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What happened when the SPEAK Project went to Washington, DC, to fight for sustainable Medicare reimbursement for speech-language pathologists?
In this episode of Fix SLP, Jeanette Benigas, PhD/SLP, and Emily Watkins, MCD/SLP, share what they can about their meetings with congressional healthcare staff and senior CMS officials as the January 1, 2027, replacement of CPT 92507 approaches.
They discuss the proposed Medicare payment reductions, the national economic analysis involving nearly 1.3 million reimbursed SLP service events, and why independent data has become central to their advocacy. They also explain the role of K&L Gates, why some congressional strategy must remain confidential, and what happened in Washington that left them cautiously optimistic.
Most importantly, Jeanette and Emily explain what SLPs should, and should not, be doing during this critical phase of advocacy.
The fight isn't over. The strategy is in the next phase, and your involvement still matters.
Learn more, submit patient and family stories, or support the effort at https://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?
#119: It’s Time to SPEAK Part 2 - Mobilizing Families for SLP Advocacy
#120: It’s Time to SPEAK: Part 3 - How to Write a CMS Comment That Matters
#120: It’s Time to SPEAK: Part 3 - How to Write a CMS Comment That Matters
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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.
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. It's time to change the field with our voices, leadership, and advocacy leading the way. So Let's Fix SLP.
Jeanette Benigas:Hey everybody, welcome back. It's Jeanette. We're finally recording this. I feel like we need to start by saying, I know you have a lot of questions. We know you have a lot of questions.
Jeanette Benigas:Who's we? I have Emily Watkins with me. She is my co founder of The Speak Project. We have been working our tails off over the last seven weeks, and we thank you for your patience. You've been hearing things or seeing things or seeing us comment like, We have a meeting.
Jeanette Benigas:We're going to Washington. We're meeting with these offices. We can't tell you everything yet. And I know what that sounds like. I know people are saying what it sounds like.
Jeanette Benigas:Right? It sounds a little mysterious. Yeah. Mysterious, secretive, like, you know, maybe we're making things up or fabricating things to make it look like we're doing something. No.
Jeanette Benigas:I don't particularly enjoy being mysterious. If you've followed Fix SLP for any length of time, you know that I tend to tell you everything honestly, probably, like, more than you want to know. And two: we had a three year anniversary since the last time you have formally heard from me. So, Fix SLP is three in a couple weeks now. We've been so busy that I missed that.
Jeanette Benigas:I knew it was happening, but I missed it. So, we're moving forward, and we've been busy. So today, we want to explain what, to the extent that we can, and we'll talk more about that, what has actually been happening with the SPEAK project, what happened in Washington, D. C, what our lobbying firm does or is doing for us, why some information can't be shared publicly, at least not right now, some information really can't be shared while the work is happening. Hopefully in the future it can be shared Emily and I were talking about that before we hit record.
Jeanette Benigas:This isn't like the AMA, where we've signed a nondisclosure or a confidentiality agreement, but we do understand the need to keep some things close to the vest for strategy's sake. But, most importantly, I think people want to know where do we go from here. So, we went to Washington, D. C. Because CMS has proposed a new coding structure for the codes replacing 92,507 beginning in 2027, and our position since we launched the SPEAK Project, which is numbers and advocacy, is that the numbers have to work.
Jeanette Benigas:You can't create a payment system where the cost of providing services exceeds or comes dangerously close to the reimbursement for providing the service and expect access to care to remain uneffective. You you just have... You can't do that. The numbers have to work.
Emily Watkins:And I think that's important to say right at the beginning because there's been so much happening that people can lose sight of what we're actually trying to accomplish.
Jeanette Benigas:Yeah. The SPEAK Project, what we've been doing, it's not having meetings so we can say, we had a meeting. It's not about... I know Fix SLP in the past has called out advocacy days on the hill and advocacy days in DC, and you see a bajillion pictures all over ASHA's page and Representative's page from ASHA, and while that's all well and good and we've been critical of that in the past, this wasn't going to Washington, D. C.
