform rollout period, which began last October 1, 2011, our lives are now characterized by increased stress due to company requested higher productivity levels, which in many cases will become a red flag to investigative teams seeking out fraud. Medical records of patients are now being copied for the RAC teams, and other investigative teams, and fines are being leveled because “perfection” is the rule of the law. Even we here at the Speech Team are altering our tests to include the patient’s name and date of evaluation on every single test page since RAC team reviewers require “absolute coherency” in every chart. The point being that a patient’s medical chart must read like a novel by non-medical accountants!  No more “off or low energy days” for any of us, even though we are human beings.

Now, where is this leading us? If the point is to lead us painfully to a single payer healthcare system by financially crashing the healthcare companies until 2014, then responsible politicians (if there are any left) need to recognize this is a brutal way to accomplish a national goal. Fraud born of greed, I am sure, can be managed in a more civilized manner than to stress out front line therapists. But, aside of the fraud element, investigative teams are going to become more and more intelligent about the “holes” in our educational curricula. They may ask intelligent questions such as “what are your credentials for assessing and treating the dementia patients you have on your caseload?” Sooner or later, eyes are going to be looking at the university curriculum from which all strengths and ills come from. Since dementia will be the foremost diagnosis in skilled nursing facilities and long term care facilities in the near and far future, shouldn’t dementia become a standardized curriculum course across all ASHA accredited universities? Since ASHA published their position statement in 1988 stating:

Increasing involvement in the evaluation and management of the patient with Alzheimer’s disease and related disorders through such assessment of level of communications skills, control of the potential confounding effects of unrecognized communication disorders on the diagnosis of dementia, interdisciplinary participation in program development, provision of specific treatment programs designed to facilitate and maintain functional communication for as long as possible, and assistance to families in understanding communication breakdown, specific deficits and needs.

Well, those are nice words, but that is only what they are – words! Where is the course that should have followed up ASHA’s position statement to promote SLPs as dementia specialists, and which would now legally  protect our newest graduates who work with dementia patients? Don’t rehab companies get tired of training SLPs in the areas they are supposed to be educated in? I would.

Tell me what you think of all this.

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