Private Practice (Co)owners - ASHA · 2013-08-15 · Private practice (co)owners in outpatient clinics or offices (n = 122) earned a median hourly wage of $65.00, while those working

Private Practice (Co)owners

For additional information, please contact Jeanette Janota, Surveys & Analysis

American Speech-Language-Hearing Association Rockville, MD 20850

800-498-2071, ext. 8738 [email protected]

ASHA SLP Health Care Survey 2013: Private Practice (Co)owners

Contents Executive Summary ...................................................................................................................... 1 Who They Are ............................................................................................................................... 2

Highest Degree ................................................................................................................................ 2 Sex ................................................................................................................................................... 2 Years of Experience ......................................................................................................................... 2 Facility ............................................................................................................................................. 3 Geographic Region .......................................................................................................................... 3 Population Density ........................................................................................................................... 3

Their Practices .............................................................................................................................. 4 Full-Time, Part-Time ....................................................................................................................... 4 Facility ............................................................................................................................................. 4 Population Density ........................................................................................................................... 4 Years of Experience ......................................................................................................................... 4 Geographic Region .......................................................................................................................... 4

Their Activities ............................................................................................................................... 5 Their Clients .................................................................................................................................. 5

Pediatric ........................................................................................................................................... 5 Autism .............................................................................................................................................. 5 Adults ............................................................................................................................................... 6

Insurance Denials ......................................................................................................................... 6

What They Earn: Annual Salaries ................................................................................................. 7 What They Earn: Hourly Wages ................................................................................................... 7 Facility ............................................................................................................................................. 7 Region of the Country ...................................................................................................................... 7 Population Density ........................................................................................................................... 7 What They Earn: Per Visit ............................................................................................................. 7 Source of Payments ...................................................................................................................... 8 Facility ............................................................................................................................................. 8 Region of the Country ...................................................................................................................... 8 Population Density ........................................................................................................................... 8 Medicare Provider ......................................................................................................................... 9 What They Say About ASHA ........................................................................................................ 9 Cultural and Linguistic Diversity .................................................................................................... 9 Clinical Fellow Mentoring ............................................................................................................ 10

i

ASHA SLP Health Care Survey 2013: Private Practice (Co)owners Interprofessional Collaboration ................................................................................................... 10

Survey Notes and Methodology .................................................................................................. 11

Response Rate ................................................................................................................................ 11 Other Reports ................................................................................................................................. 11

Suggested Citation ...................................................................................................................... 11 Resources ................................................................................................................................... 11 Additional Information ................................................................................................................. 12 Thank You ................................................................................................................................... 12 Figures

Figure 1: Sex of (Co)owners ........................................................................................................... 2 Figure 2: Employed Full- or Part-Time .......................................................................................... 4 Figure 3: Activities .......................................................................................................................... 5 Figure 4: 2011 and 2012 Denials From Health Plans ..................................................................... 6 Figure 5: Payment Sources.............................................................................................................. 8 Figure 6: Medicare Provider ........................................................................................................... 9

Table

Table 1: Interprofessional Collaboration ..................................................................................... 10

ii

ASHA SLP Health Care Survey 2013: Private Practice (Co)owners Executive Summary

The American Speech-Language-Hearing Association (ASHA) conducted a survey of speech-language pathologists (SLPs) in the spring of 2013. The survey was designed to provide information about health care based service delivery and to update and expand information gathered during previous SLP Health Care Surveys. The results are presented in a series of reports. This report addresses only questions on the survey pertaining to private practice (co)owners. Data are drawn from six types of health care facilities: general medical and long-term acute care (LTAC) hospitals, rehabilitation (rehab) hospitals, pediatric hospitals, skilled nursing facilities (SNFs), home health agencies and clients’ homes, and outpatient clinics and offices. SLPs involved in private practice were oversampled in order to have a sufficient number of respondents.

Highlights: 59% of SLPs worked full-time.

