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SLPs have been screaming for a long time that reimbursement is too low, costs are rising, and access to speech-language pathology services is being threatened. But can we prove it with national data?
In this episode, Jeanette Benigas, PhD/SLP, introduces The Speech Pathology Education, Advocacy and Knowledge (SPEAK) Project and its first major initiative: building a national economic dataset that shows what it actually costs to provide SLP services and turn those numbers into credible national evidence we can use to advocate directly with CMS during the current public comment period.
Jeanette is joined by private practice owner Holly Ellis, MS/SLP, and CPA Cody Underwood to discuss how North Carolina built its own cost analysis, why independent financial analysis matters, and what the national SPEAK Project will measure, including CPT 92507, dysphagia and cognitive services, treatment time, payer mix, Medicare and Medicaid reimbursement, workforce pressures, waitlists, and access to care.
The immediate goal: collect high-quality data from all 50 states (+ DC) and turn that evidence into meaningful advocacy.
Give data. Give dollars. Or do both.
Everything starts at speakproject.net.
Get caught up, wherever you stream podcasts!
#110: CPT 92507 Is Being Deleted? What Every SLP Must Know About the New Speech Therapy Codes
#111: CPT 92507 Q&A for SLPs: Your Questions Answered
#113: CPT 92507 Option B: This Is Our Week to Advocate
#115: CMS's NEW Pediatric G Code Explained: What Every SLP Needs to Know
#116: What the New Speech Therapy Codes Mean for Adult SLPs
#117: The End of CPT 92507: Is Your SLP Documentation Ready?
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Creators and Guests
Host
Jeanette Benigas, PhD/SLP
Host of Fix SLP
What is Fix SLP: Advocacy & Accountability in Speech-Language Pathology?
Fix SLP is an SLP Podcast by Jeanette Benigas, PhD, about advocacy, autonomy, and reform in Speech-Language Pathology. This show exposes credentialing gatekeeping, dismantles CCC requirements, and helps SLPs advocate for change. Each episode equips SLPs with tools to reclaim their profession. Subscribe now and join the movement transforming speech-language pathology. Follow @fix.slp on Instagram and TikTok. Visit fixslp.com.
What's the word I'm going for? Substantive? Somebody answer. Holly, Cody, help me out. I'm going to cut this.
Cody Underwood:Substantial?
Jeanette Benigas:Yeah, let's change it. Welcome to Fix SLP, the podcast shaking up the field of speech language pathology. We're calling out the barriers that hold clinicians back, fixing broken systems that limit our care, and giving the power of our profession back to the people who live it every day. This is where fearless clinicians come together.
Jeanette Benigas:It's time to change the field with our voices, leadership, and advocacy leading the way. So let's fix SLP. Hey everybody, welcome back. It's Jeanette. If you are new here, please check out the show notes.
Jeanette Benigas:I will link up any previous relevant podcasts that have led to what we're going to be talking about today. We will also have a website that you can check out at the end of the podcast, but most of the important stuff, if you want to get caught up, you can find on our social media at FixSLP on Instagram or Facebook. We're just going to jump right into it today. For years, SLPs have been saying the same things. Our reimbursement is too low.
Jeanette Benigas:Our costs keep going up. Practices can't sustain these rates. Clinicians are being asked to do more and more and more with less and less and less, and our services are being undervalued. The question that I have been increasingly asking myself through the AMA process and now the CMS process is: How can we prove all of this? We have been telling stories since February to the AMA.
Jeanette Benigas:Now we're starting to think about the stories that we can tell to CMS. And that's fine, but how can we prove this not with Stories, not with a Facebook thread that someone has posted with 600 comments, not with a survey asking SLPs whether they feel underpaid or a petition making some type of statement. If somebody from CMS, Medicaid, or another payer looks across the table at one of us and says, Show me what it actually costs to provide these services. Can we? And increasingly, I think there is a second question we need to be able to answer: What happens to patients and the workforce when the economics no longer work?
Jeanette Benigas:So right now, we do not have nearly enough national evidence to answer those questions well, and so we're going to build it. Today, I am introducing the Speech Pathology Education Advocacy and Knowledge Project, or the SPEAK Project. We have been working on this behind the scenes very quickly, and I'm really excited about it because there's a lot we're going to do, but our first major initiative is a national economic data project focused on what it actually costs to provide SLP services, and after working through the design, it's becoming more than that. So we also want to understand treatment patterns, payer mix, access to care, waitlist, workforce pressures, and what happens operationally when reimbursement and coding structures change. I have already signed a $50,000 engagement letter to get the national data work underway.
Jeanette Benigas:No, PhDSLP does not have $50,000 So, we'll talk about that later, but this is an actual professional commitment, and we need to raise that pretty quickly. But the $50,000 is not going to be the whole campaign. Once we have the evidence, we need the right legal, regulatory, and advocacy expertise to help us use it, and that next phase will likely require another $100,000 or more. So this is not a $50,000 survey. This is the beginning of a serious national evidence and advocacy effort, and there are two things this profession can give us: money and data.
Jeanette Benigas:And some of you can give us one, some of you can give us the other, and some of you can give us both. So I have two very special guests today that are going to help us launch this. I've told them no pressure. We have Holly Ellis here because she was part of a collaborative group in North Carolina that has already completed a substantial SLP cost data project like the one we're going to do nationally, and their findings and white paper have not been released publicly. They have a powerful data set ready to go.
Jeanette Benigas:I've heard some of those numbers. And the group is just being really strategic about how and when they use it as they watch what happens with CMS. Holly may tell us about some of that. We're not going to tell you their numbers today. We can talk about how this group built the evidence, what they learned about the process, and why having credible data ready before you need it is really powerful.
Jeanette Benigas:Then I have Cody Underwood, the CPA, who worked on that effort and who is leading the financial data side of the SPEAK project. So Holly, I'm going to let you take the mic. Why don't you tell us who you are, and then I have a whole bunch of questions for you. My name is Holly Ellis. I am
Holly Ellis:a private practice business owner. I lead the Triangle Private Practice Owners Group here in Raleigh, North Carolina. I also help lead the NCSTOTPT Pediatric Advocacy Alliance, and I help to work and support the private practice owners committee within the North Carolina Speech- Hearing and Language Association. So the goal here is to be collaborative, bring education, support advocacy across North Carolina.
