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hesi Professional Issues practice review
Get Quizlet's official HESI A2 - 1 term, 1 practice question, 1 full practice test
Terms in this set (282)
what are the five elements of evidence-based practice?
2. integrated with practice
3. client preferences and values
4. practitioners' expertise
5. making clinical decisions
what is ASHA's definition of evidence-based practice?
the term evidence-based practice refers to an approach in which current, high-quality research evidence is integrated with practitioners expertise and client preferences and values in to the process of making clinical decisions
what are some scope of practice issues?
1. expansion and contraction of services
2. technological advances
5. academic preparation
6. specialty recognition and its consequences
under what was therapy caps instituted?
the balanced budget amendment of 1997
what was the essential purpose of therapy caps?
cost control mechanism
who administers therapy caps?
centers for medicare and medicaid services (CMS)
what is medicare part b?
outpatient therapy for medicare recipients
when did SLP and PT start sharing a combined cap?
october 1, 2012
how much do SLP and PT share as the therapy cap?
what is in place that could get more money for SLP or PT other than the amount allotted by the therapy cap?
an exception process
why didn't therapy caps work?
people were being denied adequate services
what is the manual medical review process?
GOOGLE; look at slide 5 of lecture 2
what are the main service delivery issues in health care?
2. population demographics
3. cultural diversity in the US
4. patient complexity
5. staffing shortages
what are the main service delivery issues in the schools?
2. caseload vs. workload
3. caseload size
4. expansion of services
5. compliance with federal legislation
what bill targeted health care reform?
the patient protection and affordable care act of 2010
what is a summary of the bill?
1. increasing coverage and accessibility
2. improving health care quality
3. coordinating care more effectively
4. reducing fraud and abuse
how does the patient protection and affordable care act of 2010 increase coverage and accessibility?
health care exchanges
how does the patient protection and affordable care act of 2010 improve health care quality?
1. value-based purchasing vs. fee-for-service
2. physician quality reporting systems (PQRS)
what is fee-for-service?
paying a service regardless of outcome
what are SLPs physician quality reporting systems?
NOMS (national outcome measures)
how does the patient protection and affordable care act of 2010 coordinate care more effectively?
coordinating care among professionals through the ACO (accountable care organizations)
how does the patient protection and affordable care act of 2010 reduce fraud and abuse?
using recovery audit contractors (RACS), which has now been expanded to medicaid
what is EHB?
essential health benefits
what is the relevancy of the patient protection and affordable care act of 2010 to SLPs?
rehabilitation and habilitation services are considered an essential health benefit
what is rehabilitation services?
health care services that help a person keep, get back, or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt, or disabled
what is habilitation services?
health care services that help a person keep, learn, or improve skills and functional for daily activities
what are some future issues across settings?
1. shorter course of treatment
2. increased use of caregiver/parent as therapist
3. increased use of assistants in school-based settings
4. compensation vs. rebuilding
5. increased us of technology: AAC, telepractice
6. changes in reimbursement due to changes in the healthcare system (ACA)
7. higher caseloads
8. staffing shortages: do more with less, adjusting and adapting practice methodologies
what is ASHA's definition of telepractice?
the application of telecommunications technology to delivery of professional services at a distance by linking clinician to client, or clinician to clinician, for assessment, intervention, and/or consultation
what must telepractice services conform to?
professional standards, including Code of Ethics
what is ASHA's Code of Ethics, Principle 1 Rule K state?
clinical services may not be provided solely by correspondence
what does ASHA's Code of Ethics, Principle 1 Rule L state?
telehealth may be practiced where not prohibited by law
what does ASHA's Code of Ethics Principle 11, Rule B state?
clinicians "shall engage in only those aspects of the professions that are within the scope of their competence, considering their level of education, training, and experience"
what is the importance of establishing a code of ethics in any discipline?
it creates a societal link to the discipline and promotes responsibility and accountability on the part of the practioner
what is the definition of ethical?
that which is fair, good, and right
what does ethics govern for SLPs?
our practice and our research
why are codes enforceable?
they are less subjective than oaths and prayers
what are the functions of a code of ethics?