66% of clinicians who worked full-time and 71% of those

who worked part-time reported that the majority of their time was spent providing treatment to individuals.

39% of treatment time spent with pediatric patients was in the area of language.

33% of treatment time spent with adults was in the area of

swallowing.

45% of respondents reported receiving more denials by private health plans in 2012 than they received in 2011.

The median annual salary of (co)owners was $72,798.

Hourly wages were highest in the Northeast ($80.42).

The median per visit wage was $70.00.

28% of SLPs were enrolled as Medicare providers.

Private pay was the most common payment source (82%). 69% of respondents said ASHA was doing an excellent or

good job serving its health care members.

46% of SLPs said they felt prepared to address cultural and linguistic influences on service delivery and outcomes.

26% of SLPs engaged in interprofessional collaboration on a daily basis for treatment services.

1

ASHA SLP Health Care Survey 2013: Private Practice (Co)owners Who They Are

Highest Degree

Sex

Years of Experience

The data in this report were gathered from the 688 speech-language pathologists who indicated on ASHA’s 2013 SLP Health Care Survey that they were owners or co-owners of a private practice. The number of respondents is fewer than 688 for those questions that some participants chose not to answer. Of the SLPs who were owners or co-owners (n = 686):

♦ 97% had a master’s degree as the highest degree, ♦ 3% had a doctoral degree.

Most SLPs who were owners or co-owners were female (see Figure 1). Figure 1. Sex of (Co)owners)

5%

95%

Male

Female

n = 688 Years of experience influenced the likelihood of co-owning a private practice (p = .000). For example, only 10% of SLPs who had 1–3 years of experience were owners or co-owners compared with 48% of those with 31 or more years of experience who (co)owned a private practice; years of experience was virtually directly proportional to (co)ownership.

♦ The median number of years of experience for the SLPs who were owners or co-owners was 16 (n = 688).

♦ The median number of years of experience for those who were not (co)owners was 12 (n = 1,233).

2

ASHA SLP Health Care Survey 2013: Private Practice (Co)owners Facility

Geographic Region

Population Density

Of the SLPs who were owners or co-owners (n = 671) ♦ 3% worked in pediatric hospitals, ♦ 4% worked in rehabilitation hospitals, ♦ 8% worked in general medical or LTAC hospitals, ♦ 15% worked in (SNFs), ♦ 31% worked in home health agencies or clients’ homes, ♦ 40% worked in outpatient clinics or offices.

Of the SLPs who were owners or co-owners (n = 687) ♦ 19% worked in the West, ♦ 20% worked in the Midwest, ♦ 22% worked in the Northeast, ♦ 39% worked in the South.

Of the SLPs who were (co)owners (n = 674)

♦ 16% worked in rural areas, ♦ 41% worked in metropolitan/urban areas, ♦ 43% worked in suburban areas.

3

ASHA SLP Health Care Survey 2013: Private Practice (Co)owners Their Practices Full-Time, Part-Time Facility Population Density Years of Experience Geographic Region

Private practice owners and co-owners were more likely to work full-time than part-time (see Figure 2). Figure 2. Employed Full- or Part-Time

59%

41%Full-timePart-time

n = 688 Owners/co-owners in rehab hospitals (71%) and SNFs (72%) were more likely than those in other types of facilities to be employed full-time (p = .000). (Co)owners who worked in suburban areas (54%), metropolitan/urban areas (62%), and rural areas (67%) were more likely to work full-time than part-time (p = .030). Years of experience had an effect on whether owners and co-owners worked full- or part-time. The likelihood of working part-time increased as the number of years of experience increased, although not in a straight line (p = .007). Region of the country (p = .162) had no effect on whether owners or co-owners worked full- or part-time.

