“—1—, ft: A PSRO: ITS RELATION T0 SPEECH AND LANGUAGE PATHGLOGY AND AUDIOLOGY SERVICES IN MICHIGAN TImah Ior IIw Degree of M. A. MICHIGAN STATE UNIVERSITY Debra MCLauchIin Osborn I976 :0 v ._ ('4‘. “1 ma: " 5;,0; .A I I t , Matty ,. has V\4! * . ....1-.vu....b-‘L4hu»r..f. 2 .z. ,o.-l 7:»...le- .I....Ivtt:.. . _ . . .... {ac-git n . .. . .lP... [IE . r. A «A». (F55 gin...» Rec Standarc cian he; 0f norms SPEECh a the Comp the pas1 Speech E order tc to these was deve Up norms diStribu These fa. patient I impairedI Fift question provided, ABSTRACT PSRO: ITS RELATION TO SPEECH AND LANGUAGE PATHOLOGY AND AUDIOLOGY SERVICES IN MICHIGAN BY Debra McLauchlin Osborn Recent federal legislation establishing the Professional Standards Review Organization (PSRO) mandated physician and non-physi- cian health care practitioners to become involved in the establishment of norms, standards, and criteria for their professions. The Michigan Speech and Hearing Association, through the Ad Hoc Committee on PSRO and the Committee on Community and Hospital Services has been involved during the past year in attempting to establish a system of peer review for speech and language pathology and audiology in the State of Michigan. In order to perform this task, it was necessary that available data relating to these services in Michigan be collected. As a result, a questionnaire was developed which reflected the kind of information needed in drawing up norms and standards for these professions. The questionnaires were distributed to 113 speech and hearing facilities located in Michigan. These facilities included hospitals, university outpatient clinics, out- patient rehabilitation centers, VA hospitals, State homes for the mentally impaired, and private practice clinics. Fifty-five percent of the questionnaires were returned. The questionnaires were analyzed according to three factors: service provided, clinical setting, and population of the surrounding area. The in ed wit] the du1 to both compani The dat. and aud: in theil Debra McLauchlin Osborn The interaction of these factors with the responses to questions concern- ed with cost of service, number of clients diagnosed and treated, and the duration of treatment was studied. These results may be beneficial to both government supported health programs and private insurance companies for the distribution of their funds to these health programs. The data can also act as an aid to speech and language pathologists and audiologists for the deve10pment of areas of clinical significance in their respective fields. PSRO: ITS RELATION TO SPEECH AND LANGUAGE PATHOLOGY AND AUDIOLOGY SERVICES IN MICHIGAN By Debra McLauchlin Osborn A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF ARTS Department of Audiology and Speech Sciences 1976 ACT Speech 5 Universi Abster o Accepted by the faculty of the Department of Audiology and Speech Sciences, College of Communication Arts, Michigan State University, in partial fulfillment of the requirements for the Master of Arts Degree. Guidance Committee Chairman those j experi mittee Ginsbe ment t S Hospit Hichig in dex DorGEr naire5 thOSe gan w‘ Jeff, the p ACKNOWLEDGEMENTS The author wishes to express sincere appreciation to all of those people without whose help this study and resulting learning experience would not have been possible. First, I wish to extend personal gratitude to each of my com- mittee members, Dr. Daniel Beasley, Mrs. Elaine Bailie, Dr. Paul Ginsberg, and Dr. Leo Deal, for their academic assistance and encourage— ment throughout the preparation of this thesis. Special thanks also goes to the members of the Community and Hospital Services Committee and the Ad Hoc Committee on PSRO of the Michigan Speech and Hearing Association for their help and assistance in devising the questionnaire. Sincere appreciation is offered to Mrs. Doreen Kinnee for her assistance in typing and distributing the question- naires throughout the state. Most importantly, I wish to thank all of those speech and language pathologists and audiologists throughout Michi— gan who took the time to fill out the questionnaire and return it. Finally, I wish to offer my sincere appreciation to my husband, Jeff, for his never ending encouragement, patience, and help throughout the preparation of this thesis. iii ACE LIS LIS CHA III II LIS] APPE TABLE OF CONTENTS ACKNOWLEDGEMENTS . LIST OF FIGURES. LIST OF TABLES . CHAPTER I. INTRODUCTION. Professional Standards Review Organization (PSRO). Anatomy of the PSRO. Duties of PSRO's Non—Physician Health Care Practitioner's Involvement in PSRO Review . Role of Speech Pathology and Audiology as a Health Care Profession . . . . . . Statement of the Problem . II. PROCEDURES. Subjects Questionnaire. III. RESULTS AND DISCUSSION. Cost of Services . Number of Clients Served During 1974 Duration of Services Provided. IV. SUMMARY AND CONCLUSIONS . LIST OF REFERENCES . APPENDIX A. COVER LETTER AND QUESTIONNAIRE. iv Page iii vi 10 10 10 13 14 31 4O 54 57 S8 LIST OF FIGURES Figure Page 1. Anatomy of Professional Standards Review Organizations . . . . 4 Tahl I‘x) IO, 11. Table 10. 11. LIST OF TABLES Average fee per hour for a speech and language pathology evaluation according to clinical setting and population size. . . . . . . . . . . . . . . . . . . . . Average fee per hour for an audiological evaluation according to clinical setting and population size . Frequency distribution of fees per half hour for speech and language treatment according to clinical setting and population size . Frequency distribution of fees per hour for speech and language treatment according to clinical setting and population size . Frequency distribution of fees per half hour for aural habilitative or rehabilitative services according to clinical setting and population size. Frequency distribution of fees per hour for aural habili- tative or rehabilitative services according to clinical setting and population size . Percentage of revenue obtained for Clients with neurolo- gical disorders receiving speech and language pathology services. Percentage of revenue obtained for clients with voice disorders receiving speech and language pathology services. Percentage of revenue obtained for clients with delayed language receiving speech and language pathology ser- vices Percentage of revenue obtained for clients with cleft palate receiving speech and language pathology services Percentage of revenue obtained for clients with function— al articulation disorders receiving speech and language pathology services. vi Page 15 16 17 18 20 . 21 23 25 . 27 28 29 I3. 14. 16. 17. 18. 19. 22. Table Page 12. Percentage of revenue obtained for clients with fluency disorders receiving speech and language pathology ser- vices . . . . . . . . . . . . . . . . . . . . . . . . . . 30 13. Average number of clients evaluated in 1974 by speech and language pathology services according to clinical setting and population size . . . . . . . . . . . . . . . 32 14. Average number of clients treated in 1974 by speech and language pathology services according to clinical setting and population size . . . . . . . . . . . . . . . 33 15. Percentage of clients diagnosed as aphasic during 1974 by speech and language pathology services according to clinical setting and population size. . . . . . . . . . . 34 16. Percentage of clients treated with aphasia during 1974 by speech and language pathology services according to clinical setting and population size. . . . . . . . . . . 35 17. Percentage of clients diagnosed and treated with delayed language during 1974 by speech and language pathology services according to clinical setting and population size. . . . . . . . . . . . . . . . . . . . . . . . . . . 36 18. Percentage of clients diagnosed and treated with cleft palate during 1974 by speech pathology services accord- ing to clinical setting and population size . . . . . . . 37 19. Percentage of clients diagnosed and treated with func- tional articulation disorders during 1974 by speech and language pathology services according to clinical setting and population size . . . . . . . . . . . . . . . . . . . 38 20. Percentage of clients diagnosed and treated with fluency disorders during 1974 by speech and language pathology services according to clinical setting and population size. . . . . . . . . . . . . . . . . . . . . . . . . . . 39 21. Average number of clients evaluated in 1974 by audio- logical services according to clinical setting and population size . . . . . . . . . . . . . . . . . . . . . 41 22. Average number of clients receiving aural habilitative or rehabilitative services in 1974 by audiological ser— vices according to clinical setting and population size . 42 23. Frequency distribution of the length of a speech and language pathology evaluation according to clinical setting and population size . . . . . . . . . . . . . . . 43 vii J a g a e 1 I o I I w M. 5 6 7 / . 7- 75 T Table 24. 25. 26. 27. 28. 29. 30. Frequency distribution of the length of a speech and language pathology treatment session according to clinical setting and population size. Frequency distribution of the duration of treatment for aphasia by speech and language pathology services according to clinical setting and population size . Frequency distribution of the duration of treatment for apraxia by speech and language pathology services according to clinical setting and population size . Frequency distribution of the duration of treatment for dysarthria by speech and language pathology services according to clinical setting and population size . Frequency distribution of the duration of treatment for alaryngeal clients (laryngectomees) by speech and lan- guage pathology services according to clinical setting and population size . Frequency distribution of the duration of treatment for vocal misuse/abuse by speech and language pathology services according to clinical setting and population size. Frequency distribution of the duration of treatment for delayed language by speech and language pathology ser— vices according to clinical setting and population size . viii Page . 45 . 46 . 48 . 49 . 50 . 