1. establishing the integrity of a profession
2. offering education and professional socialization
3. gaining public trust by explicating the standards of the profession
4. enforcing ethical behavior
how does a code of ethics establish the integrity of a profession?
embracing common core values, reflecting a consensus of all memebers
how does a code of ethics offer education and professional socialization
1. supporting and guiding individuals about what to expect of themselves and one another
2. deterring participation in unethical conduct
3. communicating the values of the profession to students and new professionals for the protection of the public
how does a code of ethics gain public trust by explicating the standards of the profession?
1. safeguarding consumers' welfare
2. by which the public can assess the conduct of the individuals with whom they interact
how does a code of ethics enforce ethical behavior?
1. providing clear statements of expectation
2. guiding professionals to act ethically and avoid unethical behaviors
what are the commonalities of all codes in part 1?
1. preserve human life
2. to prevent the exploitation of others
3. to provide the highest quality of healthcare available
4. to provide services without discrimination
5. to provide emergency services when needed
6. to protect the welfare, dignity, and confidentiality of the persons served
what are the commonalities of all codes in part 2?
1. to provide the highest quality of healthcare available
2. to participate in continuing education
what are the commonalities of all codes in part 3?
1. be a good citizen
2. to encourage public health through healthcare education
3. to promote harmonious relationships with other healthcare professionals
what are the commonalities of all codes in part 4?
1. to promote the interest and ideals of the profession
2. to expose unethical and incompetent colleagues
what are other areas typically addressed in ethical codes?
1. advertising (3)
2. billing (1 & 2)
3. self-aggrandizement (3)
4. conflicts of interest (3)
5. professional courtesy (3)
6. public/media relations (3)
7. employment and supervision of auxiliary personnel (1)
8. use of secret remedies and exclusive methods (3)
what are the 9 most reported ethical dilemmas?
1. documentation lapses
2. employer demands
3. use and supervision of support personnel
4. CF mentoring/student supervision
5. client abandonment
6. reimbursement of services
7. business competition
8. impaired practitioners
9. affirmative disclosures
what are documentation lapses?
signing off on services not rendered
what can employer demands tempt clinicians to do?
how could use and supervision of support personnel become unethical?
when you don't know when/how to use assistants
when could CF mentoring/student supervision become unethical?
student failures and mentor failures
how could reimbursement of services become unethical?
fraud and misrepresentation
how could business competition become unethical?
marketing and competition must not affect the welfare of the patient
what are affirmative disclosures?
what is the role of governance in an association?
primarily to identify and achieve the organization's mission, vision, and its strategic objectives and outcomes
what does a well-structured organization/association have?
vision statements and mission statements
when can ASHA be most successful?
when it is driven by strategic plans that define expected outcomes and have a plan-focused governance structure
what are aspects of a professional organization?
1. it has a scope (local, state, national)
2. its members are defined by a profession
3. it is non-profit
4. there are membership requirements
5. there is an identifiable governance structure
6. it conducts activities to benefit the membership
7. it has a budget which is generate by dues, investments, sales, and affinity programs (credit cared, insurance deals)
8. it has long-term planning strategies (mission statement, objectives, strategic plan)
why should you get involved with a professional organization?
1. to be effective
2. to be visible
3. to be accountable
4. to be part of a continuous learning experience
5. to be marketable commodity to the community
what is ASHA's vision statement?
making effective communication, a human right, accessible and achievable for all
what is ASHA's mission statement?
empowering and supporting SLPs, Audiologist, and SLH scientist by:
1. advocating on behalf of persons with communication and related disorders
2. advancing communication science
3. promoting effective human communication
what is the general structure of ASHA's current governance structure?
board (16 members), president, VPs, Audiology Advisory Council (53 members), SLP Advisory Council (53 members), Ad Hoc and Working committees
what kind of structure did ASHA previously have for governance?
what kind of structure does ASHA now have for governance?
what composed the former governance structure?
Executive Board (13)
Legislative Council (150)
what composes the new structure?
Aud/SLP Advisory Boards
what does the board of directors do?
2. approving policy documents
3. creating and dissolving committees
4. incorporating information from members and stakeholders for quality improvement
what does the advisory councils do?