Jeanette Benigas:Holly and I met at the PhDSLP After Dark meetup in Washington, DC, but Holly was recommended for today by the group that has done this work, so I just thought it was like a full circle moment that I didn't even directly ask you. They said, We think Holly Ellis would be good. I said, I know her. I have her number in my phone. I said, You don't have to introduce us.
Jeanette Benigas:We'll just message her. So, thank you for coming, Holly. Let me ask you, before this project existed in North Carolina, what led the group to realizing anecdotes weren't enough, the stories weren't enough, you needed more than just stories?
Holly Ellis:So getting the data was the most important thing. One of the things that I realized initially during advocacy efforts was to make sure that we had data. We worked with people who said, hey, you know, when you go to talk with the senators, when you go and you talk with the representatives, you need to make sure that you have data to support and back up what you're saying because they are about the numbers. And that data is so important and it's needed. And so I think that that was something that NCSLA has done proactively.
Holly Ellis:And I'm very happy to be a part of that state association and their advocacy efforts and the subcommittee that they have for the private practice owners committee. I mean, they're just amazing, and I'm so thankful that I'm able to support them and that they can support us too.
Jeanette Benigas:I think that reimbursement question really gives you credibility behind what you're doing and what you're trying to fight. So, you recognized that you needed numbers. What took the group from saying, We need the data, to actually deciding what should be collected? How did you guys go about doing that?
Holly Ellis:The private practice owners committee, they met and they came up with a list of items that were needed. And from there, they said, we actually need to look over the data and be able to have things that are looking at all aspects of owning a private practice. And what does that look like on paper? And that's where Cody came in. He was able to help in that way.
Holly Ellis:But these leaders have said, okay, we're not just looking at what it costs to provide a service, but all of the other data that needs to be included. So what are the testing costs? What does it cost for our speech language pathologists, our EMR assistants? Really looking at everything and putting that all together for what that actual reimbursement was.
Jeanette Benigas:Once you launched this, what did you learn about getting busy practice owners to participate? Because that's something I'm a little nervous about is we're gonna talk about numbers here with Cody and how many responses we need. Tell us how many you guys got because I know the number and I am so impressed because you got it in a very short amount of time. What did you learn that you needed to do or how did you get these people who are busy to participate and really give you very sensitive information?
Holly Ellis:So I think one of the things that has been a catalyst here is when private practice centers were just at a space where it's like, we can't take any more cuts. In the state of North Carolina, we had not received a rate increase for over twenty years. So when we got that 3% cut initially within the state of North Carolina, everybody was like, we can't do the 3% cut. And so we used these advocacy efforts. We used social media.
Holly Ellis:There really was a catalyst with Stephanie Molina. She was doing a video. It got shared and viewed over a million times. And people became, they noticed and they became interested and involved. And then we had a platform.
Holly Ellis:And that was one of the things that we used in our NCST OTPT advocacy group, is to to talk to people about, hey, you know, these are changes that are happening now, but we have to continue in that advocacy effort. So social media platforms really helped, spread the word, more in a, you know, again, within the state of North Carolina. But as we saw with the ninety two thousand five hundred seven, taking it to a national level, there's been some really great supports with the speech therapy advocacy Facebook group, PhDSLP. We've seen some real leaders come out from this movement where we're saying, Hey, like we can't take these cuts. And were we actually represented in this survey?
Holly Ellis:And what does that look like for us? And the data and the numbers. And we wanna be made aware. We want to know what's going on. And so I think for the state of North Carolina, our state association worked with us as the members.
Holly Ellis:And I think that that was so meaningful. When members reached out, there was information and they had the private practice owners committee gave a presentation for private practice owners and talked to them about what was needed in order to support this new effort. And, being able to help with ninety two thousand five hundred and seven and the changes that were coming out and helping us get prepared for that. And I still feel like there's so many things that we, as private practice owners, we are just unsure of right now. And that's hard because we're planners and we wanna know, we wanna know what the numbers and the data and what this looks like for us.
Holly Ellis:And the waiting has been, I think, really difficult. But I think there's strength in getting that data and knowing what it is and being able to have somebody that can come to the table to advocate and being on the same page. And I think that's so important that we're coordinated in that way. And that was definitely shown here in the state of North Carolina and our state association during that 3% cut. And when it was time to move, they were able to do it.
Holly Ellis:And they sat up there with other associations and that rate reversal that did go through. And so we were able to get all of that money reimbursed. There's strength in numbers.
Jeanette Benigas:I am always so impressed with the SLPs in North Carolina. First of all, we need to get your association on the pod to do our state by state advocacy talk because they've not done that yet. But I'm going to take people way back to early twenty twenty four, just months after PhDSLP started. Our first win I can't say it was a win that I participated in, but it was PhDSLP inspired. Clinicians in North Carolina heard what we were doing on PhDSLP and they got to work in North Carolina and they were the first state to get their CCC issue figured out and resolved for Medicaid billing.
Jeanette Benigas:You guys are just leaders. I'm so thankful for all of you because we now have a model to use to make this happen quick. We are recording this on August 14. The end of the CMS comment period is September 14. If any of you were around for the AMA stuff, you know that that window closed before we expected.
Jeanette Benigas:So really, we shouldn't wait until the final bell on the fourteenth. We need to have this in a day or two sooner. So we have to go, and you guys have just laid the groundwork for us to step in and just do it again with some modifications. And so I am so thankful for all of you, for the state association, all of you for sharing CODI with us and then getting to see those questions that you used so we could make our own data set out of those. I'm just so impressed.
Jeanette Benigas:As you were making decisions, because now I've been going through this process and we've been trying to decide how to do this, how important was it that the raw financial information that these practices were sharing and providing went to an independent CPA rather than an SLP organization like the State Association?
Holly Ellis:I think really important because those numbers are confidential, they're private, and we don't want any SLP or private practice center to be hesitant about sending those numbers over. It's really important to have that privacy and that separation in that way. So I do feel that having somebody like Cody who's able to take that information, keep things private, but then give us a raw data set that we can then use for negotiations or being able to have the data when we're speaking with people that can make a difference.