51 53 about health to sup; XIX (u. 0f thes of 1969 in the the gov Th SUPPOrt resFons develop by a Va SenatOr Standar ticing . of heal and Chi me ms] Il€a1th ( CHAPTER I INTRODUCTION In 1972, there surfaced a growing concern among members of Congress about the continuing increase in the cost of social security supported health programs. In 1969, it cost the federal government $10,894,842,000 to support Titles V (Maternal and Child Health), XVIII (Medicaid), and XIX (Medicare) of the Social Security Act. By 1972, the increase in cost of these programs exceeded 33% over the United States fiscal year figures of 1969. It was suggested that this cost could continue to escalate in the future unless an effective control mechanism was established by the government (Dale, 1974). The need to control the increasing high cost of social security supported health programs became a major concern of federal legislators responsible for drafting national health legislation and health policy development. Several cost-control proposals were offered as alternatives by a variety of sponsors (Dale, 1974). One such proposal, offered by Senator Wallace Bennett, called for the establishment of the Professional Standards Review Organization (PSRO). The PSRO involves licensed prac- ticing physicians in the performance of ongoing review and evaluation of health care services covered under Medicare, Medicaid, and Maternal and Child Health Programs in hospitals and health care institutions. The responsibility of physicians comprising PSRO was to assure that health care paid for under these programs was necessary and of a quality com; PSRO PSRO. indivi that e Securi (m T? Health geogra These Seeret. comparable to professionally recognized standards of care (Michigan PSRO Support Center, 1974). The "Bennett Amendment” to the Social Security Act was adopted into law as Public Law 92-603 by the ninety-second Congress in October, 1972. This law, as stated by Welch (1973), formed a ”basis for greater changes in the practice of medicine than had been provided by any health legislation in the history of the United States" (pg. 291). Professional Standards Review Organization (PSRO) Two basic premises most adequately explain the purpose of a PSRO. First, that health professionals are the most appropriate individuals to evaluate the quality of their services, and secondly, that effective peer review at the local level is the soundest method for securing the appropriate use of health care resources and facilities (PSRO Program Manual, 1974). The PSRO Program Manual (1974) specifies that the Secretary of Health, Education, and Welfare (HEW) is required to designate PSRO geographic areas throughout the United States by January 1, 1974. These initial geographical areas may be altered at any time if the HEW Secretary deems the proprosed changes warranted or necessary. Only a non-profit professional corporation representing a substantial portion of the licensed doctors of medicine or osteopathy, engaged in the prac- tice of medicine or surgery in an established area, may serve as a PSRO. For two years the provisional PSRO will have the opportunity to prove to the HEW Secretary whether or not it can fulfill the function outlined for it. If it does succeed, the provisional PSRO will become a permanent one for that area. If by January 1, 1976, no physician sponsored PSRO has I desir compe state Anato’ I Standg of thi Welfai physic depend Standa in a 5 Secret PhYsic mended PractiT 0f the' the St; data g; (Payne, An: each st. aPPOintw 11 PAYSI Obtain ‘ COuncil. 3 has been formed in a designated PSRO area, the HEW Secretary can designate any organization the Secretary feels has the professional competence to be a PSRO for that area (such as insurance companies, state or local health departments, and so on) (Welch, 1973; Dale, 1974). Anatomy of the PSRO Figure I designates an organizational chart of the Professional Standards Review Organization (Welch, 1973). The primary portions of this PSRO framework are the Secretary of Health, Education, and Welfare (HEW) and the local PSRO. The local PSRO is comprised of physicians and osteopaths ranging from 300 to 2,000 or 3,000 members, depending on the size of the particular area. A state-wide Professional Standards Council is formed when there are three or more PSRO's located in a single state. This state—wide council will be appointed by the HEW Secretary and will be composed of one member from each local PSRO, two physicians recommended by the state medical society, two members recom- mended by the state hospital association, and four other health care practitioners from the state, of which two are recommended by the govenor of the state (Welch, 1973). The State Council coordinates activities of the state's PSRO's, helps the HEW Secretary in the development of uniform data gathering procedures, and assists in evaluating PSRO performance (Payne, 1973). An advisory group, comprised of non—physicians and appointed by each state PSRO, will be formed. In addition, the HEW Secretary will appoint a National Professional Standards Review Council, comprised of 11 physicians (Welch, 1973). This council will advise the HEW Secretary, obtain and distribute data, and evaluate the performance of the state's councils and PSRO's (Payne, 1973). HOSP “€191, D Pro 289 FIGURE I Anatomy of Professional Standards Review Organizations SECRETARY Appoints APPfiimS—i new. I 3 NATIONAL PSR COUNCIL 11 (M.D.s) PSRO Over 50% I of all M.D.s and D.O.s 1‘ COUNCIL others) STATEWIDE PSR + 11 (M.D.s + \ I PSRO PSRO Non-Professional ADVISORY GROUP 7-ll (Non M.D.s) 1L——-—-Appoints PATIENTS HOSPITALS PAID BY S.S. STATE MEDICAL SOCIETY Welch, Dr. Claude E., Professional Standards Review Organizations: The New England Journal of Medicine, problems 289, 291 and prospects. ~295, (1973). Duti to SC HESS ' to be revieu confid h Eventuz Other I Their I Paid fc AS Pay“ determj are med are PFC N0 - ~iflgflh2 Duties of PSRO's As described by Payne (1973), the primary function of the PSRO is to set up guidelines for use in reviewing the necessity and appropriate- ness of health care services. The various PSRO areas must collect data to be used in providing adequate guidelines from which a system of peer review may be established. Data gathered by the PSRO is to remain confidential. Initially, PSRO's will be required to review only institutional care. Eventually, they will review professional activities of physicians and other health care practitioners, both institutional and non-institutional. Their primary concern will be in reviewing those services provided and paid for by Medicare, Medicaid, and Maternal and Child Health programs. As Payne (1973) described, PSRO review procedures will be designed to determine whether physicians and health care practitioner's services are medically necessary, whether the quality of their services meets professional standards, and whether the facility in which these services are provided is appropriate. Non-Physician Health Care Practitioner's Involvement in PSRO Review Health care is not necessarily limited to physician services but is provided also by practitioners of a wide variety of health care disciplines. In the PSRO Program Manual (1974) non-physician health care practitioners are defined as: Those health professionals which (a) do not hold a Doctor“ of Medicine or Doctor of Osteopathy degree, (b) are qualified by education, experience, and/or licensure to practice their profession, and (c) are involved in the delivery of direct patient care for services which are directly or indirectly reimbursed by the Medicare, Medicaid, or Maternal and Child Health programs. (Chapter Seven, Page 31, Section 730.2) resp. are 1 II 1119.851} their again. profes tion I teria, When d1 health review educati Physici 3% No: to Serv C0Unci1: These a< input 01 tiVeS. e Role\Of % As CQmed w: As further stated in the PSRO Program Manual (1974), the PSRO is responsible for assuring that non-physician health care practitioners are involved in the establishment of norms, criteria, and standards for their professions. Norms are defined as the numerical or statistical measures of performance, while criteria are those predetermined elements against which the quality of service may be compared. Standards are professionally developed expressions of the range of acceptable varia- tion from a norm or criterion. The establishment of these norms, cri— teria, and standards remains true for PSRO direct development and also when development is delegated to hospitals. In essence, non-physician health care practitioners will be involved in conducting health care review of their professions, will work with established continuing education programs within their professions, and will participate with physicians in reviewing committee activities where appropriate (PSRQ_ Program Manual, 1974). Non-physician health care practitioners also have the opportunity to serve on advisory groups to State Professional Standards Review Councils and to the PSRO's in the states which do not have Councils. These advisory groups provide an ongoing and formal mechanism for the input of non—physician health care practitioners, hospital representa- tives, and other health care facilities into the PSRO. Role of Speech and Language Pathology and Audiology as a Health Care Profession As explained by Richard J. Dowling (1974) to Senator Herman E. Talmadge, the professions of speech pathology and audiology are con- cerned with: and A hold plete. also a (ASHA) Compet gists ; univers Veteran PTaCtic Th. United 5 Peer TEL 811 Prov able for did not 1 l.ndividue Skills of non‘medlc; 19M). .5 a SYSte fields of: to Medicare ...systems, structures, and functions that make human communication possible, with the causes and effects of delay, maldevelopment, and disturbance of communication, and with the identification, evaluation, and habilitation of individuals with speech, language, and hearing dis- orders (pg. 1). In order to be considered "qualified providers” under Medicare and Medicaid regulations, speech pathologists and audiologists must hold a masters degree in their field of specialization and have com- pleted a year of supervised clinical fellowship. These standards are also among those set by the American Speech and Hearing Association (ASHA) for its members in obtaining the ASHA Certificate of Clinical Competence in speech pathology or audiology. Qualified speech patholo- gists and audiologists serve in clinical settings such as hospitals, university outpatient clinics, outpatient rehabilitation centers, Veterans Administration hospitals, Head Start programs, and private practice (Dowling, 1974). The American Speech and Hearing Association testimony to the United States Senate Finance Committee in 1972 focused on the issue of peer review as related to PSRO. Support was offered for the concept that all providers of medical and health care services should be held account— able for services rendered (Dowling, 1974). The Association, however, did not support a peer review concept which incorporated evaluation by individuals who did not possess the indepth professional knowledge and skills of the specific service being evaluated. Physician evaluation of non-medical health care services was opposed by the Association (Dowling, 1974). As stated by Dowling (1974), the Association specifically support- ed a system in which speech pathologists and audiologists review their fields of specialization as related to those services which they provide to Medicare and other recipients. was t titio profe: Studie In 1975, a six montthSRO contract was awarded to the eleven independent health organizations, belonging to the Coalition of Inde- pendent Health Professions (CIHP) by the Bureau of Quality Assurance (ASHA, 1975). ASHA was chosen by CIHP to administer the grant under the direction of the Bureau of Quality Assurance (BQA). The BQA is a federal organization responsible for administering the PSRO program throughout the country (ASHA, 1975). The purpose of this contract was to implement an educational program for training health care prac- titioners in establishing appropriate PSRO screening criteria for their professional specialties and in conducting medical care evaluation studies (Curlee, 1975). It has been recommended by ASHA that state speech and hearing associations establish committees which will attain norms, criteria, and standards for their areas of practice in the states (Dowling, 1974). The major intention of these committees would be to obtain data related to state services which provide speech, language, and hearing services to recipients of Medicare, Medicaid, and Maternal and