1. discussing and ranking concerns of the membership and presenting them to the BOD
2. advising the BOD on budgetary and strategic plans and initiatives
3. electing members to ASHA standing committees
4. peer review of policy documents
what was role ambiguity formerly referred to as?
what is role ambiguity?
when one discipline gradually begins to perform/deliver services which are historically within the scope of practice of another discipline
what percent of SLPs consider encroachment a moderately significant problem?
what percent of academic language therapist are perceive to encroach on SLPs?
what percent of OTs are perceive to encroach on SLPs?
what percent of teachers are perceive to encroach on SLPs?
what percent of nurses are perceive to encroach on SLPs?
what percent of reading specialists are perceive to encroach on SLPs?
how vulnerable are language/literacy populations to encroachment?
how vulnerable are ASD populations to encroachment?
how vulnerable are LD populations to encroachment?
how vulnerable are EI populations to encroachment?
how vulnerable are dysphagia populations to encroachment?
what are some reasons encroachment occurs?
1. lack of knowledge of SLPs and their scope of practice (71%)
2. administrative and facility-level policies (71%)
3. changes in our scope of practice and its overlap with others (47%)
4. personnel shortages (47%)
who should address the issue of encroachment?
state licensure boards
individual facilities through development of policies and procedures
what is a possible solution to pressures due to changes in education and healthcare?
what is no teaming?
what is parallel practice?
when each discipline is treating the case independently of the others
what is integrative or interdisciplinary practice?
occurs when team members are reinforcing and responding to each other's goals for the patient
what are some barriers to effective teamwork?
1. lack of time
2. lack of information
3. lack of harmony
what can cause a lack of time?
productivity requirements and other pressures
what is a lack of information?
"what is it that you do again?"
what can cause a lack of harmony?
what is multiskilling?
training one employee to perform/deliver more than on specific service
what are some issues with multiskilling?
1. workforce diversity
2. clinical judgement and accountability
3. educational preparation
4. practitioners preference
7. diverse locations
regarding multiskilling issues, what is the problem with workforce diversity?
others not trained as we are
regarding multiskilling issues, what is the problem with clinical judgement and accountability?
each discipline has it own
regarding multiskilling issues, what is the problem with educational preparation?
different; may need new concepts in education
regarding multiskilling issues, what is the problem with practitioners preference?
we are SLPs by choice, not nurses
regarding multiskilling issues, what is the problem with expanding knowledge and skills?
driven by cost effectiveness and caseload
regarding multiskilling issues, what is the problem with credentialing?
may need to have competency based on credentials that are more broad
regarding multiskilling issues, what is the problem with liability/accountability?
as the lines blur, who gets sued?
regarding multiskilling issues, what is the problem with diverse locations?
rural settings may need multiskilled personnel
regarding multiskilling issues, what is the problem with reimbursement?
payment needs to be addressed
what is vertical substitution?
delegation or adoption of tasks across disciplinary boundaries where the levels of training or expertise are not equivalent between workers
what are examples of vertical substitution?
1. nursing role expanding into prescribing
2. SLP role expanding into endoscopy
3. SLPAs engaging in therapy
4. dentists expanding into cosmetic surgery procedures
what is the difference between vertical substitution and specialization?
vertical substitution occurs across disciplines and specialization occurs within a discipline
what is horizontal substitution?
providers with a similar level of training and expertise, but from different disciplinary backgrounds, undertake roles that are normally the domain of another discipline
what are examples of horizontal substitution?
1. PTs and OTs both working on transfers
2. PTAs and OTAs becoming "general assistants" which blurs the lines between the disciplines
does salary or power change in vertical substitution or horizontal substitution?
what are the pros of the substitution model?
1. has value during times of workforce shortages
2. has the potential for budgetary savings
what are the cons of the substitution model?
1. where the boundaries between disciplines leave room for ambiguity, encroachment can occur
2. very appealing to regulatory issues because the patient gets service, despite shortages, fiscal constraints, etc
what is specialty recognition?
ASHA's method for recognizing and credentialing professionals in areas of expertise
what are the two levels of specialty recognition?
BA + 1 year = basic cert
MA/PhD = advanced certification
what year was speech and audiology recognized as separate professions?
what year was the ad hoc committee charged with looking at specialty recognition?
what year were two scopes of practice, on for SLP and one for Audiology created?
what year was specialty recognition put in place?
what is the purpose of specialty recognition program?
1. consumer protection (main purpose)
2. recognition of advanced skills/knowledge
what is the structure of specialty recognition program?
1. clinical specialty board
2. petitioning group
3. specialty commission
what is the job of the petitioning group?
designs the program/requirements
what is the job of the specialty commission?
administers the plan
what are the prevailing workforce issues in CDS?