Jeanette Benigas:And I know people get so anxious. They want to know what the data says and what do you have, and it's so hard to wait to hear. So, we're not going to be talking any numbers, anything unpublished yet. So, without telling us those unpublished numbers, what kinds of questions can the completed North Carolina analysis now answer or help support.
Holly Ellis:When I was filling out the white paper information for the cost analysis survey, it was something that I had to come back to several times. It did take some time. I had to gather numbers. And you know, and I think that for me, it was quite shocking to see what the actual cost of it running the business. And when I'm looking at all of the things and the components that go along in that data set, and then to see what the reimbursement was from North Carolina State Medicaid, and then what I actually needed was surprising, to say the least, especially because I want everything for my staff.
Holly Ellis:I want to be able to have a nice space for our families to come. I want all of these lovely things. I want to have the right testing protocols. I want to have materials that aren't broken for our families to come and use. And so again, all of these things that we spend money on to have the space for people to be that they can come and get therapy and be able to get the help that they deserve, be able to have that five star quality therapist that has the continued education and has the materials that they need to be able to diagnose and to treat and all of those things cost money.
Holly Ellis:And so I think to see that in the analysis and that survey was pretty extensive, when you're really breaking every single thing down. And that is what that cost analysis did. It looked at everything from travel, administrative support costs, technology, what it costs for staff. And when we think about this over time, all of those costs just continue to rise. Our testing protocols cost more, shipping costs more.
Holly Ellis:I mean, it's just there are things that we want to support our staff and being able to have raises and that they should have that. They have a higher education and they shouldn't stay stagnant at a job for several years. They should be able to be paid for their documentation time. They should be able to grow and into leadership and all of that stuff costs money. And so I think being able to look at a survey and actually analyze all of that data to me was quite shocking when I looked at what the actual reimbursement rates are and then the diversification of our payer sources, whether that was Medicaid or through insurance reimbursements.
Holly Ellis:And when I looked at what the percentage of Medicaid was, was almost half. And so to think of, Oh, that could be decreased and not just decreased by 3% this time, but maybe more. And I think that that was sad, you know, because I want to be able to give our families and our staff everything they deserve.
Jeanette Benigas:-I've talked to some of the other women that you've worked with throughout this AMA and CMS process, was on the phone very, very early with North Carolina. And actually, last week I was on vacation in North Carolina, and what are the chances that the two women I've been talking to the most were like twenty minutes from where I was vacationing. So, I got to go have coffee with them don't tell my kids, but I think it was my favorite part of vacation, was going to meet with them and just get to know them better and talk about what you guys have done, which wasn't the purpose of getting together, but of course that's where we went. And one of them shared that you knew about this before almost anyone else did, and you followed and you stayed on top of it, and you've gone through this process even longer than I have, and it's just, it's powerful. And so, you all know what's happening.
Jeanette Benigas:You are all aware. And so, what does it strategically to have that evidence ready while you're watching all of this, while you're watching what CMS does? You started this before those rates were even out. You started this before you knew if if FixSLP representing SLPs everywhere with a smaller team of business owners was going to win at that table at the AMA. You guys were just collecting data and getting ready and and getting your ammo ready.
Jeanette Benigas:And so now that you know you have this evidence ready, what does it mean strategically for all of you in your state?
Holly Ellis:I can honestly say that I feel so much more confident and hopeful for our state association to have this information. I feel like I have somebody that is in my corner. I feel that for them to have the data and that they've been proactive, we have great private owners committee. And I know Jerry Bates, she was the leader of that private practice owners committee when this started before her retirement. And she really helped in this guidance and as team and collaboration and leaders and business owners that have been through this kind of in negotiations, but then also to have just gone through that 3% rate cut.
Holly Ellis:Here they are leading the way again. And so I feel confident and to see what's going to happen when they take this to our Medicaid and CDHHS. And hopefully, my goal is that we will see not a significant rate reduction. And I know that there should be some expectation of that. But I hope that by having this data and this numbers and their strong advocacy efforts, and the lobbyists that they're also going to hire in addition to what they have done with Cody Underwood, I hopeful and I look forward to seeing what the results are going to be.
Jeanette Benigas:I'm excited too. Hopefully, we'll have you all in the pod along the way just to keep following this story because it's really just incredible. We all know what is happening in the field of speech pathology. So can you share with me what is the difference between knowing something is happening in practices and having the data to demonstrate it?
Holly Ellis:So having the data is very important. The reason that the data is important is because it's going to back up in actual numbers what the reality is. Just like when I looked at that cost survey and I looked at all of those numbers and I said, wow, this number is completely off. And I think that when you look at the data and you say, hey, this isn't congruent, this isn't aligning. It's important for us to remember that not only does the data support what we're asking, but it also is needed when we're going to the table to have these conversations with people that may not be aware of what we're actually spending within a private practice and in order to be able to continue to provide the services that we are providing.
Jeanette Benigas:Right. And no one is coming to save us. If you watch Shark Tank, they drill down numbers down to price per unit of a little piece of plastic, right? And no one knows what we do generally speaking. And so, if no one knows that, no one is going to know what it costs to do what we do, because they don't know what we're doing.
Jeanette Benigas:And it is our job to know those numbers, and maybe not every SLP needs to know those numbers. A clinician fresh out of school isn't responsible for knowing the numbers of who hires her, right? That's the business owner's job. And so this is where it's our job to come together with our numbers to show people what it costs to do what we do. That is our responsibility.
Jeanette Benigas:Yes, it would be nice to have a larger organization that has this stuff ready to go, but we don't have that. And so this is where I'm happy to step in with the platform that I have been growing with all of you over the last three years to say, Let's go. This is why we're here because we know what we all do. We know that we deserve more with master's degrees and higher level education and hours and hours and hours of continuing education to refine our craft. We all know that.
Jeanette Benigas:And now we have to put numbers on a page to show the decision makers in Washington DC how much we actually are worth and what our value is because no one else is doing that. So we're here to save ourselves, and we need to get it done. So, Holly, thank you for sharing all of that. I'm going to pivot over to Cody now to talk about the mechanics of all of this, and why respondents should trust the process if they're thinking about giving numbers. So Cody, before we start going with questions, why don't you tell me who you are and what you do and why you're here?