Child Health programs. From the compiled date, standards for each state could be devised which would provide a review mechanism for peer assessment of speech pathology and audiology services (Dowling, 1974). As of August, 1974, ten state speech and hearing associations in the United States have created committees for developing appropriate peer review standards for speech pathology and audiology (Dowling, 1974). In Iowa, the Peer Review Committee of the Iowa Speech and Hearing Association has drawn up a method of reviewing speech pathology and audiology services. These professional guidelines were presented at the 1974 American Speech and Hearing Convention. Statement of the Problem To date, no data base exists which describes speech and language pathology and audiology services administered in hospital and clinical settings in the State of Michigan. In order to provide adequate guide- lines from which a system of peer review may be established, norms describing speech, language, and hearing services given to social security supported health programs must be obtained. With the establishment of PSRO, the need now exists to compile current data related to speech, language, and hearing services in Michigan given under Medicare, Medicaid, and Maternal and Child Health programs. The purpose of the present study was to obtain such data with the assistance of the Michigan Speech and Hearing Association (Ad Hoc Committee on PSRO and Committee on Community and Hospital Services). The data were acquired through the use of a questionnaire. Information relating to the following areas were covered on the ques— tionnaire: type of clinical setting, services offered, location and population served, diagnostic and treatment procedures, types of cases accepted, and costs of services. Based upon the data, suggestions were made for developing standards for use in implementing a peer review system for speech and language pathology and audiology services in the State of Michigan. SUbjt Michi servi outpa istra pract compi excep the t Pract ties; deter: (£9841 CHAPTER II PROCEDURES Subjects The subjects of this study were 113 facilities in the State of Michigan which provided speech and language pathology and/or audiology services during 1974. These facilities included hospitals, university outpatient clinics, outpatient rehabilitation centers, Veteran's Admin— istration hospitals, state homes for the mentally impaired, and private practice clinics. The names of the facilities were obtained from lists compiled by the Michigan Speech and Hearing Association. With the exception of universities the name of the facility did not always reflect the type of setting which it represented (agency, hospital, private practice, etc.). Due to this inaccuracy, the specific number of facili- ties in each group to which questionnaires were sent could not be determined. Questionnaire A questionnaire relating to speech pathology and audiology services was distributed to the subjects in July, 1975 (see Appendix A). The ques- tionnaire contained 78 questions which were divided into three main sec- tions. The first section of the questionnaire related to clinical setting information. The questions in this section were used as a means of 10 subca1 cernir clinic Ianguz and la ology pertai staff A) whi in form direct the FE Was tc aDSWe] and/O] allowe the Qt time. Heari, and AC 1118 tl Of the anonlm 11 subcategorizing the data. This section contained seven questions con- cerning the location of the service, population served, and type of clinical setting. The second and third sections related to speech and language pathology and audiology services, respectively. The speech and language pathology section contained 51 questions, whereas the audi— ology section contained 18 questions. Both sections covered information pertaining to diagnosis and treatment procedures, types of cases accepted, staff make-up and cost of service. Included with the questionnaire was a cover letter (see Appendix A) which described the purpose of the study and the importance of the information requested on the questionnaire. Directions were given to the directors of the facilities to answer the question using information from the year 1974. Any question that did not apply to a specific facility Was to be left unanswered. In order to respond to each specific question, answers could be estimated in cases where accurate data were unavailable. The questionnaires were mailed to 113 speech and language pathology and/or audiology facilities throughout Michigan. The subjects were allowed three weeks in which to complete the questionnaires; however, the questionnaires were accepted up until a month after this allotted time. During the three week period, members of both Michigan Speech and Hearing Association committees (Community and Hospital Services Committee and Ad Hoc Committee on PSRO) contacted these facilities by phone, explain- ing the importance of the information needed and answering any questions of the facility representatives. The completed questionnaires were anonymously sent to: Michigan Speech and Hearing Association 724 Abbott Road East Lansing, Michigan 48823 SGTVIL settinl the po than 1‘ questic and tre 12 The questionnaires were then analyzed according to three factors: service provided (speech and language pathology or audiology), clinical setting (hospital, agency, private practice, university, 'other'), and the population of the surrounding area (less than 100,000 or greater than 100,000). The interaction of these factors with the responses to questions which concerned cost of service, numbers of cases diagnosed and treated, and duration of treatment were studied. facilit Nine of the sen reaching vices. the ques Onlj among th< received not anal; gory, it and PTIV; IIOnnair' reSPOndi] hospital: were Sec( In thOse reSpondet CHAPTER III RESULTS AND DISCUSSION From the 113 questionnaires distributed to speech and hearing facilities throughout Michigan, a total of 57 were answered and returned. Nine of the total were returned unopened due to the discontinuation of the service or an address change. This left a total of 104 questionnaires reaching the existing speech and language pathology and audiology ser- vices. Since 57 of these 104 were returned, a 55 percent response to the questionnaire was obtained. Only three clinical settings were analyzed. Universities were not among those facilities analyzed because of the small percentage of return received. The facilities who listed themselves as "other" were also not analyzed. Due to the wide diversity of the facilities in this cate- gory, it was difficult to study them as a "group”. Hospitals, agencies, and private practice were compared since the largest percentage of ques- tionnaires were returned from these settings. Of these three largest responding settings offering speech and language pathology services, hospitals were the largest group with 21 questionnaires returned, agencies tvere second with 8, while private practice ranked third with 4 responses. In those settings which offered audiological services, 13 hospitals responded, 7 agencies, and 6 private practice clinics. 13 (Tabi and I divi: In p< tion: agen< VaIU1 Whicl thes: rEfII tiOn 100,. with 14 Cost of Services The first area examined dealt with the cost of services provided (Tables 1 - 6). Table 1 reflects the average fee per hour for a speech and language pathology evaluation in the three clinical settings as divided into populations greater than 100,000 and less than 100,000. In populations less than 100,000, the costs were similar. In popula— tions greater than 100,000, the cost varied from $9.78 per hour in an agency to $40.00 per hour in a private practice setting. For the mean values, private practice had the highest cost of $33.75 per hour, which was close to the mean hospital cost of $27.70 per hour. However, these values were comparably greater than the mean cost of $18.64 reflected by service agencies. Table 2 shows the average fee per hour for an audiological evalua- tion in the same settings and populations. In populations less than 100,000, agencies had the higher cost of $22.50 per hour for an evaluation with a limited range of $20.00 to $25.00. Hospitals in this group had an average fee of $17.50 per hour but a larger range from O to $40.00. No answer was given to this question by the two private practice settings responding in this population group. In urban populations greater than 100,000, there was a greater difference among the clinical settings for the cost of an audiological evaluation. A much larger cost per hour 'was noted in the private practice setting as compared to the hospitals and agencies. The mean value for these groups showed the hospitals and agencies to have similar fees compared to the private practice group. Table 3 and Table 4 show the frequency distribution of fees per half hour and hour sessions, respectively, for group and individual ffl3eech and language therapy sessions. In the half hour group sessions, Table 15 Table 1. Average fee per hour for a speech and language pathology evaulation according to clinical setting and population size. Private Population Hospital Agency Practice Less than 27.40 27.50 27.50 100,000 (16.00-40.00) (20.00-35.00) (20.00-35.00) (range) Greater than 28.00 9.78 40.00 100,000 (15.00-35.00) (1.60-15.00) (40.00) (range) Mean 27.70 18.64 33.75 (range) (15.00-40.00) (l.60-35.00) (20.00-40.00) Table 16 Table 2. Average fee per hour for an audiological evaluation according to clinical setting and population size. Private Population Hospital Agency Practice Less than 17.50 22.50 N.A. 100,000 (0-40.00) (20.00-25.00) (range) Greater than 26.25 18.33 48.00 100,000 (l5.00-35.00 (0-35.00) (40.00—60.00) (range) Mean 21.88 20.42 48.00 (range) (0-40.00) (0—35.00) (40.00—60.00) N.A. = no answer Table HOSPITA less than 100,0 great< than 100,0( mean AGENCY less than ( 100.00 greate than 100,00 mean pRIYATE PRACTICE 17 Table 3. Frequency distribution of fees per half hour for speech and language treatment according to clinical setting and population size. GROUP INDIVIDUAL less less than $10- $20— than $10— $20- N.A. $10 $20 $30 $10 $20 $30 HOSPITAL less than (7) 50 50 0 40 6O 0 29 100,000 greater than (14) 28 57 14 O 92 8 7 100,000 mean 39 54 7 20 76 4 18 AGENCY less than (4) 50 50 O 50 50 0 0 100,000 greater than (4) O 100 0 67 33 0 0 100,000 mean 25 75 0 58 42 0 0 PRIVATE PRACTICE less than (2) - - - - - — 100 100,000 greater than (2) - - - - - - 100 100,000 mean - - - - - - 100 Answers expressed in percentages N.A. = no answer n=() Tab b-‘HOQ PR1 PR: Table 4. Frequency distribution of fees per hour for speech and language treatment according to clinical setting and population size. INDIVIDUAL less less than $10- $20- $30- than $10- $20- $30- N.A. $10 $20 $30 $40 $10 $20 $30 $40 HOSPITAL less than (7) 25 50 25 0 0 80 20 0 29 100,000 greater than (14) O 57 28 15 0 25 50 25 7 100,000 mean 13 53 26 8 0 52 35 13 18 AGENCY less than (4) 100 0 O 0 67 33 0 0 0 100,000 greater than (4) 67 33 0 0 0 0 100 0 0 100,000 mean 84 16 0 0 34 16 50 0 O PRIVATE PRACTICE less than (2) O 100 0 0 O 50 50 0 50 100,000 greater than (2) - - - - 0 0 100 0 50 100,000 mean 0 100 O 0 O 25 75 0 SO Answers expressed in percentages N.A. = no answer n=() 19 Table 3 indicates that a large percentage of fees were less than $20.00 in the hospital setting. All agency group