1. fiscal constraints
2. staffing shortages in educational and healthcare settings
3. legislation affecting service delivery
4. training of qualified professionals
5. caseload vs. workload approach to practice
what system was fee-for-service moving towards?
prospective payment system
what is HMO?
flat fee paid for whatever services are rendered
what is PPS?
HCF receives a single payment for a single medicare beneficiary to cover a defined period or the entire stay
what is PPS based on?
medical dx, co-morbidities, assessments by professionals
why was PPS introduced into the healthcare setting?
1. as an incentive to be more cost-efficient
how would PPS be more cost-efficient?
it would set limits on reimbursement for care
who was PPS applied to?
inpatient services provided to medicare patients
how did PPS shift payment?
from a retroactive schedule to a prospective schedule
what did the balanced budget amendment of 1997 do?
applied PPS to SNFs OP, acute rehab, and mental health
Section 4523 of the BBA provided authority for CMS to implement a prospective payment system under medicare for who?
1. hospital outpatient services
2. certain part b services furnished to hospital inpatients who have not part a coverage
3. partial hospitalization services furnished by community mental health centers
what are the effects of PPS on the workforce in the healthcare setting?
1. less patients in rehab = less staff = staff reductions
2. leads to burn-out and staff conflict
3. fiscal constraints produce higher productivity demands
4. higher productivity demands can reduce the quality of service
what are fiscal effects in the educational setting?
1. may see it in space allotment
4. most districts need more SLPs than they currently employ except in areas of reduced population density
5. NCLB and IDEA require more SLPs not less
what are some effects of staffing shortages in the educational setting?
1. increased caseload
2. decreased quality of service
3. decreased individual service and more reliance on groups
what are some effects of staffing shortages in the healthcare setting?
1. clinical and reimbursement paperwork
2. insufficient reimbursement for needed patient services
3. current productivity requirements in healthcare settings is 80%, up from 77%
4. salaries affected
5. caseloads affected
what does IDEA stand for?
individuals with disabilities act
what ages does idea apply to?
what is IDEA for?
to provide education of children with disabilities
what are the components of IDEA?
1. no cessation of services due to behavior
3. attorney fees and mediation is regulated
4. discretionary programs
5. personnel standards
what do discretionary programs provide?
funding to educate progessionals
what does personnel standards allow?
the use of "paraprofessionals" who are "appropriately trained and supervised"
what did the rehab act amendment of 1998 do?
vocational rehab for people with disabilities
what did the assistive technology act of 1998 do?
makes the public aware of AAC and the professionals who can train them and/or educate them
what was the intent of NCLB?
to improve student achievement
what were the principal components of NCLB?
1. accountability and results
2. evidence-based practice
3. expand parental options
4. expand local control and flexibility
what were the effects of NCLB on SLP?
1. the use of "highly qualified" teachers and paraprofessionals
2. use of accommodations, modifications, and alternatives
3. assessment of english language learners
4. sanctions for schools identified as in need of improvement, including the provision of supplemental services
5. accountability and adequate yearly progress (AYP)
what is caseload?
number of students with IEPs or IFSPs that school SLPs serve through direct and/or indirect serviced delivery options
what is workload?
all activities required and performed by school-based SLPs
what are examples of workload?
face-to-face, supporting students' educational programs, using best practice approaches, ensuring compliance with federal mandates
what are considered special populations in CSD?
1. the high-risk pediatric populations
4. school-age children
what are these children at high risk for?
2. birth defects
3. failure to thrive
4. developing communication disorders
what places these children in a high risk category?
1. socioeconomic status
2. parental educational level
3. pre-natal, post-natal, peri-natal causes
4. environmental factors: lead in home
5. cultural issues
why are high risk populations a professional issue?
high-risk populations demand greater resources in time, money, and material
what is subtractive bilingualism?
a language is learned and lost and a new one is learned
who are subtractive bilingualism common in?
internationally adopted children
how do children with subtractive bilingualism require different practice standards?
1. typical bilingual standards are not appropriate for this population
2. establish receptive/expressive status within 3 months
3. assess oro-motor skills to rule out their role int he communication disorder
4. use english-language based assessments to establish strengths and weaknesses
5. assist school-age children in obtaining academic modifications as needed
what ways are intellectually challenged and developmentally disabled people special?
