Recent changes in Medicare reimbursement systems have had a dramatic impact on speech-language pathologists and the patients that they serve. One of the most dramatic changes has been the implementation of the prospective payment system (PPS). PPS is a per-diem based reimbursement system for sub-acute patients (i.e., those coming to the nursing home following a three-night hospital stay). Under PPS, the cost of therapy is included in the overall reimbursement the facility receives for the patient. In this situation, much less money is available for many aspects of patient care, including rehabilitation.

Since the implementation of PPS, therapy services for PT, OT, and SLP have been reduced by approximately 70% in many nursing homes. Currently, most patients with sub-acute conditions participate in only 65 minutes of skilled therapy per day, across all three disciplines.