4

ASHA SLP Health Care Survey 2013: Private Practice (Co)owners Their Activities

Their Clients Pediatric

Autism

Regardless of whether they were employed full- or part-time, private practice owners and co-owners spent the overwhelming majority of their time providing direct treatment to individuals (see Figure 3). Figure 3. Activities

66%

2%

19%13%

71%

2%

20%7%

0%

25%

50%

75%

100%

Full-timePart-time

n = 660 Private practice owners/co-owners served children and adults (n = 591):

♦ 22% of their services were delivered to infants and toddlers; ♦ 20% of their services were delivered to preschoolers; ♦ 17% of their services were delivered to school-age children; ♦ 40% of their services were delivered to adults.

Of private practice owners and co-owners who treated pediatric patients (n = 400)

♦ 1% of their time was spent on prevention/wellness, ♦ 1% of their time was spent on voice, ♦ 1% of their time was spent on resonance, ♦ 4% of their time was spent on fluency, ♦ 6% of their time was spent on augmentative and alternative

communication (AAC), ♦ 7% of their time was spent on cognitive communication, ♦ 12% of their time was spent on swallowing and feeding, ♦ 27% of their time was spent on articulation-phonology, ♦ 39% of their time was spent on language, ♦ 2% of their time was spent on other areas.

Children with autism accounted for an average (mean) of 25% of the caseload of private practice owners and co-owners. The median was 20%.

5

ASHA SLP Health Care Survey 2013: Private Practice (Co)owners Adults

Insurance Denials

Of the private practice (co)owners who treated adult patients (n = 327) ♦ 2% of their time was spent on accent modification/

communication effectiveness, ♦ 5% of their time was spent on AAC, ♦ 6% of their time was spent on voice/resonance, ♦ 7% of their time was spent on cognitive communication:

traumatic brain injury, ♦ 13% of their time was spent on cognitive communication:

dementia, ♦ 4% of their time was spent on other cognitive communication

disorders, ♦ 8% of their time was spent on motor speech, ♦ 16% of their time was spent on aphasia, ♦ 33% of their time was spent on swallowing, ♦ 5% of their time was spent on other areas.

Nearly half (45%) of the owners and co-owners said that there were more denials by private health plans in 2012 than in 2011. Only 3% said there were fewer denials in 2012 (see Figure 4). Figure 4. 2011 and 2012 Denials From Health Plans

3%

23%

45%

29%

Fewer in 2012

No change

More in 2012

Don't Know

n = 662

6

ASHA SLP Health Care Survey 2013: Private Practice (Co)owners What They Earn: Annual Salaries

What They Earn: Hourly Wages

Facility

Region of the Country Population Density

What They Earn: Per Visit

The salaries in this report are median salaries (the one in the middle when salaries are ordered from lowest to highest). Salaries are presented only when there are sufficient cases for the category, that is, a minimum of 25 respondents. The median salary of the 161 private practice (co)owners in the survey who received an annual wage was $72,798. Most of the SLPs in this category worked in outpatient clinics or offices (n = 95) for a median annual salary of $71,000. The median number of weekly hours worked by owners or co-owners who received an hourly wage was 25, with a range from 1 to 60 hours. Those who worked up through 25 hours per week (n = 159) earned a median hourly wage of $60.00, while those who worked more than 25 hours (n = 149) received a median hourly wage of $40.00. Private practice (co)owners in outpatient clinics or offices (n = 122) earned a median hourly wage of $65.00, while those working in home health agencies or clients’ homes earned $70.17 (n = 51), those in SNFs earned $41.00 (n = 80), and those in general medical and LTAC hospitals earned $36.77 (n = 34). Too few owners/co-owners who worked in rehabilitation hospitals (n = 12) and pediatric hospitals (n = 7) received an hourly wage to report their results. Owners/co-owners in the Northeast earned more than did their counterparts in other regions of the country; the median hourly wage was

♦ $80.42 in the Northeast (n = 58), ♦ $53.89 in the West (n = 59), ♦ $44.00 in the South (n = 110), ♦ $43.00 in the Midwest (n = 76).