1. across the lifespan
2. social skills (pragmatics)
3. language for ADL needs: think functional
what type of therapy approach do intellectually challenged and developmentally disabled people usually receive?
intellectually challenged and developmentally disabled people are covered by what?
SSI and SSD
who cares for intellectually challenged and developmentally disabled people?
caregiver may or may not be parents; living situations usually atypical
what is the highest risk group?
how could a TBI occur?
MVAs and falls
what makes the TBI population special?
has long-term physical, emotional, behavioral, communicative, and cognitive deficits of varying levels of severity
what type of treatment approach is common for those with TBI?
by the year 2030, people over 65 and over will comprise how much of the US population?
what are the most common disorders among the elderly?
3. oral and verbal apraxia
4. laryngeal pathology
5. cognitive-linguistic impairments
what are the service settings for the elderly?
6. free-standing rehabs
in what areas do patients with dementia exhibit?
what type of treatment do patients with dementia receive?
direct or indirect
treating dementia patients is holistic meaning what?
you treat the family, environment, deficit areas if applicable
what populations are underserved?
economically disadvantaged populations, linguistic minorities, institutionalized populations
what percent of the total population in the US is considered poor?
what are considered institutionalized populations?
prisons, psychiatric hospitals, nursing homes
where is a higher incidence of communication disorders across genders found?
how do remote and rural populations usually receive services?
increased use of assistants, telepractice, team appraches
health services are provided to native americans through what?
Indian Health Service (IHS)
SLP services are not routinely offered
audiological and ENT services are offered to native americans how often?
what is the incidence of communication disorders in native americans compared to the rest of the US population?
what type of setting is long-term care considered?
a special setting
how many people are in LTC?
what are service delivery issues for LTC more related to?
what are some issues of home health care?
paperwork, travel, family dynamic, unsafe neighborhoods, competition among agencies for referrals, getting the referral
what are some private practice issues?
education, legislation, marketing, reimbursement, inter-professional relationships, recruitment, supervision
what are the elements necessary to securing employment?
what are some important questions to ask yourself during self-analysis?
1. who am i?
2. what do i want?
3. what will i need to keep my interested?
4. what are my geographic, academic, and clinical limitations?
what are some things to do during your research?
1. use faculty who know you to help you focus your job search
2. what type of clinical fellowship is available?
3. what will your contribution be?
how should you build your networking?
1. form a healthy working relationship with ALL of your field supervisors
2. get to know the other staff at the facilities, schools, institutions where you do your clinical assignments
3. always be collegial
4. ask if new staff is needed
what are some very important and very simple steps to prepare for an interview?
1. prepare your resume
2. advise your references that employers will be calling them. no family or friends
3. your cover letter must show your readiness for the job, your motivation to continue learning, address some strengths that you think may benefit the employer
4. look at interview tips
how should you practice for interviews?
1. role play
what are they looking for at the interview?
intelligence, self-starter, interpersonal skills, clinical skills/experience, interest in continuing education, client-first mentality
what should be your style in an interview?
wear business attire, no slouching, bring a copy of your resume, body language and eye contact
how should you follow-up after an interview?
send a typed "thank you" note within one week, call after one week if you do not get a response from the interviewer, formal offer may come by letter or phone, get everything in writing
what is the traditional definition of autonomy?
working without the need for others
what is the current perspective on autonomy?
maintaining your professional identity and scope of practice
what is ASHA's definition of autonomy?
an autonomous profession is "one which the practioner has the qualifications, responsibility, and authority for the provision of services which fall within its scope of practice"
what must professional autonomy include?
1. formulating standards for preparation for practice
2. a defining scope of practice
3. a code of ethics
4. personal land institutional standards for service delivery
how do autonomy and regulation relate to each other?
independence is comprised by increased governmental and corporate scrutiny and accountability
what are the professional qualifications?
1. ASHA standards
2. state standards
3. JCAHO (joint commission on the accreditation of hospital organizations)
4. ASHA code of ethics
what is referral-based practice?
legislation states that we require a referral and not the supervision of a physician
what is effects of managed care?
(HMOs, PPOs); insurers determine who is eligible to receive treatment and for how long
can private practioners bill CMS for service provided to medicare/medicaid subscribers?
how does interdependence take place in the educational setting?
1. collaborative consultation
3. meaning-based instruction (providing access to the curriculum)
how does interdependence take place in the healthcare setting?