Cody Underwood:Sure. Thanks Jeanette for having me. So my name is Cody Underwood. I'm a senior manager with Ritchie May. We're a national accounting and professional services firm.
Cody Underwood:I am located here in Raleigh, North Carolina. A lot of what I do is really consulting work. It's taking numbers, breaking them down, trying to find trends, trying to forecast, trying to show budgets, and trying to get things in the right cost buckets, really painting a picture to help the reader understand their internal organization. So that's kind of who I am.
Jeanette Benigas:And someone like you is so important because, yes, I have a PhD, I'm published, I should know about statistics, but I took a statistics series, and I just asked you yesterday, how many statistics classes did you have to take to do all of this? Because you are the pro. Can someone like me run some of this? Yes, but we really need someone who knows how to drill down and do this right. And that's always been who I am.
Jeanette Benigas:If I'm going to do this, I'm going to do it right. And, I'll just say this, you know, if I'm going to buy my kid a needle, we're not getting the one at the dollar store. We're going go find the one that's affordable and real. Okay? So, that's what we did with you.
Jeanette Benigas:You are real. You have a proven track record. And everybody hears those numbers and thinks, oh my gosh, but you are charging a fair wage for what you're going to provide us. And that's why I said, Okay, let's give Cody a call. He's coming highly recommended.
Jeanette Benigas:So I imagine there are a lot of skeptical practice owners out there. There are certainly people who don't like FixSLP, who don't like me, who don't like what I'm doing. And that's fine. That's not what we're here to talk about today. But if those people are thinking, I'm not giving Jeanette or FixSLP my books, good, because I don't want them.
Jeanette Benigas:My brain already has enough in it. I don't need any of that coming in to make it messier. Can you explain where the information is going to go? And I have a bunch of questions that I've outlined because I'm also a business owner, so I could put myself in the shoes of having to give all of these numbers to someone. Can you tell us first who receives an individual organization's completed financial information throughout the SPEAK project?
Cody Underwood:So completed surveys, when they're submitted, they're sent directly to me via email. Between me and Richie Mae, that raw data set stays internal. The only thing that is released to fix SLP or speak would be aggregated average numbers without all the identifying specifications and factors.
Jeanette Benigas:Okay. So, I think you just said this, but I'm going to ask it so we're really clear. What raw information will I, Jeanette, or PhCSLP, or the SPEAK project ever see?
Cody Underwood:Nothing that identifies any one practice from another.
Jeanette Benigas:So, this isn't a research project where we're trying to publish in a major journal. I'm not employed by a university, so this isn't being run through an IRB because we don't need one for this and it will slow us down. But, because of my background, you and I have talked a lot, we are going to run this thing like there is an IRB above board. We are going to do all the things, like I am going up for tenure at the end of this, okay? We are doing this right if we're going to do it.
Jeanette Benigas:And so, for easy translation, any time you enter a research project, you become a participant. And you are given it's blinded or double blinded, you are given a participant number, and your name and that number are matched together, and they are held in one file under lock and key for the principal investigator to hold. And it's never accessed. There's no reason to ever access that. So, you, Cody, now, Richie Mae is that principal investigator, right?
Jeanette Benigas:That's if we were submitting an IRB, your name or the Richie Mae group, that would be listed there. So it is only the principal investigator that will have that information, and it is locked down.
Cody Underwood:That is correct. I believe the only time that information would be sent out is your information back to you. Again, there's nothing in which you've already had. You were the one who submitted it. The confidentiality, I think, is big piece in understanding a little trust here.
Cody Underwood:There's a lot that goes into these analytics. There's a lot that can be turned out from them. So I think keeping that, again, with Ritchie May only helps solidify that.
Jeanette Benigas:This is a really good place to say, because I failed to say it at the front of the episode. I am working on this with Emily Watkins from Pediatric Therapy Partners in Louisiana. Some of you may know her as the administrator of the SLP Advocacy Alliance Group on Facebook. She also does a lot of private practice work out there, so you may know her from another organization, but she and I have been the ones meeting with Cody and the legal teams behind the scenes. So, when I say we, I'm really referring to Emily and I.
Jeanette Benigas:So, Emily and I have talked behind the scenes about how we're going to keep people updated. And I have a very large email list, which you can subscribe to at fixslp dot com, and certainly there will be a couple emails going out. But we thought it might be important to keep financial donors and data donors up to date via a separate email list. So, I think what we'll do, Cody, just on the survey itself, we will ask for explicit permission for you to share the email address with me and Emily so we can give people information about what's going on because they've donated data, so we want them to be able to be in the know. And so, we'll add that, and if you don't even want him to share the email address, that is fine.
Jeanette Benigas:Just make sure that you sign up for our regular email list at fixslp dot com. But I do think there's going to be separate emails for both of those subscription groups.
Cody Underwood:In the survey, we'll have a yes or no dropdown list that whether your email address be given for that mailing list.
Jeanette Benigas:If they don't, but they want to provide a different email, can they do that?
Cody Underwood:Absolutely.
Jeanette Benigas:I think we've talked about it a little bit, but again, I'm going to ask all of these questions just to make sure we're very clear. How will identifying information be masked and the results be aggregated?
Cody Underwood:So just kind of like you said, every survey gets responded with a survey ID. It's a randomly generated ID number. That bridge between the survey ID and the actual survey respondent, again, remains 100% with Ritchie Mae. So it's that ID that now becomes your identifier, but again, that's a completely random number assigned to your survey.
Jeanette Benigas:And we talked about this in-depth yesterday. What happens if an outside organization later asks for the underlying data?
Cody Underwood:Same thing. The identifying factors are not released. It would either be reported in an aggregate number or setting or individual, but again, no identifying factors being released.
Jeanette Benigas:And this is a good place for me to say, we really talked about some organizations by name specifically about who can have this data and who can't. So, we already have some agreements between Emily and I that we've said to Cody, they're never getting this information. But one thing that I want to make clear is any time that a state like North Carolina is facing a cut, information like this is going to be needed. And so, it is my genuine hope that we can continue to do this. I don't know if it's going to be needed yearly.