fees in this category were less than $20.00, with 75 percent of the settings ranging from $10.00 to $20.00 per half hour. No answer was supplied to this question by the private practitioners. In half hour individual sessions, 96 percent of the fees in the hospital setting were less than $20.00. Note that more individual fees ranged from $10.00 to $20.00 than the group fees for this category. No agencies charged more than $20.00 per half hour for individual speech and language treatment, but a greater percentage of group fees were at a higher cost than individual fees. None of the private practice settings responded to this question. Table 4 shows the frequency distribution of fees per hour for group and individual speech and language treatment sessions. In group therapy, the largest percentage of hospital and pri— vate practice fees for treatment was between $10.00 and $20.00 per hour. Agencies had the largest percentage of fees less than $10.00 per hour. Relative to individual therapy, most hospitals charged between $10.00 and $30.00 which was similar to that of the private practitioners. However, in the agencies there is a greater variation in fees extending from less than $10.00 to $30.00 for individual therapy. It is also important to note that 50 percent of the private practitioners did not respond to this question. Table 5 and Table 6 show a similar comparison between the frequency distribution of fees per half hour and hour for group and individual aural habilitative or rehabilitative services. As indicated in Table 5, group fees in the hospital setting show all fees to be less than $20.00 with the largest percentage between $10.00 and $20.00. All agency half hour fees were also less than $20.00, but a larger percentage of the fees were less than 100,0 great! than 100,0( mean AGENCY less than (; 100,00l greate than (, 100,00: mean pRIVATE pRACIICE than 100:001 greate: 100,001 A“Shers M. n : ( ) Table 5. Frequency distribution of fees per half hour for aural habili- tative or rehabilitative services according to clinical setting and population size. GROUP INDIVIDUAL less less than $10- $20— $30- than $10— $20- 330- N.A. $10 $20 $30 $40 $10 $20 $30 $40 HOSPITAL less than (6) 67 33 0 0 50 50 0 0 37 100,000 greater than (3) 0 100 0 0 0 33 67 0 40 100,000 mean 33 67 0 0 25 42 33 O 39 AGENCY less than (2) 50 50 0 0 50 50 0 0 0 100,000 greater than (4) 100 0 0 0 50 50 0 0 40 100,000 mean 75 25 0 0 50 50 0 O 20 PRIVATE PRACTICE less than (0) No response from this population. 100,000 ‘ greater than (5) - - — - 0 33 67 0 20 100,000 mean No answer 0 33 67 0 20 Answers expressed in percentages N.A. = no answer n = ( l 21 Table 6. Frequency distribution of fees per hour for aural habilitative or rehabilitative services according to clinical setting and population size. GROUP INDIVIDUAL less less than $10- $20- $30- than $10~ $20- $30- N.A. $10 $20 $30 $40 $10 $20 $30 $40 HOSPITAL less than (6) 67 0 33 O 40 20 40 0 37 100,000 greater than (3) O 0 0 100 0 0 0 100 40 100,000 mean 33 O 17 50 20 10 20 50 39 AGENCY less than (2) O 100 0 0 0 100 0 O 0 100,000 greater than (4) 100 0 0 0 33 0 67 0 40 100,000 mean 50 50 0 0 17 50 33 0 20 PRIVATE PRACTICE less than (0) No response from this population. 100,000 greater than (5) - - - — 0 0 33 67 20 100,000 mean No answer. 0 0 33 67 20 Answers expressed in percentages N.A. = no answer n = ( ) 22 less than $10.00. No answer was given for group fees by private practi- tioners. In individual sessions, 33 percent of the hospital fees were greater than $20.00 per half hour. None of the agencies charged over $20.00. Private practice settings greater than 100,000 responded with their range of individual fees between $10.00 and $30.00, with 67 percent ranging from $20.00 to $30.00 In Table 6 the frequency distribution of fees per hour for group sessions indicates a large variation in hospital fees with 33 percent charging under $10.00 and 67 percent charging between $20.00 and $40.00 per hour. The agencies all charged less than $20.00 per hour. No group fees per hour were given by those private practitioners responding to the question. In individual sessions, fees were again largely varied in the hospital setting. Agency fees were also variable but all under $30.00, whereas private practice fees ranged from $20.00 to $40.00 per hour. Numerous questions were asked about the percentage of revenue ob- tained for clients with various disorders receiving speech and language pathology services. These disorders included neurological problems, voice problems, delayed language, cleft palate, functional articulation problems, and dysfluency problems. Table 7 through Table 12 reflect the percentage of revenue obtained for these disorders. Table 7 reflects the percentage of revenue obtained for clients with neurological dis- orders receiving speech and language pathology services. Seventy-one percent of the hospital—treated clients, whose ages ranged from 0 to 25 years, obtained revenue from third party payers. This left only 29 per- cent of these clients requiring private patient patyment. Likewise, clients in this age range treated by private practitioners used 100 percent 23 Table 7. Percentage of revenue obtained for clients with neurological disorders receiving speech and language pathology services. 0 — 2. Years 26 - 64 Years 65 Years 5 Older G PI A PP NA G PI A PP NA G PI A PP NA HOSPITAL less than (7) 4 ll 57 28 43 0 S7 13 30 29 90 5 0 5 29 100,000 greater than(l4) 100,000 to O 35 15 3O 1 27 47 8 18 1 82 11 2 6 1 mean 12 23 36 29 22 13 52 11 24 15 86 8 1 5 15 AGENCY less than (4) 50 0 35 15 75 50 0 35 15 75 80 10 0 10 75 100,000 greater than (4) 0 0 O 100 75 - - - - 100 - - - - 100 100,000 mean 25 O 18 57 75 50 O 35 15 88 80 10 O 10 88 PRIVATE PRACTICE less than (2) - - - - 100 - - - - 100 - - - - 100 100,000 greater than (2) 5 95 5 O 50 60 20 10 10 50 95 5 5 0 50 100,000 mean 5 95 5 O 75 60 20 10 10 75 95 5 5 0 75 G = Government Health Insurance Carriers Answers expressed as percentages PI = Private Health Insurance Carriers n = ( ) A = Agencies = Private Patient Payments = no answer 24 of their revenue from third party payers. Agencies, however, showed 57 percent of their clients requiring private patient payment, with only 43 percent receiving third party reimbursement. In the 26 to 64 year age range, 76 percent of the clients treated in hospitals and 90 percent treated by private practitioners received third party payment for speech and language treatment of neurological disorders. Clients treated in agencies received 85 percent third party reimbursement. In the 65 year and older age group, 95 percent of these clients treated in hospitals, 100 percent treated by private practitioners, and 90 percent treated by agencies received third party payment. In should be further noted that several of the agencies and private practitioners left this question unanswered. Table 8 reflects the percentage of revenue obtained for clients with voice disorders receiving speech and language pathology services. Thirty- two percent of the clients whose ages ranged from 0 to 25 years treated in hospitals obtained revenue from third party payers. Note the differ- ences in the amount of third party reimbursement received in hospital settings of less than 100,000 as compared to those hospital settings greater than 100,000. In agencies, clients in this age range received 50 percent of their revenue from third party payers, leaving 50 percent requiring private patient payment. Private practitioners obtained 35 percent of their revenue from third party payers. In the 26 to 64 age range, 48 percent of the clients treated in hospitals and 0 percent by agencies received third party reimbursement. Clients treated by private practitioners received 60 percent of their revenue from third party payers. Of those clients in the 65 year and older age group, 90 percent of those clients treated in hospitals, 90 percent treated by agencies, and 90 25 Table 8. Percentage of revenue obtained for clients with voice dis- orders receiving speech and language pathology services. 0 - 25 Years 26 - 64 Years 65 Years 8 Older TPP PPP 0 NA TPP PPP 0 NA TPP PPP 0 NA HOSPITAL less than (7) 45 55 0 43 45 55 O 43 90 10 0 71 100,000 greater than (14) 18 82 0 36 51 49 0 29 91 9 0 57 100,000 mean 32 68 0 4O 48 52 O 36 90 10 O 64 AGENCY less than (4) 50 50 O 75 0 100 0 75 90 10 O 75 100,000 greater than (4) - - - 100 - - - 100 - - - 100 100,000 mean 50 50 O 88 0 100 O 88 9O 10 O 88 PRIVATE PRACTICE less than (2) - — - 100 - - - 100 - - - 100 100,000 greater than (2) 35 65 O 0 6O 40 O 50 90 10 O 50 100,000 mean 35 65 O 50 60 40 O 50 90 10 0 50 Answers expressed in percentages n = ( ) TPP = Third Party Payment PPP = Private Patient Payment 0 = Other 26 percent treated by private practitioners received reimbursement for voice disorders. The percentage of revenue obtained for clients with delayed lan- guage is indicated in Table 9. Hospitals and agencies showed a similar mean value of 31 percent and 38 percent, respectively, from third party payment. However, a wide variance in the values is noted in the popula- tion groups within these categories. Private practitioners show a larger percentage receiving third party payment in comparison to the other two categories. Table 10 designates the percentage of revenue obtained for those clients with a cleft palate. In hospitals, 68 percent received third party payment, whereas 50 percent of those clients treated in agencies received third party reimbursement. Again, a variation within the two categories is noted in population groups. Private practitioners did not respond to this question. The percentage of revenue received for clients with functional articulation disorders receiving speech and language pathology services is cited in Table 11. Hospitals received the least percentage (14 per- cent) of third party payment. However, 30 percent of their revenue was obtained through "other” sources. These values combined were close to the reimbursement by third party payment received in agencies (38 per- cent) and in private practice (49 percent) settings. Lastly, Table 12 gives the percentage of revenue supplied to those clients with fluency disorders. Again, hospitals received the least percentage of payment from third party payers (44 percent) but surpass the two other settings when the "other" category (13 percent) is added to this value. In agencies, 50 percent of the clients received third 27 Table 9. Percentage of revenue obtained for clients with delayed language receiving speech and language pathology services. Third Private Party Patient Other N.A. Payment Payment HOSPITAL less than (7) 50 48 2 43 100,000 greater than (14) 12 79 9 29 100,000 mean 31 63 6 36 AGENCY less than (4) 75 25 0 75 100,000 greater than (4) 0 100 0 75 100,000 mean 38 62 0 75 PRIVATE PRACTICE less than (2) 80 20 0 50 100,000 greater than (2) 50 SO 0 0 100,000 mean 65 35 0 25 Answers expressed as percentages N.A.: n=() No answer 28 Table 10. Percentage of revenue obtained for clients with cleft palate receiving speech and language pathology services. Third Private Party Patient Other N.A. Payment Payment HOSPITAL less than 100,000 greater than 100,000 mean AGENCY less than 100,000 greater than 100,000 mean PRIVATE PRACTICE less than 100,000 greater than 100,000 mean (7) (14) (4) (4) (2) (2) 96 41 68 3O 57 57 57 100 50 100 50 75 75 75 100 100 100 Answers