1. managed care integrates services along a product line
2. consequently, all professionals associated with that product line become interdependent
what are grinnell's operatives or four modes of interaction?
1. collaboration by command
2. collaboration by specialist division of labor
3. competitive cold war
4. collegial collaboration
what are grinell's foundational principles?
1. total autonomy is today's world is not possible
2. we need to move from autonomy to interdependence
3. practicing in CSD today is more collaborative in nature vs. independent in nature
4. in order to function we must dispel the myth of independence at the level of practice
what is collaboration by command?
dependence; autocratic, top-down, limited autonomy, except for person at the top
what is specialist division of labor?
mutuality; working within the bounds of their scope of practice; all is well as long as everyone stops there
what is competitive cold war?
negative independence; one profession is dominant and the others are fighting for autonomy; unintentional; occurs during times of rapid change; turf battles develop; energies are funneled into battles and not patient care
what is collegial collaboration?
autonomous interdependence; enhances performance of all involved
what is autonomous interdependence?
the final stage of development in the interdependence model
when does autonomous interdependence work best?
1. when the professionals have complex knowledge and skills
2. where the client needs are diverse
3. where high value of care is demanded
what are the approaches to patient care?
what is the interdisciplinary approach?
the goals of one discipline are reinforced by all the others
what is the transdisciplinary approach?
professionals in on discipline may carry out the activities of the other disciplines while supervised
what is the multidisciplinary approach?
everyone is responsible for their own activities and separate goals are formulated
what are some prevailing threats to autonomy?
1. transdisciplinary issues
2. reimbursement issues
3. organizational re-structuring (role ambiguity?)
4. system fraud and/or abuse
what are some transdisciplinary issues?
1. being asked to do something that is in conflict with your professional judgement
2. role ambiguity
what are challenges to the service delivery in the health care setting?
2. professional challenges
3. corporate compliance
4. the patient protection and affordable care act of 2010
what is challenge with accountability?
1. shift form providing services to producing results/outcomes
2. case management from a results perspective
3. evidenced-based practice
what is the goal of service delivery in a health care setting?
what is the clinicians role in delivering services in a health care setting?
use EBP to obtain the most functional outcome in the shortest amount of time
why was PPS implemented?
1. enforce cost-effective services
2. provide greater accountability (is CMS getting what it pays for?)
what is PPS intended to focus providers on?
PPS covers the ____, while HMOs can cover ______?
individual; more than one person
in an acute care setting, a patient's hospital is governed by what factors?
age, type of insurance, DRG for patient's current complaint
what is DRG?
diagnosis related group
how does DRG work?
each DRG has a payment weight assigned to it, based on the average resources used to treat medicare patients in that DRG
what is the 60% rule for rehab patients according to CMS 13?
60% of all patients admitted must fall within 13 diagnostic categories; they must require intensive multidisciplinary services; the remaining 40% may be admitted with other diagnoses not within the 13 categories; CMS can look back at your discharges and deny payment if you have not met the rule; starting in 2008, co-morbidities were disallowed as determinants for admission under the 60% rule
what are the CMS 13?
2. spinal cord injury
3. congenital deformity
5. major multiple trauma
6. fracture of femur (hip fracture)
7. brain injury
8. neurological disorders
10. active polyarticular rheumatoid arthritis
11. joint inflammation impacting ambulation or ADLs
12. severe or advanced osteoarthritis
13. knee or hip joint replacement (special circumstances apply)
what are examples of neurological disorders?
1. multiple sclerosis
2. motor neuron diseases
4. muscular dystrophy
5. parkinson's disease
what is a inpatient rehab facility (IRF)?
a rehabilitation unit in an acute care hospital
what does PAI stand for?
patient assessment instrument
what does MDS stand for?
minimum data set
what does RUG stand for?
resource utilization group
how soon does a patient admitted into IRF have to be assessed?
how does CMS receive the results of the assessment?
MDS sent electronically
what are patients placed within based on the MDS?
RUG category (very high, high, low)
what does the RUG category determine?
how many minutes of therapy the patient must receive in one 5-day period (time divided by PT, OT, and SLP)
what is FIMS?
functional independence measures
where are FIM scores used?
IRFs, free-standing rehabs, SNFs
what do FIM scores represent?
patient's functioning in categories specific to PT, OT, and SLP
what is the range for FIMS?