The median hourly wage was $49.66 in the suburbs (n = 129), $47.87 in metropolitan/urban areas (n = 111), and $45.42 in rural areas (n = 62). A total of 131 private practice owners and co-owners reported receiving a per visit wage. Their median wage was $70.00 per visit. Nearly all (n = 118) of them were employed in a home health agency or client’s home, where the per visit wage was $70.00 (n = 118).

7

ASHA SLP Health Care Survey 2013: Private Practice (Co)owners Source of Payments

Facility Region of the Country

Population Density

Private practice (co)owners were invited to select from a list of five sources of payments for services. The most common source was private pay, followed by private insurance. Fewer SLPs selected Medicare than any of the other sources of payment (see Figure 5). Figure 5. Payment Sources

82% 74%59% 50% 45%

0%25%50%75%

100%

n ≥ 531 Payment sources varied by several characteristics, including type of facility.

♦ Patient private pay ranged from 62% in SNFs to 94% in outpatient clinics or offices (p = .000).

♦ Private health insurance ranged from 65% in home health agencies or clients’ homes to 83% in rehab and pediatric hospitals (p = .015).

♦ Agency or school contract ranged from 13% in rehab hospitals to 63% in home health agencies or clients’ homes (p = .000).

♦ Medicare was reported as a source of payment by as few as 23% of owners and co-owners in pediatric hospitals to 80% of those in SNFs (p = .000).

Payment sources varied by region of the country.

♦ Reimbursement from an agency or school contract ranged from 35% in the Midwest to 66% in the Northeast (p = .000).

♦ Medicaid was reported as a source by 46% of owners/co-owners in the Northeast, 54% of those in the West and Midwest, and 70% of those in the South (p = .000).

Population density affected three payment sources.

♦ The range for patient private pay was from 72% in rural areas to 84% in suburban areas (p = .039).

♦ Medicaid ranged from 54% in suburban areas to 57% in metropolitan/ urban areas to 75% in rural areas (p = .002).

♦ Reimbursement from Medicare ranged from 39% in suburban areas to 55% in rural areas (p = .030).

8

ASHA SLP Health Care Survey 2013: Private Practice (Co)owners Medicare Provider

What They Say About ASHA

Cultural and Linguistic Diversity

More than one quarter of the private practice (co)owners have enrolled as Medicare providers (see Figure 6). Figure 6. Medicare Provider

28%

72%

Yes

No

n = 669 The type of facility where the SLPs worked had no effect on whether they had enrolled as a Medicare provider (p = .272). The first question on the SLP Health Care Survey asked about the kind of job the Association is doing in serving its health care members. A few owners/co-owners (3%) said poor, more than one quarter (28%) said fair, more than half (59%) said good, and 10% said excellent (n = 649). Region of the country (p = .437) and population density (p = .319) had no effect on their responses, and both type of facility and years of experience had too few respondents at each level to be able to test for differences. When private practice owners and co-owners were asked how professionally prepared they were, on a 5-point scale, to address cultural and linguistic influences on service delivery and outcomes, 13% said they were very prepared. When very prepared was merged with the next response category, 46% identified themselves as prepared. Too little data were available in some facility categories to test whether responses varied by type of facility.

9

ASHA SLP Health Care Survey 2013: Private Practice (Co)owners Clinical Fellow Mentoring

Interprofessional Collaboration

When asked to refer to a list of five topic areas, most (73%) of the private practice co-owners who responded said that they did not need more guidance from ASHA in order to supervise or mentor clinical fellows. This response ranged from 44% of SLPs in rehab hospitals to 80% of those who worked in home health or clients’ homes (p = .003). Other co-owners needed guidance in the following areas:

♦ 3% acknowledged needing help with the consequence of failing to supervise, 6% with terminating a CF-SLP for cause, and 8% with the required amount of supervision. There were too few owners and co-owners in some categories to test whether facility had an effect on their responses to these topics.

♦ 9% need help with completing the CF report. The range was from 6% of private practice owners and co-owners in home health agencies and clients’ homes to 20% in rehab hospitals (p = .043).