expressed as percentages N.A. = No answer n=() 29 Table 11. Percentage of revenue obtained for clients with functional articulation disorders receiving speech and language pathology services. Third Private Party Patient Other N.A. Payment Payment HOSPITAL less than (7) 15 35 50 71 100,000 greater than (14) 13 78 9 29 100,000 ' mean 14 56 30 50 AGENCY less than (4) 75 25 0 75 100,000 greater than (4) 0 100 0 75 100,000 mean 38 62 0 75 PRIVATE PRACTICE less than (2) 0 100 0 50 100,000 greater than (2) 98 2 0 0 100,000 mean 49 51 0 25 Answers expressed as percentages N.A. = No answer n=() Table 12. Percentage of revenue obtained for clients with fluency dis- orders receiving speech and language pathology services. Third Private Party Patient Other N.A. Payment Payment HOSPITAL less than 100,000 greater than 100,000 mean AGENCY less than 100,000 greater than 100,000 mean PRIVATE PRACTICE less than 100,000 greater than 100,000 mean (7) (14) (4) (4) (2) (2) 25 44 28 59 43 10 16 13 29 29 29 100 50 100 50 75 75 75 53 53 47 47 100 50 Answers expressed as percentages N.A. = No answer n = ( l 31 party reimbursement and 53 percent of those who were treated by private practitioners received third party reimbursement. Number of Clients Served During 1974 Information pertaining to the number of clients served during 1974 was also sought. Table 13 designates the average number of clients evaulated in the three age categories by speech and language pathology services. In hospitals, a similar mean number of clients was evaluated in all three age groups. Agencies, however, reflect a greater mean number of clients evaluated in the 0 to 25 and 25 to 64 year age cate- gories than in the over 65 year old category. The number of clients evaluated by speech and language pathologists in a private practice setting was much less than the other two settings. This result might have been due, however, to the fact that only 50 percent of the private practitioners responded to the question. Table 14 indicates the average number of clients receiving speech and language treatment during 1974. In hospitals, the largest age group treated were those clients between the ages of 26 and 64 years. In agencies, a large number was treated in the 0 to 25 year group, whereas none was treated in the 65 year and older age group. Small numbers were again indicated by those private practitioners responding, with the largest number treated in the 0 to 25 year category. Tables 15 through 20 designate the number of clients diagnosed and treated within the various disorder groups. Among those were those clients with disorders of aphasia, delayed language, cleft palate, functional articulation, and dysfluency. Of the disorders diagnosed and treated, the largest number of clients who were served fell within the 32 Table 13. Average number of clients evaluated in 1974 by speech and language pathology services according to clinical setting and population size. 0 - 25 26 - 64 65 Years Years Years and Older N.A. HOSPITAL less than 100,000 (7) 24.5 51.0 47.3 43% (range) (1 - 70) (9 — 120) (l - 120) greater than 100,000 (14) 114.2 69.4 78.0 14% (range) (5 - 400) (0 - 300) (O - 200) mean 69.4 60.2 62.7 29% (l - 400) (0 - 300) (0 - 200) AGENCY ’ less than 100,000 (4) 146.0 95.3 34.3 25% (range) (98 - 190) (60 - 150) (0 - 100) greater than 100,000 (4) 128.3 80.0 0 25% (range) (35 - 250) (0 - 200) (0) mean 137.2 87.7 .17.2 25% (range) (35 - 250) (O - 200) (0 - 100) PRIVATE PRACTICE less than 100,000 (2) 5.0 0 1.0 50% (range) (5) (O) (1) greater than 100,000 (2) 33.0 0 O 50% (range) (33) (0) (0) mean 19.0 0 0.5 50% (5 - 33) (0) (0 - 1) Answers expressed as average number N.A. = No answer n=() 33 Table 14. Average number of clients treated in 1974 by speech and language pathology services according to clinical setting and population size. 0 - 25 26 - 64 65 Years Years Years and Older N.A. HOSPITAL less than 100,000 (7) 21.8 53.5 44.3 43% (range) (1 - 60) (4 - 110) (l - 115) greater than 100,000 (14) 63.3 94.8 80.5 14% (range) (1 - 300) (20 - 318) (12 - 250) mean 42.6 74.2 62.4 29% (range) (1 - 300) (4 - 318) (l - 250) AGENCY less than 100,000 (4) 140.0 10.0 0.0 50% (range) (120 - 160) (0 — 20) (0) greater than 100,000 (4) 67.5 37.5 0.0 50% (range) (35 - 100) (0 - 75) (0) mean 103.8 23.8 0.0 50% (range) (35 - 160) (0 - 75) (0) PRIVATE PRACTICE less than 100,000 (2) 5.0 0.0 1.0 50% (range) greater than 100,000 (2) 19.0 0.0 0.0 50% (range) mean 12.0 0.0 0.5 50% (range) (5 - 19) (0 — 1) Answers expressed as average number N.A. = No a n=() nswer 34 Table 15. Percentage of clients diagnosed as aphasic during 1974 by speech and language pathology services according to clinical setting and population size. 0 - 51 — 101 — 151 - greater N.A. 50 100 150 200 than 201 HOSPITAL less than (7) 58 14 14 0 l4 0 100,000 greater than (14) 15 39 15 8 23 7 100,000 mean 37 26 15 4 18 4 AGENCY less than (4) 75 25 0 0 0 0 100,000 greater than (4) 100 0 0 0 0 25 100,000 mean 87 13 0 0 0 13 PRIVATE PRACTICE less than (2) 100 O 0 0 0 50 100,000 greater than (2) 50 50 0 0 0 0 100,000 mean 75 25 0 0 0 25 Answers expressed as percentages N.A.: n=() No answer 35 Table 16. Percentage of clients treated with aphasia during 1974 by speech and language pathology services according to clinical setting and population size. 0 - 51 - 101 - 151 - greater N.A. 50 100 150 200 than 201 HOSPITAL less than (7) 57 29 14 0 0 0 100,000 greater than (14) 14 43 14 22 7 0 100,000 mean 36 36 14 11 3 O AGENCY less than (4) 100 0 0 0 O 0 100,000 greater . than (4) 100 O 0 O 0 25 100,000 mean 100 0 0 0 0 13 PRIVATE PRACTICE less than (2) 100 0 O 0 0 0 100,000 greater than (2) 50 50 0 0 0 0 100,000 mean 75 25 0 O 0 O Answers expressed as percentages N.A. = No answer n = I 1 36 Table 17. Percentage of clients diagnosed and treated with delayed language during 1974 by speech and language pathology services according to clinical setting and population size. DIAGNOSED TREATED less greater less greater than 31- than N.A. than 31- than N.A. 30 7O 71 30 70 71 HOSPITAL less than 60 20 20 29 60 40 0 29 100,000 (7) greater than 66 17 17 14 67 25 8 14 100,000 (14) mean 63 19 18 22 64 32 4 22 AGENCY less than 33 0 67 25 33 0 67 25 100,000 (4) greater than 25 25 50 0 25 50 25 0 100,000 (4) mean 29 13 58 13 29 25 46 0 PRIVATE PRACTICE less than 100 0 0 50 100 0 0 50 100,000 (2) greater than 100 0 0 0 100 0 0 0 100,000 (2) mean 100 0 0 25 100 0 0 25 swers expressed as percentages N.A. = No answer I]: (1 37 Table 18. Percentage of clients diagnosed and treated with cleft palate during 1974 by speech pathology services according to clinical setting and population size. DIAGNOSED TREATED less greater less greater than 31- than N.A. than 31— than N.A. 30 70 71 3O 70 71 HOSPITAL less than 100 0 0 14 100 0 0 14 100,000 (7) greater than 84 8 8 14 100 0 0 14 100,000 (14) mean 92 4 4 14 100 0 0 14 AGENCY less than 100 0 0 25 100 0 0 25 100,000 (4) greater than 75 0 25 0 100 0 O 0 100,000 (4) mean 88 0 12 13 100 0 O 13 PRIVATE PRACTICE less than - - - 100 - - - 100 100,000 (2) greater than 100 0 0 0 100 0 0 0 100,000 (2) mean 100 0 0 50 100 0 0 50 Answers expressed as percentages N.A. = No answer n=() 38 Table 19. Percentage of clients diagnosed and treated with functional articulation disorders during 1974 by speech and language pathology services according to clinical setting and population size. DIAGNOSED TREATED less greater less greater than 31- than N.A. than 31- than N.A. 30 70 71 30 70 71 HOSPITAL less than 100 O 0 14 100 0 0 14 100,000 (7) greater than 82 9 9 21 84 8 8 14 100,000 (14) mean 91 5 4 18 92 4 4 l4 AGENCY less than 50 25 25 0 75 0 25 0 100,000 (4) greater than 67 33 0 25 67 33 0 25 100,000 (4) mean 59 29 12 13 71 17 12 13 PRIVATE PRACTICE less than 100 0 0 50 100 O 0 50 100,000 (2) greater than 100 0 0 O 100 0 0 50 100,000 (2) mean 100 0 0 25 100 0 0 50 Answers expressed as percentages N.A. = No answer n=() 39 Table 20. Percentage of clients diagnosed and treated with fluency dis— orders during 1974 by speech and language pathology services according to clinical setting and population size. DIAGNOSED TREATED less greater less greater than 16- than N.A. than 16— than N.A. 15 35 36 15 35 36 HOSPITAL less than 100 0 0 0 100 O 0 0 100,000 (7) greater than 93 0 7 0 93 0 7 0 100,000 (14) mean 97 0 3 0 97 0 3 0 AGENCY less than 75 25 0 0 75 25 0 0 100,000 (4) greater than 100 0 0 25 100 0 0 25 100,000 (4) mean 88 12 0 13 88 12 0 13 PRIVATE PRACTICE less than - — - 100 - - - 100 100,000 (2) greater than 100 O 0 0 100 O O 0 100,000 (2) mean 100 0 O 50 100 0 0 50 Answers expressed in percentages N.A. = No answer n=() 4O aphasia category (Tables 15 and 16). The fewest number of clients served within a specific disorder group was those with the disorder of dysfluency (Table 20). The average number of clients evaluated by audiology services and those receiving aural habilitation or rehabilitation is designated in Tables 21 and 22. Table 21 shows the average number of clients evaluated for audiological services in 1974. In hospitals, the 26 to 64 year age range reflected the largest number of clients evaluated. In the agency setting, the 0 to 25 year category showed a much larger number of clients evaluated than in the older age groups. Private practitioners showed a similar number of clients evaluated in the O to 25 year old category and the 26 to 64 year old category. Agencies and private practice set- tings had a high percentage, respectively, not answering the question. In Table 22 the average number of clients receiving aural habilita- tive or rehabilitative services during 1974 is shown. In the hospital setting, the largest age group served were those between 26 and 64 years of age. In agencies, the largest age group which received aural rehabili- tation was the 65 year and older age category. Private practitioners showed a similar number served in the 26 to 64 year age group as compared to those 65 years and older. A high percentage of no response to the question was reflected in the agency setting. Duration of Services Provided The final area of analysis for the study was the duration of the services provided by speech and language pathology services. Table 23 reflects the frequency distribution of the average length of a speech and language pathology evaluation in the three clinical settings according Table 21. Average number of clients evaluated in 1974 by audiological services according to clinical setting and population size. 0 - 25 Years 26 — 64 65 Years Years and Older HOSPITAL less than 100,000 (8) 256 (range) (0 - 900) greater than 100,000 (5) 410 (range) (20 - 1,200) mean 222 (range) (0 - 1,200) 348 125 (40 - 1,000) (50 - 300) 550 158 (O - 1,920) (0 - 360) 449 142 (0 - 1,920) (0 - 360) AGENCY less than 100,000 (2) - (range) greater than 100,000 (5) 833 (range) (250 - 2,000) mean 833 (250 - 2,000) 83 67 (0 - 250) (0 - 200) 83 67 (0 - 250) (0 - 200) 100% PRIVATE PRACTICE less than 100,000 (1) - (range) greater than 100,000 (5) 713 (range) (250 - 1,500) mean 713 (range) (250 - 1,500) 600 263 (300 - 800) (200 - 400) 600 263 (300 - 800) (200 - 400) 100% Answers expressed as average number N.A. = No answer n = ( ) Table 22. Average number of clients receiving aural habilitative or rehabilitative services in 1974 by audiological services according to clinical setting and population size. 0 - 25 26 - 64 65 Years Years Years and Older N.A. HOSPITAL less than 100,000 (6) 39.8 55.8 14.4 20% (range) (0 - 120) (1 - 175) (0 - 40) greater than 100,000 (3) 34.5 139.0 41.5 33% (range) (30 - 39) (70 - 208) (13 - 70) mean 37.2 97.4 28.0 27% (range) (0 - 120) (l - 208) (0 - 70) AGENCY less than 100,000 (2) - — - 100% (range) greater than 100,000 (4) 17.5 32.5 76.0 50% (range) (10 - 25) (15 - 50) (2 - 150) mean 17.5 32.5 76.0 75% (range) (10 - 25) (15 - 50) (2 - 150) PRIVATE PRACTICE less than 100,000 (0) No response for this population. (range) greater than 100,000 (5) 26.3 45.0 43.8 20% (range) (5 - 75) (20 - 75) (10 — 100) mean 26.3 45.0 43.8 20% (range) (5 - 75) (20 - 75) (10 - 100) Answers expressed as average number N.A. = No answer n=() 43 Table 23. Frequency distribution of the length of a speech and language pathology evaluation according to clinical setting and popula- tion size. HOURS 1/2 1 l-l/2 2 greater N.A. than 2 HOSPITAL less than 5 39 22 23 11 29 100,000 (7) greater than 9 50 25 15 1 1 100,000 (14) mean 6 45 24 19 6 15 AGENCY less than 17 30 23 25 5 25 100,000 (4) greater than 20 26 6 44 4 0 100,000 (4) mean 19 28 15 34 4 13 PRIVATE PRACTICE less than 0 62 38 0 0 0 100,000 (2) greater than 0 90 10 0 0 50 100,000 (2) mean 0 76 24 O 0 25 Answers expressed as percentages N.A. = No answer n=() 44 to the two population groups. In hospital settings, a variation was noted in the duration of the evaluation where the larger percentage was at one hour. A variation was also seen in the agency setting with the greater mean percentage showing a two hour evaluation to be the most frequent. In contrast, the private practice settings showed evaluations to be within the 1 to 1 1/2 hour range, with the larger percentage of evaluations being one hour in length. Table 24 shows the frequency distribution of the average length of a speech and language pathology treatment session in the same settings and populations. In the hospital setting, all sessions ranged from one half hour to 1 1/2 hours, with 69 percent of these sessions lasting one half hour. A slightly larger variation was noted in the agency setting with sessions scheduled between a half hour to two hours. Again the majority of sessions (58 percent) were a half hour long. In contrast, the private practitioners' mean duration of a treatment session ranged from a half hour to an hour, whereby 97 percent of these sessions were one hour in length. Various questions in this study called for data relating to the average duration of treatment by speech and language pathology services for clients with specific disorders. Tables 25 through 30 reflect the frequency distribution of the duration of treatment for clients with disorders of aphasia, apraxia, dysarthria, alaryngeal conditions (laryngectomees), vocal misuse/abuse and delayed language. In Table 25 clients with the disorder of aphasia who were treated in a hospital showed a mean range of treatment lasting from 0 months to 1 1/2 years. The largest percentage (47 percent) laid within the 4 to 8 month range. The same disorder treated in an agency setting showed a duration from 45 Table 24. Frequency distribution of the length of a speech and language pathology treatment session according to clinical setting and population size. HOURS 1/2 1 1-1/2 2 greater N.A. than 2 HOSPITAL less than 77 21 2 0 0 14 100,000 (7) greater than 60 40 O 0 0 0 100,000 (14) mean 69 30 1 O 0 7 AGENCY less than 65 33 2 0 O 25 100,000 (4) greater than 51 36 1 12 O 0 100,000 (4) mean 58 35 1 6 0 13 PRIVATE PRACTICE less than 0 100 0 0 O 0 100,000 (2) greater than 5 95 0 O 0 50 100,000 (2) mean 3 97 O 0 0 25 Answers expressed as percentages N.A. = No answer n=() 46 Table 25. Frequency distribution of the duration of treatment for aphasia by speech and language pathology services according to clinical setting and pOpulation size. 0-3 4-8 9-12 1 - 1-1/2 1-1/2 - 2 greater M0. M0. M0. Years Years than 2 N.A. years HOSPITAL less than (7) 0 57 14 29 O 0 0 100,000 greater than (14) 29 36 14 21 O 0 0 100,000 mean 14 47 14 25 0 0 0 AGENCY less than (4) 0 34 66 0 0 0 25 100,000 greater than (4) 0 33 0 0 33 33 25 100,000 mean 0 34 33 0 17 17 25 PRIVATE PRACTICE less than (2) O 0 50 0 0 50 0 100,000 greater than (2) 0 100 0 0 O 0 50 100,000 mean 0 50 25 0 0 25 25 Answers expressed in percentages N.A. n= () = No answer 47 4 months to over 2 years. The highest percentage of treatment (34 percent) lasted from 4 to 8 months in agencies. The private practitioners indicated an average range of treatment for this dis- order from 4 months to over 2 years. The larger percentage served (50 percent) was similar to the other settings, and the average duration of treatment was 4 to 8 months. The frequency distribution of the duration of treatment for apraxia by Speech and language pathology services is shown in Table 26. A wide variation in the average duration was noted in the hospi— tal setting with the largest percentage within the 4 to 8 month range. Agencies again showed a variation in duration with the majority of treatment lasting from 9 to 12 months. Private practitioners showed the least variation in duration with treatment ranging from 4 months to 1 year. Fifty percent of the apraxic clients treated in this setting received their therapy for a duration of 4 to 8 months, while the remaining 50 percent were treated for 9 to 12 months. Table 27 shows the frequency distribution of the duration of treatment for the disorder of dysarthria. In hospitals, the greatest percentage of clients (43 percent) were treated for 4 to 8 months, whereas agencies indicated their average duration (50 percent) to be from 9 to 12 months for this disorder. All private practitioners showed their treatment for dysarthria to last from 4 to 8 months. Tables 28 and 29 reflect the frequency distribution of the dur— ation of treatment for two types of voice disorders. Table 28 repre- sents the average duration of treatment for laryngectomee clients. Both hospitals and agencies showed the largest percentage of treatment lasting from 3 to 6 months for this type of disorder. Private 48 Table 26. Frequency distribution of the duration of treatment for apraxia by speech and language pathology services according to clinical setting and population size. 0-3 4-8 9—12 1 - 1-1/2 1-1/2 - 2 greater Ho. Ho. Mo. Years Years than 2 N.A. years HOSPITAL less than (7) 0 43 28 0 29 0 0 100,000 greater than (14) 29 36 21 0 0 14 0 100,000 mean 14 40 25 0 14 7 0 AGENCY less than (4) O 0 100 0 0 0 75 100,000 greater than (4) 0 33 0 33 0 33 25 100,000 mean 0 17 50 17 0 17 50 PRIVATE PRACTICE less than (2) 0 100 0 0 0 0 50 100,000 greater than (2) 0 0 100 0 0 0 50 100,000 mean 0 50 50 0 0 0 50 Answers expressed in percentages N.A. n= () = No answer ‘- ctr-bun. ' . ‘Ii‘.’ . 49 Table 27. Frequency distribution of the duration of treatment for dysarthria by speech and language pathology services according to clinical setting and population size. 0-3 4-8 9-12 1 - 1-1/2 1-1/2 - 2 greater M0. M0. M0. Years Years than 2 N.A. years HOSPITAL less than (7) 14 57 O 29 0 0 0 100,000 greater than (14) 50 29 7 0 7 7 0 100,000 mean 32 43 4 15 3 3 0 AGENCY less than (4) 0 0 100 0 0 0 50 100,000 greater than (4) 33 0 0 0 0 67 25 100,000 mean 17 0 50 0 0 33 38 PRIVATE PRACTICE less than (2) O 100 0 0 O 0 50 100,000 greater than (2) 0 100 O 0 0 0 50 100,000 mean 0 100 0 0 0 0 50 =(1 Answers expressed in percentages N.A. = No answer 50 Table 28. Frequency distribution of the duration of treatment for alaryngeal clients (laryngectomees) by speech and language pathology services according to clinical setting and popula- tion size. less 1-3 3—6 6-9 9-12 greater than mo. mo. mo. mo. than 1 N.A. 1 mo. year HOSPITAL less than 0 40 60 0 0 O 29 100,000 (7) greater than 17 33 33 17 O O 14 100,000 (14) mean 9 36 46 9 0 0 22 AGENCY less than - - - - - - 100 100,000 (4) greater than 0 0 100 0 0 0 50 100,000 (4) mean 0 0 100 0 0 0 75 PRIVATE PRACTICE less than 0 50 50 0 0 0 50 100,000 (2) greater than - - — - — - 100 100,000 (2) mean 0 50 50 0 O 0 75 Values expresed as percentages N.A. = no answer n=() 51 Table 29. Frequency distribution of the duration of treatment for vocal misuse/abuse by speech and language pathology services according to clinical setting and population size. less 1-3 3-6 6-9 9—12 greater than mo. mo. mo. mo. than 1 N.A. 1 mo. year HOSPITAL less than 0 50 17 35 0 0 14 100,000 (7) greater than 0 69 23 8 0 0 7 100,000 (14) mean 0 60 20 20 0 0 ll AGENCY less than 0 100 0 0 0 0 25 100,000 (4) greater than 0 100 0 0 O O 50 100,000 (4) mean 0 100 O O 0 O 38 PRIVATE PRACTICE less than - - - - - — 100 100,000 (2) greater than 0 100 0 0 0 O 0 100,000 (2) mean 0 100 0 0 O 0 50 Answers expressed as percentages N.A. = No answer n=() 52 practitioners showed all of their clients being treated within the range of 1 month to 6 months. However, there was a high percentage of no response to this question by agencies and private practitioners. For clients with voice disorders due to vocal misuse/abuse, Table 29 indicates a variation from 1 to 9 months for duration of treatment in the hospital setting. The largest percentage of clients treated in this setting (60 percent) were in the l to 3 month category. Both agencies and private practice settings designated 100 percent of their average duration of service with these clients to be from 1 to 3 months. Lastly, Table 30 indicates the frequency distribution of the aver- age duration of treatment for disorders of delayed language. In all settings a wide variation in the average duration of treatment was indicated. Both agencies and private practice settings showed the duration of treatment to be longer as compared to the duration of treatment in a hospital setting. 53 Table 30. Frequency distribution of the duration of treatment for delayed language by speech and language pathology services according to clinical setting and population size. 0—3 3—6 6-9 9-12 1 - 1-1/2 - greater Ho. Ho. Mo. Mo. l-l/2 2 than 2 N.A. Years Years HOSPITAL less than (7) O O 50 25 25 0 0 43 100,000 greater than (14) 26 l7 l7 l7 0 l7 8 14 100,000 mean 13 8 33 21 12 9 4 29 AGENCY less than (4) O O 33 33 O O 33 25 100,000 greater than (4) 0 0 25 O 25 25 25 0 100,000 mean 0 0 29 l6 l3 13 29 13 PRIVATE PRACTICE less than (2) O O O O O 0 100 50 100,000 greater than (2) O O 50 50 0 O O 0 100,000 mean 0 O 25 25 O 0 50 25 Answers expressed as percentages N.A. = No answer n=() CHAPTER IV SUMMARY AND CONCLUSIONS The implications for these compiled data are numerous. First, these data are the first to be gathered in the State of Michigan for speech and language pathology and audiology services. From these data, a more relevant system of guidelines and criteria for developing stan- dards for these professions can be devised to reflect differences which may occur according to various populations, clinical settings, and so on. Particular questions from this questionnaire can also serve as a source for speech and language pathology and audiology facilities for keeping records of their services throughout the year. Such records and data can serve as an influence to government supported health programs and private insurance companies to distribute their available funds in a more efficient manner. By the same token, these data can act as an aid to the speech and language pathologist and audiologist to serve the primary areas of clinical significance within their respective fields. Although valuable information was accumulated from