7= independent for that skill
0= dependent for that skill
what are FIM scored used to monitor?
change during the rehab stay; readiness for discharge
what is the type of service delivery in acute care settings?
what is done in an acute care setting?
assess patient, write goals, prepare patient for next level care
in an acute care setting, payment for medicare patients is covered by what?
part a and DRGs apply
in an acute care setting, payment for non-medicare patients is based on?
a DRG type of plan
what electronic documentation platform is used for home care services?
OASIS (outcome and assessment information set)
what are some common structured care methodologies for managing outcomes?
1. clinical guidelines
3. clinical pathways
5. disease management
what are some professional challenges in service delivery in health care settings?
1. SLP needs personal skills to navigate the new healthcare environment
2. role ambiguity and multiskilling
3. fluctuations in staffing patterns
what are some skills the SLP needs to navigate the new healthcare environment?
who insures that the HCOs are in compliance with ALL accreditors standards, federal regulations, and stage regulations?
chief compliance officer (CCO)
what is the most important function of the CCO?
to combat fraud
all hospital employees must attend mandatory in-services to learn about what?
legal issues, regulatory issues, ethics, and standard of conduct
how will the patient protection and affordable care act of 2010 affect SLPs practicing in health care?
1. increasing coverage and accessibility (higher caseloads)
2. improving health care quality (stringent documentation and accountability measures)
3. coordinating care more effectively (autonomous interdependence)
4. reducing fraud and abuse (close scrutiny of service delivery)
what are the school-based setting service delivery models?
1. pull-out therapy
2. consultative service
3. classroom collaboration
4. "blast" treatment
6. therapy in a self-contained classroom
what is the traditional school-based setting service delivery model?
what percent of therapy is conducted as pull-out therapy?
what are some aspects of pull-out therapy?
individual or group treatment
what is the consultative service delivery model?
collaborative model in that the SLP works with the classroom teacher or other professionals
what does the consultative service delivery model emphasize?
joint problem-solving among professionals
what type of students does the consultative service delivery work well for?
transitioning students; students that have achieve their IEP goals
can the consultative service delivery be a one time service?
yes, observe the child in the classroom and provide recommendations
what is the classroom collaboration model?
the SLP is present in the room with the classroom teacher
what are the advantages of the classroom collaboration model?
delivery model is consistent with the emphasis on tying the IEP goals to the curriculum (IDEA mandate)
what are the disadvantages of the classroom collaboration model?
1. not good for all disorders (i.e. fluency)
2. created planning and scheduling problems for the SLP who must be efficient due to workload requirements
what are the types of classroom-based services?
1. one teach, one observes
2. one teach, one drift
3. station teaching
4. parallel teaching
5. remedial teaching
6. supplemental teaching
7. team teaching
what is one teach, one observes?
one observes while the other teaches
what is one teach, one drift?
one assumes primary teaching responsibilities while the other assists individual students
what is station teaching?
each teaches at a separate center
what is parallel teaching?
each instructs half the class using the same material
what is remedial teaching?
one presents material while the other re-teaches previously taught material
what is supplemental teaching?
one presents the lesson in a standard format while the other adapts the lesson
what is team teaching?
both share lecturing
what is push in service delivery?
classroom teacher teaches content and SLP facilitates through strategies (curriculum based)
what is blast treatment?
providing short burst of intervention more intensely
what is clustering?
placing 4-5 students who are eligible for SLP services in the same classroom setting and working with them there; efficient way to manage service delivery
what is the self-contained classroom model?
must be LRE for child; typically in are of autism; blurs line of teacher or SLP (teach curriculum from therapeutic perspective)
where do SLP work in school based settings?
preschools, head start, elementary, middle, high, home-based, center-based
what are some critical roles in school based settings?
1. working across all levels
2. serving a range of disorders
3. ensuring educational relevance
4. providing unique contributions to curriculum
5. highlighting language/literacy
6. providing culturally competent services
what are the range of responsibilities in school based settings?
4. program design
5. data collection and analysis
according to federal law, what are the disability categories?
3. emotional disturbance
4. hearing impairment
5. intellectual disability
6. multiple disabilities
7. orthopedic impairment
8. other health impairments
9. specific learning disabilities
10. traumatic brain injury
11. communication impairment
12. visual impairment
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