Jeanette Benigas:That's not something I've looked into yet, because we're on such a crunch to get this out. But maybe every other year, every three years. There's certainly going to be some type where this type of information is needed. And it's my hope that the SPEAK Project can continue in that capacity so we always have the nationwide information, but then we're going to talk about how we're going to do this by state. So, I'm in Ohio.
Jeanette Benigas:If Ohio is facing significant Medicaid cuts in a year, it is my plan that the Ohio Speech-Language and Hearing Association could come to the SPEAK Project and say, Can we have the data? And that answer would be yes. We're not going to fund the analysis specifically of Ohio's data, but they can take it, and they can fund that and they'll have it so they don't have to collect it when we pass that. We can pass it however it's needed. It's not going to be aggregated by the state.
Jeanette Benigas:But they can pay to have that done themselves, either through CODI or another party, but it won't come with any identifying information, and it would be passed to a reputable organization. If Jane Smith off the street says, We're facing Medicaid cuts. Can I have that information? That answer will be no. So there will be some criteria set up on how organizations can get it.
Jeanette Benigas:But it is my plan to be able to always have it available for the profession, and we can talk about that down the road. Right now, we just need to get this job done for all of us. I've said it a couple times in a couple ways, but why does an independent CPA analysis make the final product more credible?
Cody Underwood:Just understanding the facts, the procedures, the confidentiality, the trust, I think there's a lot of things that go into that. There are things that between me and you, we will find and discuss certain scenarios. I think there's a lot that can be added to that. So the survey that we did in North Carolina, we started with this idea to try to come out with what are the true costs of performing 92,507. And it multiplied into quite a lot of things.
Cody Underwood:So there were things that we dove into such as an inflated rate. The rate hasn't increased in fourteen, fifteen years. If we take consumer price indexes and walk that forward, what does that rate look like today? Some other things we looked at were non Medicaid rates, comparing Medicaid rates to non Medicaid rates. And then we dove into a whole another, I guess I'll call it like just other factors.
Cody Underwood:We dove into employee turnover. We looked into what are the steps to become an SLP in the state of North Carolina? What about wait list? Do you have them and how many people are on them? So we had all these factors and then that bundled package, when it all comes together, I think is really pretty powerful.
Jeanette Benigas:Yeah. I also think it makes this project more credible because you don't have any skin in this game. You're being paid for a service. You're not an SLP. Your financial future doesn't depend on what the numbers say.
Jeanette Benigas:You just have a job to do. We're going to get you the numbers, and then you're going tell us what they say. And like any research project, you have a hypothesis, but that outcome doesn't always match that hypothesis that you hoped you were trying to prove. And there is a chance that maybe these numbers won't show that. But given what we've seen in North Carolina, we're pretty sure we will have some numbers to send to CMS.
Jeanette Benigas:And that's another reason why this is so important, because you aren't going to sit in your office and massage numbers to say what we want them to say. You are going to give us numbers that mean something one way or another because you have a reputation to protect too, right? If you're caught massaging numbers, you don't have a job anymore. So, I think that's another really good reason that someone other than Jeanette or or some other person within our profession is doing this work for us because it just completely removes the chance that something would be changed to work in our favor. So that way, we call this inter rater reliability.
Jeanette Benigas:That way, if someone else does take this set of numbers and analyzes it in the same way, they should be very reliable outcomes. That Cody does it and then somebody else from somewhere else does it, the numbers should really be exact, if not very, very, very close. So that's another reason to do it.
Cody Underwood:I think you had asked Holly the question of, you know, what is the difference between approaching from an opinion versus a data set? The way I view that is opinions versus facts. And although the opinions may be correct, there's nothing really to support that. And so if we're gonna go the factual side of this, they indeed have to be facts. The numbers are going to be what the numbers are.
Cody Underwood:They're based off the surveys. They're not toyed with. They're not skewed. They're exactly as they're sent in.
Jeanette Benigas:Yep. So, North Carolina focused exclusively on pediatric private practices, but we have a much bigger job to do because all of our jobs are at risk of cuts. We've made some decisions about who should participate. So what did we decide? Who should complete this for a pediatric outpatient practice?
Cody Underwood:So any private practice that is doing pediatrics or those that are closely tied to that industry, again, this would be private practice only.
Jeanette Benigas:I think it's a long shot that we're going to get this, But if you're listening right now and you bill Medicare for pediatrics, which is less than one percent of the pediatric population, we really need your responses to talk about the G code that's pending. So, if that's you, don't assume someone else is going to send in a number. You might be it. So, please, please consider sending us information, especially if you're billing Medicare for a child. So, with Medicare, that brings in adults.
Jeanette Benigas:So, North Carolina only did peds. We have to go across the board. So, who should be completing this for an adult outpatient Medicare Part B provider?
Cody Underwood:Again, any private practice that's doing Medicare Part B, or again, those closely tied to that.
Jeanette Benigas:Yes, and I would take it a step further. We do have in facility and out of facility costs. In facility would include skilled nursing, but if there is someone interested in submitting us numbers from a skilled nursing facility, don't hold back. Send it in. If we can't use it, we still have it and it can be used for something else at some other point.
Jeanette Benigas:But we would love to see those numbers. I've expressed in a previous podcast that I really feel like skilled nursing facility SLPs are at the highest risk for cuts when they are employed by a contract therapy company. So, we can support that fight if we have those numbers. It just has to be a skilled nursing facility willing to share those numbers, their Part B numbers, with us, and we will gladly take them because we can definitely use that information. So, really any Part B service across the board, it just has to be someone intimately familiar with the numbers.
Jeanette Benigas:So why is simply being a treating speech language pathologist not enough to fill out the dataset?
Cody Underwood:This survey takes a deep dive into a lot of different costs. It's costs that maybe a specific SLP may not have access to. So a lot of these costs are split in between direct services and indirect services. The direct would be the one on one therapy time. The indirect would be the administrative support, the maintenance, everything that goes along with making sure that SLPs can perform their jobs.
Cody Underwood:So really getting at that high level of who can really break down the financials of their own practice is the correct person to fill the survey out.
Jeanette Benigas:Good. So to say this again, I don't want your books as a trained researcher. I want the evidence that comes from asking strategically planned questions from a large representative sample that is given to an independent professional, smarter than me with the mathing, to analyze many organization numbers together. That's what we want. So this part has been explained as we've worked through the design that North Carolina has so generously shared with us.