this study, there were several limitations. First, the length of the questionnaire made it particularly undesirable and difficult for many facility personnel to complete. The speech and language pathology section, containing 51 questions, could have been more effectively condensed. This may have been one factor accounting for a large number of "no 54 55 response” answers within the speech and language pathology section. Also, many facilities throughout the state may not have kept accurate records concerning information requested on the questionnaire, a fact which would also contribute to the large number of "no response” answers to questions. Secondly, since the questionnaires were returned to the Michigan Speech and Hearing Association anonymously, it was not possible to determine which particular facilities did not respond. The facilities identified their service in the questionnaire according to the clinical setting which they felt best described their facility. From the mailing addresses of the various facilities, it was not possible to determine the number of questionnaires sent to each type of clinical setting. Thus, in evaluating the responses of each clinical setting, an accurate determination could not always be made. It was by no means the intention of this study to generalize the results of these data and apply it to State or National speech and language pathology and/or audiology facilities. The significance of the data was to show what differences and similarities can occur in various populations and clinical settings. Although many differences were noted between the various clinical settings and population groups in this study, close similarities were also shown in some situations. One such instance concerned the cost per hour for a speech and language pathology evaluation. As was indicated in Table 1, a similar cost was noted in all three clinical settings in populations less than 100,000 with the average fee ranging from $27.40 to $27.50. Other similarities in the data were shown in the average duration of treatment for vocal misues-abuse clients 56 (Table 29). In all clinical settings and populations, the most frequent duration of therapy ranged from 1 to 3 months. The data presented in this study are only a small amount of the collected data. Many avenues remain open for futher research such as correlation studies comparing facility personnel, diagnoses and treatment procedures, and cost of services. This study will hopefully serve as an aid in developing criteria fbr relevant standards in the professions of speech and language pathology and audiology in relation to PSRO in Michigan. This research can also serve as a basis for the collection of further information with respect to these professions. It was the primary interest of this author that the information collected be used by the Ad Hoc Committee on PSRO of the Michigan Speech and Hearing Association for the purpose of evaluating the existing practiced criteria of these professions and using that information to establish goals for the development of the statewide PSRO. In order to effectively accomplish this task, it is felt that the committee should further inform and educate the professions of speech and language pathology and audiology of the need to establish their own criteria for patient service in their individual facilities. It is felt that PSRO can insure quality patient service at the statewide level only if a system of patient care auditing is established and used at the local level. LIST OF REFERENCES "ASHA Administers PSRO Grant". ASHA, 17, 109-110 (1975). Curlee, Richard E., Letter to PSRO Liaison Representatives of ASHA. January 16, 1975. Dale, Martin G., PSRO: A primer. J. Amer. Med: Assoc., 223, 157-158. Dowling, Richard J., ASHA statement to Senate Subcommittee regarding PSRO. (Letter to Senator Herman Talmadge), May 1, 1974. Dowling, Richard J., Letter to State Association Presidents concerning recent PSRO developments. August 2, 1974. Michigan PSRO Support Center, PSRO: Professional Standards Review Organization (pamphlet). March, 1975. O'Neill, John J., Strandberg, Twila E., National Study of United States Hospital Speech Pathology Services. University of Illinois at Urbana - Champaign. January 10, 1975. Payne, Thomas C., Important to understand what PSRO's mean to you. Medicina, 6—7, (1973). Peer Review Committee of Iowa Speech and Hearing Association, ”Tri-level Peer Review Plan: Disorder Classification System and Example of Professional Service Guidelines”. 1974. United States Department of Health, Education, and Welfare, PSRO Program Manual, March 15, 1974. Welch, Claude E., Professional Standards Review Organizations: problems and prospects. New England J. Med., 289, 291-295 (1973). S7 APPENDIX APPENDIX A COVER LETTER AND QUESTIONNAIRE V1 E] [E1 MICHIGAN SPEECH AND HEARING ASSOCIATION 1500 Kendnle Boulevard East Innsing, Michigan 48823 Phone: (517) 332-5691 July 8, 1975 MICHIGAN STUDY OF SPEECH PATHOLOGY AND AUDIOLOGY CLINICAL AND HOSPITAL SERVICES Dear Speech and Hearing Professionals: As you are undoubtedly aware, recent federal legislation has mandated the establishment of the Professional Standards Review Organization (PSRO) to be applied to medical and health care pro- fessions. As allied health professions, the areas of speech and language pathology and audiology will also be involved in the estab— lishment of standards and guidelines for speech and hearing services. As speech pathologists and audiologists, we have the opportunity for direct and indirect input to advisory boards of local PSRO's. In order to effectively represent our profession we must have some cri— teria or data base which describes the necessity and effectiveness of our services. The Michigan Speech and Hearing Association, through the Ad Hoc Committee on PSRO (Dan Beasley, Chairperson) in conjunction with the Committee on Community and Agency Service (Elaine Bailie, Chairperson), is attempting to establish a system of peer review for speech path- ologists and audiologists in the state of Michigan. In order to perform the task effectively, it is necessary that the committee have available data pertaining to speech and hearing services in Michigan. To this end, the committee has developed the enclosed questionnaire which reflects the kind of information needed. The committee would be most grateful if you would take a few moments to complete the enclosed questionnaire. All responses will be treated confidentially. If you have any questions concerning the questionnaire or the project, please do not hesitate to contact myself, Dan Beasley, or Elaine Bailie at (517) 353-8780, Michigan State University. 58 Michigan Study of Speech Pathology and Audiology —2- Clinical and Hospital Services The questionnaire should be returned by July 24, 1975 to: Michigan Speech and Hearing Association, 724 Abbott Road, East Lansing, Michigan 48823. Thank you for your time and cooperation. Sincerely, Debbie McLauchlin-Osborn Member, Ad Hoc Committee on PSRO Michigan Speech and Hearing Association Elaine Bailie, M.A. Vice—President for Community and Agency Service Member, Ad Hoc Committee on PSRO Michigan Speech and Hearing Association Daniel Beasley, Ph.D. President-Elect Chairman, Ad Hoc Committee on PSRO Michigan Speech and Hearing Association 59 6f) MICHIGAN STUDY OF SPEECH PATHOLOGY AND AUDIOLOGY CLINICAL AND HOSPITAL SERVICES This questionnaire is to be completed by a representative of your speech pathology and/or audiology service for the year 1974. For the first question indicate which area (speech pathology, audiology, or both) is being evaluated on the questionnaire. If any of the following questions do not apply to your services, leave blank, or mark "other" or "not applicable" if indicated. Give an estimate or approximation where necessary. CHECK THE APPROPRIATE ANSWER FOR EACH QUESTION UNLESS OTHERWISE INSTRUCTED. Section 1: Clinical Setting Information 1. This questionnaire is being evaluated for the service (5) of Speech Pathology Audiology Both Speech Pathology and Audiology I I 2. Are your speech pathology and audiology services provided for under separate administrative units? Yes No Not Applicable 3. Which of the following best describes your speech pathology and/or audiology setting? Hospital Private Practice Agency University Other (specify) 4. In what size city is your hospital or clinic located? Less than 10,000 10,001 - 25,000 25,001 — 50,000 50,001 - 100,000 100,001 - 250,000 - 250,000 - 500,000 500,001 -l,000,000 Over 1,000,000 5. Which of the following best describes the location of your hospital or clinic? Urban Suburban Rural 61 6. Rank the following populations in order of frequency treated. (Record "1” for the most frequent, "2" for next most frequent, etc. Record ”0" for populations not treated.) University Rural Industrial Suburban Urban llll 7. What certification does your clinic hold (ETB, PSB, CARF, etc.)? Section II: Speech Pathology Services (Questions 8—59 for Speech Pathology only) 8. What were the number of patients diagnosed in your setting during 1974 of the three age categories? (Fill in number evaluated) Age Range Number Diagnosed (Approximate) 0 - 25 years 26 - 64 years 65 years and older 9. What is the average fee per hour for a speech evaluation at your clinic? 10. What percentage of your speech evaluations are: 1/2 hour in length 1 hour in length 1-1/2 hours in length 2 hours in length More than 2 hours in length 11. What were the number of patients receiving habilitative or rehabilitative services during 1974 for the three age categories? (Fill in number treated) Age Range Number Diagnosed (Approximate) 0 - 25 years 26 - 64 years 65 years and older —— —_—_— -——— 62 What is the average fee per treatment session for speech pathology? Individual Grou L a) 1/2 hour Less than $10.00 $10.01 - $20.00 $20.01 - $30.00 $30.01 - $40.00 More than $40.00 b) 1 hour Less than $10.00 $10.01 - $20.00 $20.01 - 830.00 $30.01 - $40.00 $40.01 - $50.00 More than $50.00 HIHI llll Hill! lllt What percentage of your speech therapy sessions are: 1/2 hour in length 1 hour in length 1-1/2 hour in length 2 hours in length More than 2 hours in length How many speech pathologists comprise your staff? (including yourself, if applicable) Part—time Full-time How many members of your speech pathology staff hold the following as their highest academic degree? B.A. M.A. Ph.D. How many speech pathologists on your staff hold their Certificate of Clinical Competence (CCC) or are completing their Clinical Fellow- ship Year (CFY)? CCC CFY How many speech pathologists on your staff are current members of the American Speech and Hearing Association (ASHA) and/or the Michigan Speech and Hearing Association (MSHA)? (Fill in number) ASHA MSHA A medical referral is always required before a patient can be evaluated for speech services -- All of the time Some of the time None of the time Ill 19. 20. 21. l\) l\) 24. 63 If some of the time, please explain the circumstances below. How often are progress reports written on patients? Weekly Monthly Tri-monthly Semi-annually lllil Annually Other Estimate the percentage of patients you see on an ”inpatient" basis 0 - 25% 25 — 50% 50 - 75% 75 «100% Estimate the percentage of patients you see on an ”outpatient" basis. 