♦ 14% said they needed help with establishing outcomes and performance levels. The range was from 9% of (co)owners in home health or clients’ homes to 33% in rehab hospitals (p = .007).

Interprofessional collaboration was defined in the survey as occurring “when individuals from different fields work together to provide integrated services in a health care environment.” Respondents were asked to identify how frequently they engaged in interprofessional collaboration for each of five services using a 5–point scale where: N = Never L = Less often than monthly M = Monthly W = Weekly D = Daily The service most likely to occur daily with other professionals was treatment (26%). Treatment, clinical team meetings, and patient/family meetings were more likely to occur weekly than in any other time frame. Only documentation was more likely to never occur than to occur at any other interval (see Table 1). Table 1. Interprofessional Collaboration Frequency Service N L M W D

Assessment 15% 26% 17% 25% 17%

Treatment 6% 19% 19% 30% 26%

Documentation 28% 22% 18% 17% 15%

Clinical team meeting 13% 24% 25% 30% 8%

Patient/family meeting 7% 21% 20% 35% 18% n ≥ 660

10

ASHA SLP Health Care Survey 2013: Private Practice (Co)owners Survey Notes and Methodology

Response Rate

Other Reports

Suggested Citation

Resources

The SLP Health Care Survey has been fielded in odd-numbered years since 2005 to gather information of interest to the profession. Members, volunteer leaders, and staff rely on data from the survey to better understand the priorities and needs of SLPs. Results from the 2013 SLP Health Care Survey are presented in a series of reports at www.asha.org:

• Survey Summary Report • Caseload Characteristics • Workforce and Practice Issues • Annual Salary Report • Hourly and Per Visit Wage Report • Survey Methodology, Respondent Demographics, and Glossary

American Speech-Language-Hearing Association. (2013). ASHA SLP

Health Care Survey 2013: Private practice (co)owners. Available from www.asha.org.

Medicare and SLPs in private practice.

www.asha.org/practice/reimbursement/medicare/SLPprivatepractice.htm

Private practice resources. www.asha.org/slp/ppresources.htm

The survey was mailed in February 2013 to a random sample of 4,000 ASHA-certified SLPs who were employed in health care settings in the United States. An e-mail reminder was sent a week later. Second (March) and third (April) mailings followed, at approximately 3- or 4-week intervals, to individuals who had not responded to earlier mailings. The sample was a random sample, stratified by type of facility and by private practice. Small groups, such as pediatric hospitals, were oversampled. Therefore, weighting was used when presenting data to reflect the actual distribution of SLPs in each type of facility within ASHA. Of the original 4,000 SLPs in the sample, 1 was deceased, 10 were retired, 4 had bad addresses, 133 were employed in other types of facilities, 20 were not employed in the field, and 5 were ineligible for other reasons, leaving 3,827 possible respondents. The actual number of respondents was 2,048, resulting in a 53.5% response rate. The results presented in this report are based on responses from the 688 individuals who said they were private practice owners or co-owners.

11

ASHA SLP Health Care Survey 2013: Private Practice (Co)owners

Additional Information

Thank You

For additional information regarding the 2013 SLP Health Care Survey, please contact Gennith Johnson, associate director of Health Care Services, at 800-498-2071, ext. 5681, or [email protected]; Monica Sampson, associate director of Health Care Services, at ext. 5686, or [email protected]; or Janet Brown, director of Health Care Services, at ext. 5679, or [email protected]. To learn more about resources for ASHA members working in health care, visit ASHA’s website at www.asha.org/slp/healthcare. ASHA would like to thank the speech-language pathologists who completed the 2013 Health Care Survey. Reports like this one are only possible because people like you participate. Is this information valuable to you? If so, please accept invitations to participate in other ASHA-sponsored surveys and focus groups. You are the experts, and we rely on you to provide data to share with your fellow members. ASHA surveys benefit you.

8/13/13 12