Jeanette Benigas:We have a big group, lots of followers, lots of people listening to this, lots of people checking in, lots of people online saying, What can I do? We have a big group with a big chance to do big things. And if you have learned anything about me over the last three years, I go big or go home. Okay? I'm going to go for the best, and we'll see what we can get done.
Jeanette Benigas:So, North Carolina only asked about ninety two thousand five hundred seven. We want enough detail to understand what reimbursement changes could actually do in the real world across more than ninety two thousand five hundred seven. So, we're expanding to include the dysphagia code, because if they've come after ninety two thousand five hundred seven, is that one next? So we have our arsenal ready if and when, hopefully it doesn't happen, but if it happens, we're ready to go and we're not chasing our tails to get information. And we know we have a cognitive treatment problem, so we are also including cognitive codes or cognitive information so the dataset can support more than one immediate reimbursement question.
Jeanette Benigas:We're going to need to fight for this cognition issue beyond the CMS rulemaking period, because it's not included right now in the numbers that have been put before us. So, this will give us what we need to fight well. Some other topics that may have been covered in the North Carolina survey that might be still included in ours but expanded to adults and some other things that we'll be asking is payers. We need to understand Medicaid and commercial insurance, Medicare Advantage, and Medicare rather than just treating it all as one market. We need to know all of that individually.
Jeanette Benigas:We need to break this down to cost per minute. So how does having an underlying time distribution let you know the impact of a timed code structure more accurately. We want to know about treatment duration because we know, we said in our last podcast, every minute matters now. So instead of relying on an average session length, it's probably stronger to understand the actual distribution of treatment times. We want to know treatment areas because now we have these codes that break it out into treatment areas.
Jeanette Benigas:So practices will be asked, when you provide 92,507, what does that look like across those treatment areas, and why does this matter if this code change affects services differently? We're going to be asking complexity questions and exploring information about factors with behavior and access and participation, and that can be useful with advocacy, which we have to do behind the scenes. It's not a direct accounting expense, but we're looking at the bigger picture because on the other side of this, we have a second half of a dream team that's going to be working with what we collect, and we want to know about the workforce. So something that we've learned along the way that I've mentioned already is beneficiary impact. If there's staff turnover, if there's less staff to be hired, one of the people we've spoken with said, If SLPs are going to choose to not use their degree anymore, that will cause a beneficiary impact.
Jeanette Benigas:So we need to know about the turnover now. We need to know about any planned cuts for compensation plans for future hires. That can tell us a lot about the downstream effect of these reimbursement changes and help us give something to say as we move along in this process. So, this is where this becomes much bigger than what does a therapy visit cost and much bigger than we deserve higher reimbursement. If low reimbursement is associated with long Medicaid waitlist, I know where I live, there's a small handful of practices and three off the top of my head I can think of are cash, cash service for pediatrics.
Jeanette Benigas:I'm not sure about the fourth one. And then we have the hospital. And the hospital waitlist for Medicaid is over a year long. I have two kids. I'm in the mom group.
Jeanette Benigas:And I see the question asked every day. Where can I go to get my child services on Medicaid? The hospital waitlist is thirteen months long, or whatever it is at the time. So, we need to know that. We need to know if reimbursement is associated with staffing instability, compensation pressure, reduced capacity, or certain services becoming harder to provide, then we're not just talking about a business problem anymore.
Jeanette Benigas:We're talking about that bigger problem that our representatives in Washington, D. C. Want to hear about. We're talking about access to care. We have already learned in preliminary meetings, as I've said, that this is what they want to hear about.
Jeanette Benigas:So when Medicare and Medicaid beneficiaries are losing service, we have a big problem. So, can you tell us, if you're comfortable, how many responses did you guys get in North Carolina?
Holly Ellis:So, there should be approximately forty, forty three is the number for the responses. And that was for pediatric private practice centers across the state of North Carolina.
Jeanette Benigas:And that's amazing. So we've worked with Cody about what we might need to give a really good representative sample, and we've decided that we need 200 high quality responses nationally. So we must have representation from every state. Alaska, I'm looking at you. I know you're there.
Jeanette Benigas:Every state has to respond at least once. I would love to see every state respond twice with pediatric and adult numbers. Because remember, we're representing everyone. But we need at least one response for this to be a nationwide dataset collected. Within those responses, we're going to look at region, practice type, urban and rural markets, the balance of the sample, because more responses from a populous state does not automatically make the dataset better if the rest of the country is missing.
Jeanette Benigas:And now I want to speak directly to North Carolina. You've all already done this, but we need you to participate in this one too. We need you again because our national instrument, like I just said, is slightly different and expanded. So we can't simply borrow what has already been collected and drop it into the Speak Project. We need you to answer a few more questions.
Jeanette Benigas:But you have a huge advantage because if you did the other one, you have 90% of what we're asking for. But also, adult practices didn't have the opportunity in North Carolina to respond, so now's your moment to shine. So don't assume North Carolina is already covered. We need you represented in the national analysis too. Cody, can you tell us how we will handle multi state organizations so we don't distort geography?
Cody Underwood:Yeah, if a practice is in multiple states, it's one survey. That survey will have different sheets that split out all the states, and you're just recording state by state identifying items. So, something as simple as how many 92,507 events in the year 2025 per state.
Jeanette Benigas:And what makes one response from a state valuable even when another state gives us many more? So maybe Rhode Island gives us one, but California gives us 10. Why is that Rhode Island one still valuable?
Cody Underwood:Based on that 200 ask that we're wanting to get, we've kind of divided that up based off of US population. However, we need at least one survey from every state to be considered nationwide. If we receive more than 200 surveys, that's phenomenal.
Jeanette Benigas:And we've discussed that we're going to do a timed code analysis. We talked about this a lot yesterday in our meeting. It really matters because if we only know an average treatment time, can you tell us what could that hide about how many visits would fall into a different timed code threshold, which we know we're moving to time codes, so why would that matter?