0 — 25% 25 - 50% 50 - 75% 75 —100% Of the following problem areas, rank the three most frequently encountered disorders (cerebral palsy; cerebral vascular disease and injury; cleft palate; craniofacial anomalies; diseases and disorders of the central nervous system; diseases, disorders, and trauma of the larynx; mental retardation; others) lst 2nd 3rd Of the following speech and language disorders, which are the most frequently habilitated or treated at your clinic. (prosody, rhythm, articulation, adult language, child language, voice) lst 2nd 3rd anal-5“. 25. 26. 27. 28. 64 How many patients in 1974 were diagnosed as ”aphasic"? More than 226 0 - 25 26 — 50 51 - 75 76 - 100 101 - 125 126 - 150 151 - 175 176 - 200 201 - 225 How many patients in 1974 that were diagnosed as aphasic were seen for treatment? 0 - 25 25 - 50 51 - 75 76 — 100 101 - 125 126 - 150 151 - 175 176 - 200 201 - 225 More than 226 What were the average number of treatment sessions per week for patients diagnosed as aphasic? lllllll I 2 3 4 5 6 7 7 More than What was the average duration of treatment (time from initial treatment session until termination of treatment for an aphasic patient)? 0 - 3 months 4 - 8 months 9 - 12 months 1 - l-1/2 years l-1/2 — 2 years More than 2 years llllll 30. 31. 32. 33. 65 What was the average duration of treatment for an apraxic patient? 3 months 8 months 12 months - l-1/2 years 1-1/2 — 2 years More than 2 years I—IchDO I III!!! What was the average duration of treatment for a dysarthric patient? 0 - 3 months 4 - 8 months 9 - 12 months 1 - l—1/2 years 1-1/2 - 2 years More than 2 years If your most frequently treated neurological disorder was not aphasia, apraxia, or dyarthria: Fill in this question with the neurological disorder that your clinic most frequently treats. (Omit this question if not applicable) What was the average duration of treatment for 0 - 3 months 4 — 8 months 9 - 12 months 1 - 1-1/2 years 1-1/2 - 2 years More than 2 years How often are progress reports written on neurologically disordered patients? Weekly Monthly Tri-monthly Semi-annually Annually Other (please specify) Of those patients with neurological disorders, please estimate the average percentage of revenue obtained through the following sources in the three age categories. Age Range a) 0 - 25 years 1. Government health insurance carriers (Medicare, Medicaid, etc.) % 2. Private health insurance carriers (Blue Cross and Blue Shield, Travelers, etc.) 3. Agencies (Easter Seal, Crippled Children, V.A., Vocational Rehabilitation) 6 o\° 66 o\° 4. Private patient payments I = 100% 5. Cannot determine b) 26 — 64 years 1 Government health insurance % 2. Private health insurance % 3. Agencies % 4 Private patient payments % = 100% 5. Cannot determine c) 65 years and older 1 Government health insurance % 2. Private health insurance % 3. Agencies % 4 Private patient payments % = 100% 5. Cannot determine 34. What do you estimate to be the average yearly cost of speech treatment for a neuropathological disorder? (Include third party payment and patient payment) Less than $1,000 $1,000 - 2,500 $2,500 - 3,000 $3,000 - 3,500 $3,500 - 4,000 $4,000 and above Hill 35. Which of the following neurological disorders do you consider to have the "successful treatment rate." (Record "1" for most successful, ”2" for next most successful, etc. Record "0" for disorders not treated.) Aphasia Apraxia Dysarthria Parkinson's Cerebral palsy Myasthenia Gravis Other (please specify) llllll 36. (Voice Disorders) Rank the following voice disorders in order of frequency treated. (Record "1” for most frequent, etc., "0” for disorders not treated.) Vocal misuse-abuse (Benign tumors of vocal folds) Non-organic dysphonia Alaryngeal dysphonia (Laryngectomies) Neurogenic—myogenic dysphonias Other (please specify) llll 37. 38. 40. 41. 67 What is the average number of hours per week an alaryngeal (laryngectomized) patient is treated? Less than 1 hour 1 hour 2 hours 3 hours 4 hours 5 hours 6 hours 7 hours 8 hours lllllllll More than What is the average duration of treatment for an alaryngeal patient (laryngectomy)? Less than 1 month 1 - 3 months 4 — 6 months 7 - 9 months 9 - 12 months More than 1 year llllH What is the average number of hours p§r_week that a "vocal misuse" patient is treated? Less than 1 hour 2 hours 3 hours 4 hours 5 hours 6 hours 7 hours 8 hours More than What is the average duration of treatment for a patient with a ”vocal misuse” condition? Less than 1 month 1 - 3 months 3 - 6 months 6 - 9 months 9 - 12 months More than 1 year Hill Which age groups are most frequently seen for voice treatment? (Record "1" for most frequent, etc., ”0" for age groups not treated.) Prepuberty Puberty - 20 years 20 - 40 years 40 - 60 years 60 years and older 43. 44. 45. 46. 68 Of those patients seen for voice disorders, indicate average percentage of revenue obtained through the following sources for the three patient age categories. 0 — 25 years Third party payer % Private patient payment % = 100% 26 - 64 years Third party payer % Private patient payment % = 100% 65 years and older Third party payer % Private patient payment % = 100% Cannot determine (Delayed Language) How many patients during 1974 were diagnosed as having a delayed language condition? Less than 10 10 - 3O 31 - 50 51 - 70 71 - 90 91 — 110 More than 110 How many patients during 1974 were treated with a delayed language condition? Less than 10 10-30 31-50 51-70 71-90 91 -110"..— More than 110 What was the average age of those patients receiving delayed language treatment? Under 2 years 2 - 3 years 3 - 4 years 4 - 5 years 5 - 6 years 6 - 7 years Over 7 years Of those patients treated for delayed language, indicate the average percentage of revenue obtained through the following sources: Third party payment Private patient payment Other (be specific) Cannot determine I o\° o\° 47. 48. 49. 50. 51. 69 What is the average number of hours per week that a delayed language patient is treated? Less than 1 hour 2 hours 3 hours 4 hours 5 hours 6 hours 7 hours 8 More than hours What is the average duration of treatment for a delayed language patient? months months - months 9 - 12 months 1 - 1-1/2 years 1—1/2 - 2 years More than 2 years 0010 I~DC7\€N (Cleft palate) How many cleft palate patients were evaluated for speech and language problems at your clinic during 1974? Less than 10 11 - 30 31 - 50 51 - 70 71 - 90 91 - 110 More than 110 How many cleft palate patients were treated for speech and language problems at your clinic during 1974? Less than 10 11 - 30 31 - 50 51 - 70 71 - 90 More than 90 lllll Of those patients with a cleft palate condition seen for speech and language treatment, indicate the average percentage of revenue obtained through the following: Third party payer Private patient payments Other (be specific) o\° 0‘9 Cannot determine 52. 53. 55. 57. 70 (Articulation) What is the average age of patients most fre- quently evaluated for functional articulation disorders? Below 4 years 4 - 8 years 8 - 12 years 12 - 18 years Above 18 years Hi! Do you receive any articulation (functional or organic) referrals from the public schools? yes no How many patients did you evaluate (diagnose) during 1974 with functional articulation problems? Less than 10 More than 110 11 — 30 31 — 50 51 - 7O 71 - 90 91 — 110 How many patients did you treat during 1974 with articulation problems? Less than 10 11 - 30 31 — 50 51 - 7O 71 - 90 More than 90 Of those patients treated for functional articulation problems, indicate the average percentage of revenue obtained through the following: Third party payer Private patient payments Other (be specific) Cannot determine o\° o\° (Dysfluency) How many patients were diagnosed as having fluency problems in 1974? Less than 5 5 - 15 16 - 25 26 - 35 36 — 45 46 - 55 More than 55 lllfill 58. 59. 71 How many patients with fluency problems were treated during 1974? Less than 5 5 - 15 16 — 25 26 - 35 36 - 45 46 - 55 More than 55 Of those treated for fluency problems, indicate the average percentage of revenue obtained from the following: o\° Third party payer Private patients' payments Other (be specific) Cannot determine o\° Section III: Audiology Services (Quesions 60 - 78 for Audiology only) 60. 61. 62. 63. 64. What were the number of patients diagnosed in your setting during 1974 in the three age categories? (Fill in the number evaluated) Age Range Number Diagnosed (Approximate) 0 — 25 years 26 - 64 years 65 years and older What is the average fee per hour for a hearing evaluation at your clinic? A medical referral is required before a patient can be evaluated audiologically -- All of the time Some of the time None of the time If some of the time, please explain the circumstances below: Rank the following physicians according to the frequency with which you receive patient referrals from them. (Record "1" for the most frequent, "2" for the next most frequent, etc.; Record "0" if no referrals are received from any group.) Neurologists Otolaryngologists Pediatricians General Practitioners Psychiatrists Physiatrists Other (specify) IHHI 65'. 66. 67. 68. 69. 70. 72 Rank the following according to the frequency with which you refer patients tg_the following physicians. Neurologists Otolaryngologists Pediatricians General Practitioners Psychiatrists Physiatrists Other (specify) llllll Are aural rehabilitation services available at your clinic? Yes No I If the answer to #66 was yes, check the following aural rehabilitation service(s) that your clinic provides. lipreading auditory training speech conservation hearing and evaluation other (specify) HI! What was the number of patients receiving habilitative or rehabilitative services during 1974 in the three age categories? Age Range Number Treated (Approximate) 0 - 25 years 26 - 64 years 65 years and older What was the average length of a habilitative or rehabilitative treatment session during 1974? 1/2 hour 1 hour Other (specify) What is the average fee per treatment session for aural rehabilitation? Individual I "3 '1 O I: a) 1/2 hour Less than $10.00 10.01 - 20.00 20.01 - 30.00 30.01 - 40.00 40.01 — 50.00 More than $50.00 lllll lllll 71. 72. 73. 74. 75. 76. 77. 73 CT) '1 O C U Individual b) 1 hour Less than $10.00 10.01 — 20.00 20.01 - 30.00 30.01 - 40.00 40.01 - 50.00 More than $50.00 III! III! How many audiologists comprise your staff? (Include yourself if applicable.) Part-time Full-time How many audiologists on your staff hold their Certificate of Clinical Competence (CCC) or are completing their Clinical Fellowship Year (CFY)? CCC CFY How many audiologists on your staff hold the following as their highest academic degree? B.A. M.A. Ph.D. H9w_many audiologists on your staff are current members of the American Speech and Hearing Association (ASHA) and/or the Michigan Speech and Hearing Association (MSHA)? ASHA MSHA How often are progress reports written on patients? Weekly Monthly Tri-monthly Semi-annually Annually Other (Specify) lilll Estimate the percentage of patients you see on an "inpatient" basis. 0 - 25% 25 - 50% 50 - 75% 75 - 100% Estimate the percentage of patients you see on an "outpatient” basis. 75 — 100% 0 — 25% 25 — 50% 50 - 75% 74 Of the following disorders, rank the three most frequently encountered during 1974. (Otitis Externa, Otitis Media, Mastoiditis, Menieres Disease, Otosclerosis, Conductive Hearing Disorders, Sensorineural Hearing Disorders, Mixed Hearing Disorders, Congenital Anomalies of the ear causing impairment, other.) lst 2nd 3rd THANK YOU! 1 ! Itu111111;WillimmmmnI 2373