Back to Basics: Assessment Practices with Neurogenic Communication Disorders In Part I of this Back to Basics article we look at the dilemma of determining appropriate evaluation practices with patients with neurological impairment in light of increasingly limited coverage for assessment time in some settings. We consider ethics, costs, reimbursements, and accreditation standards with regard to patient assessment. In ... Article
Article  |   July 01, 1999
Back to Basics: Assessment Practices with Neurogenic Communication Disorders
Author Affiliations & Notes
  • Lee Ann C. Golper
    University of Arkansas Medical Center, Little Rock
  • Leora Cherney
    Rehabilitation Institute of Chicago
Article Information
Articles
Article   |   July 01, 1999
Back to Basics: Assessment Practices with Neurogenic Communication Disorders
SIG 2 Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, July 1999, Vol. 9, 3-8. doi:10.1044/nnsld9.3.3
SIG 2 Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, July 1999, Vol. 9, 3-8. doi:10.1044/nnsld9.3.3
In Part I of this Back to Basics article we look at the dilemma of determining appropriate evaluation practices with patients with neurological impairment in light of increasingly limited coverage for assessment time in some settings. We consider ethics, costs, reimbursements, and accreditation standards with regard to patient assessment. In Part II we discuss some of the options available for quick and abbreviated testing. We suggest that when time is limited, clinicians select instruments that provide a differential diagnosis and are easily translatable to everyday communicative abilities.
One of the more often repeated complaints from clinicians in recent months relates to the virtual elimination of standardized test batteries in patient assessments. Clinicians feel they no longer are permitted the time to conduct the kind of comprehensive evaluations they were accustomed to and have been trained to conduct. This change is principally blamed on the proliferation of managed care coverage and the implementation of the Budget Reconciliation Act of 1997. It has been suggested that there may be widespread misinterpretation, or misapplication, of the new regulations for reimbursements under the Health Care Financing Administration’s (HCFA) Prospective Payment System (PPS). Some rehabilitation advocates are attempting to gain further clarification. They have indicated that HCFA ultimately will allow for costly tests (such as modified barium swallow examinations) to be exempted from the per diem coverage and that “treatment time” will be interpreted to be any patient-related activity, including evaluations (McCann, 1999; Moore, 1999). The current climate, however, is one in which clinicians feel caught in an ethical dilemma: How do we keep our clinical productivity time largely in the “billable” column and still do all of those “nonbillable” activities essential to quality clinical practices? The obvious answer to that question, as to other ethical dilemmas, is, “just do the right thing.” But, if the right thing was obvious, there would be no dilemma. What is the “right” amount of testing and how do we justify that to our providers/employers? The answer lies with a consideration of a number of factors: ethics, costs, reimbursements, and minimal standards of quality care.
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