Cody Underwood:Going from a 92,507 to the different projected codes, we really need to figure out, well, how many of those potentially would be speech, language, speech and language, and so forth. So breaking that down and analyzing and saying, based off of the current 92,507 rates compared to the projected rates, how different really is that? We can calculate not only a dollar figure, but we can calculate a percentage.
Jeanette Benigas:Some people have looked at some of these codes and thought, Oh, we might be okay with the reimbursement proposed for this code. Can you tell us why a code that looks maybe better or okay on a fee schedule could still produce worse financial results when you modeled the whole day?
Cody Underwood:So you're doing this conversion between an event based versus a time based. So I know a lot of people have considered the add on. There's several things you have to consider. There's more time involved with that add on. What that does is then is it reduces your daily take of services.
Cody Underwood:So depending on timing of each 92,507 and how that applies to each of the new code structures, we can kind of reverse engineer your 2025 financials to kind of back into if 2025 was based on what is proposed, what does that look like?
Jeanette Benigas:As a medical SLP, I've heard, well, now you guys got what you've asked for. You're going to get longer sessions. You're going to get to see your people longer. Isn't that what you wanted? No, this is not what we wanted.
Jeanette Benigas:I've said it before. But explain this to people. If longer required sessions to maybe meet that same reimbursement rate means fewer available appointments, what happens to capacity and wait lists?
Cody Underwood:Everything grows. Everything backs up. There will be a stronger demand for SLPs, but with the rates where they are, the supply may not be there.
Jeanette Benigas:Right. And because businesses won't be able to hire more people, right? They won't even be able to hire people. And I don't know the answer to this question. I hope you can answer it.
Jeanette Benigas:How do payer mix and service type change that analysis?
Cody Underwood:I think there's a risk with practices analyzing a little bit too deeply into trying to get the most out of the codes. What they can do is unethically pick and choose. They can pick and choose different service codes. They can pick and choose different payers. There's a lot of things that can unwrap and cause major issues down the road.
Cody Underwood:And it's not issues strictly with the practice, it's issues with the speech therapy industry as well as their communities.
Jeanette Benigas:And we said it, Cody's not an SLP. He doesn't know what's going on over here with us. We see this with cognition right now, Right? In 2017, ASHA told us, start billing 92,507 for Cognition. And so we did.
Jeanette Benigas:And now a ton of commercial payers won't reimburse the two, nine, and three, oh codes. They want us to bill 92,507. And the new code set doesn't have a place for us to bill for those services. And now the commercial payers aren't paying the other codes. So, that has happened.
Jeanette Benigas:But the other thing that has happened is exactly what he just said. People trying to play the game to find the most money where the reimbursement for those cognitive codes was lower. So, even if they were reimbursed in nursing homes, we were told always bill 92,507 because our employer knew, our employers knew, that's how they were going to make the most money. So, what he just said is exactly what has happened in the world of cognition. So, it's not out of the realm of possibility that this could happen again with equal trickle down effects.
Jeanette Benigas:It's going to cause issues later on if we don't do this the right way. And I said that in a Facebook group recently where someone was like, Well, if we just change our wording a little bit, if we just change recall to comprehend, first of all, those are two different things. Second of all, doing that is going to do this entire profession a disservice. And I said that, do we want to do this right, right now, or do we want to risk walking the line of ethics that could put us in a bad spot later on? We need to do this right from the beginning so we can fight to get the changes we need so we can continue to do it right with the right compensation for years down the road.
Jeanette Benigas:If we start bending our ethics, we're we're gonna end up in a place worse than we are right now. Might take decades, but it's going to come. So, I think that's what Cody was trying to say nicely, but you know I've already called this out. So, that's what he's talking about. So, a fee schedule tells you what a code pays.
Jeanette Benigas:It does not tell you what that code does to a practice, a workforce, or a patient's ability to get an appointment, and that's what we're trying to measure with some of this that we're going to collect. Okay. I'm going to be precise because the next phase of this strategy is still being finalized. We're bringing in high level outside experts to determine the strongest legal, regulatory, and advocacy path once we know what the national numbers show. I'm not going to announce a firm strategy before I have signed an engagement letter.
Jeanette Benigas:But we're also building this so the value doesn't end with this one CMS rule. I've already said that. If these numbers are strong enough, this can inform federal advocacy, Medicaid advocacy, state level work, payer conversations, and future reimbursement and valuation questions. And because we're expanding the instrument beyond one code and one payer, we're trying to build evidence that remains useful after this immediate fight is over. So the data will determine what we can responsibly say.
Jeanette Benigas:We're not collecting numbers to prove a conclusion we've already decided true, although I hope it does prove our conclusion, but that's not why we're doing it. We're collecting them to learn what is true and then advocate from the evidence that we have. A lot of you are asking, even Cody has heard, and he's not an SLP or a business owner, what should I put in my CMS comment? That is going to be the next episode unless something else comes up before we record with the other half of our dream team that I'm hoping we get worked in the next day or two. Today, this episode is about building the evidence.
Jeanette Benigas:The next episode is about the opportunity to speak in the public comment process. What makes a useful comment, what belongs inside of it, what doesn't belong inside of it, how we can make our comments count, and how some of us can use these numbers within our comment. Data are one strategy. Public comments are another. We need both.
Jeanette Benigas:Everybody's going to need to participate. So now, my least favorite part, I'm asking you for money. Not to fund an idea, not to fund work that is already underway. I signed a $50,000 engagement letter for this national data project. That is our immediate need.
Jeanette Benigas:Then comes the legal, regulatory, advocacy strategies. All of that is going to help us turn this evidence that we're gathering in this piece into action. And that may require more than $100,000 over the next six months. So when you see the fundraising side of this, don't just think they need $50 and they're done. We're building something bigger.
Jeanette Benigas:And I want you to look at what your donation is actually going to help us measure. Not just cost, we're looking at treatment time, payer differences, access, Medicaid waitlist, workforce turnover, compensation pressure, service differences, the real operational impact of reimbursement policy. That's the kind of evidence that gives an advocate something substantial to walk into a room with. So, I'm going to break some of this down. If 5,000 SLPs give $10 that's the first 50,000 of this.
Jeanette Benigas:I know there are more than 5,000 SLPs out there that can do this. If 2,000 give 25, that's the first 50,000. If a thousand give the 50, that's the first 50,000. And I know some practices, companies, organizations, and individuals can give way more than that. I don't need everyone to give the same amount.
Jeanette Benigas:I need this profession to decide that building its own evidence is worth investing in and then fighting for. How bad do we all want this? You have people ready to fight for you, but we cannot fund this alone. We need collective power in finances, And we'll do the work. We just need you behind us.
Jeanette Benigas:SLPs love to love things on social media. We need you to go beyond that and give something. Because otherwise, this doesn't work. And again, no one is coming to save us. We have to save ourselves.
Jeanette Benigas:So Holly, as I'm talking about this, why don't you tell us about the numbers you raised and how quickly you did it?
Holly Ellis:So initially when we had a 3% rate cut, Nixle did a fundraising effort to help pay for the attorney. The attorney cost was $10,000 but they had raised a total of $20,000 They had that additional $10,000 in advocacy funds. And then from there, they were able to raise additional money and they did a presentation to all of the business owners that were interested in learning about 92,507, just like we're doing right now, the importance of the data, how this is gonna affect the constituents that we're serving, all of the patients, and being able to raise additional money. There was an amount for each business owner here in the state of North Carolina. They were then able to raise additional money for a service fee for Cody to be able to do the data and the collection.
Holly Ellis:And so, again, we were able to get to those amounts and still some additional money was needed for the next part for the lobbying. But again, we were in a very short amount of time able to raise that $30,000 just in the state of North Carolina for business owners. So that way we can put forth these efforts to help an advocacy. That was something Nixla is able to help us and be able to come to the table to be able to advocate for us. That's so important to have somebody that can represent us as a profession.
Holly Ellis:Putting money forth to help us, to have somebody lead the way, help us come to the table. We have our money. We have our data. But to have somebody speak on our behalf as well is also so important. But we have to have that information to support it.
Holly Ellis:And again, those things do cost money.
Jeanette Benigas:Man, just imagine if every single state in The US came up with $30,000 for the SPEAK project. What could we do nationally with that much money? I mean, we could retain this firm forever to help work with us, right? We can bring them on staff if you all came up with that much money. As I've mentioned, PhDSLP has always been very serious about being good stewards of the $5 a month sustaining partnership donations that I have squirreled away for this purpose.
Jeanette Benigas:I have $10,000 to put into this. There are other costs behind the scenes. We have our normal lawyer who y'all have not met yet. He was supposed to come on and then all of the AMA stuff happened. So, I talked with him the other day.
Jeanette Benigas:I said, I haven't forgotten. You're coming on eventually when we get through this. But I'm paying him to file some paperwork for the IRS so we can handle this money because right now, as a single owner LLC, Jeanette does not want your donations as her personal income to pay taxes on when she's not touching it as personal income. So, I have some other payments behind the scenes that I need to take care of to make all of this work ethically and securely. So, some of that money is being used for that, but it's all being dumped in.
Jeanette Benigas:So, please don't stop your $5 a month sustaining partnership. We have business expenses every month. So please don't pull back on that. We're asking in addition. And as extra comes in every month, I'll just be dumping it into this project.
Jeanette Benigas:The lawyer's gonna be writing some terminology that will make it safe for me to take fixed SLP money and put it into the Speak project. So, I'm making sure every I is dotted and every T is crossed, we are above board with all of this. There are two currencies that I've said that move this project forward: money and the data. If you cannot provide organizational financial data, then donate. If you can provide numbers for us, then participate.
Jeanette Benigas:If you're in North Carolina and you already did the earlier project, we need you again. You already have most of the answers, so please don't sit this one out. If you can donate both numbers and money, do both. And if you're not the right person for either, because you have a circumstance that you just have to sit this one out, get this episode to the person who is the right person. Maybe your boss is a physical therapist or an occupational therapist.
Jeanette Benigas:Get this episode to them. They surely know that change is coming. Maybe you have someone in your life who has been impacted deeply by speech therapy. Maybe they could give. We are not leaving families and patients and clients and students' families out of this.
Jeanette Benigas:We need them to rally around us. We need the first 50,000 quickly, and the broader advocacy effort is going to require more. Big law firms like this require big retainers. And when I sign on the dotted line, I'm probably going to be expected to furnish a retainer. So that's coming just as quick.
Jeanette Benigas:So 50,000 is not the goal. We need much more than that. And I started this episode by saying, for years, SLP services have been undervalued. We've been saying, our service is undervalued, we're undervalued. And now we're going to ask harder questions.
Jeanette Benigas:What does it actually cost to provide our services? What happens to access when reimbursement doesn't keep up? What happens to the workforce? What happens to treatment capacity? What do the numbers actually show?
Jeanette Benigas:I have committed to getting the work started. And by the way, like always, I'm not being paid for this. I'm here. I'll do it. We have people who will do it with us.
Jeanette Benigas:We need the SLP community to come with us, donate, give us the numbers, or do both. Let's build the evidence we're missing. And before you go, I just wanna make this incredibly easy. Everything that you need is at speakproject.net. That will be linked in the show notes.
Jeanette Benigas:Everything you need for patients, families, your business to donate, go to speakproject.net. These episodes drop at 5AM. Our portal to give us your numbers is not opening until noon if you are listening to the day that this drops. Everything you need, speakproject.net. And I wanna mention one more thing.
Jeanette Benigas:This is not an SLP owned private practice project. If you own or operate a business that employs SLPs, you aren't one, we still need you. You do not have to be an SLP to donate or participate. We can't build a national picture of SLP services if entire types of providers, communities, or parts of the country are missing from it. Money builds the infrastructure.
Jeanette Benigas:The numbers build the evidence. And getting this into the right hands via the right people will build the reach. It all starts at speakproject.net. We'll see you next time. And for real this time, thanks for fixing it.
Jeanette Benigas:Go to speakproject.net. Thanks for listening to the FixSLP podcast, the podcast shaking up the field of speech language pathology. Don't forget to check out our social media or fixslp.com for our latest promo codes for continuing education, therapy materials, merch, and more. Supporting our sponsors also supports our PhDSLP team. Don't just listen, be a part of the change.
Jeanette Benigas:Share this episode and our social media content, and let's keep fixing the field one bite at a time.