Jeanette Benigas:To take photos. And, in fact, you're not going to see one picture of Emily and I on the steps of the Capitol Building on Capitol Hill because we didn't have time to do that, okay? That's not why we were there afterwards. We have a couple, like, really far out from a couple of places. We were walking back to the hotel with blisters on our feet at that point, okay?
Jeanette Benigas:But we're like, Oh, man, we should take a couple pictures. So, it wasn't about going to take pictures. It's not about having a great lobbying firm, you know, because it sounds fancy and impressive. The goal is that reimbursement is going to make it financially possible for SLPs in any setting to continue providing services. That was the mission before we went to DC.
Jeanette Benigas:It's the mission today, and so we want to talk about that. So, Emily, I think we might have some new people tuning in. I know we've had a ton of new followers. Do you wanna kinda start to talk about how we got here?
Emily Watkins:Yes. I think we need to back up a little bit and Mhmm. Say kind of the history because, yes, somebody may be listening to this six months from now and may not know our entire story. At the center of all of this is CPT code 92507. So for years, as you know, SLPs have used 92507 for individual treatment of speech, language, voice, communication, auditory processing disorders, and the like.
Emily Watkins:Beginning 01/01/2027, 92507 is being replaced by a family of 10 new treatment codes. That is happening. There is no stopping that train whether we like it or not. So what we are fighting for is not really if those codes are going to exist or not. The issue in front of CMS right now is how Medicare values and pays for the services.
Emily Watkins:And when the proposed Medicare values come out, we started looking at what those numbers would actually mean operationally. For many services, we're looking at reductions of 22% compared to what practices have been accustomed to receiving for 09/25/2007. When you think about 22%, offices operate maybe between eight, 15. If you're just incredible one year, 20%, that still doesn't cover the 22% cut. So what we're trying to get people to realize is that when you hear 22%, they think, okay.
Emily Watkins:Well, businesses are just gonna have to tighten up. No. We need to realize that reimbursement... If your reimbursement is a $100, that $100 is not profit. That pays the clinician, payroll taxes, benefits, rent, billing, scheduling, electronic medical records, credentialing, insurance, supplies, technology, admin staff, and everything else that is required to operate a health care practice.
Jeanette Benigas:Those special CEUs sometimes. It's going for that too, That we all have to pay for.
Emily Watkins:Absolutely. I want to jump in
Jeanette Benigas:and say when this was the number we were using on the Hill, we were saying on average 22%. That was just easier to talk about the range, because if you look at the 10 new codes, it ranges from something like 13% to what, 39%, Emily? Or what was that top number? 34%. Okay.
Jeanette Benigas:So, that's a range, and so, on average, it's 22%. That doesn't mean that's the cut we're going to see across the board, so just remember when we say that it's speaking generally, and we made sure the folks we were meeting with on the Hill and in CMS knew that as well, but that was kind of the benchmark that we stuck to for the purposes of the conversation. Like Emily said, this goes to cover a lot, and when this happens on January 1, the expenses aren't just going to suddenly decrease by 22% because CMS decided. No. The landlord isn't going to say, Oh, they lowered your reimbursement?
Jeanette Benigas:We'll take 22% off your rent. Software companies, EMRs, malpractice insurances, all those things that she kind of just went through real quick, they don't do that. In fact, the cost of living right now is going up. Inflation is wild! Emily said most healthy businesses in healthcare are operating between an 815% margin.
Jeanette Benigas:And so when you are removing 22% of that from the gross revenue, where do you take it from? And I don't want you to miss that because she said it a minute ago. There's not 22% of administrative fluff sitting around waiting to be eliminated from the places where Part B is being provided. And I might say with the caveat there that perhaps some contract therapy companies could be eliminated or some contract companies could be eliminated who are acting as a middleman. But other than that, that 815% margin is from our private business owners providing the outpatient services.
Jeanette Benigas:The margin is probably lower for the organizations using the contract therapy companies and therapy companies to help staff the SLPs. So, eventually, you reach the largest expense in most practices. And I've been saying this since the beginning, especially for the med SLPs, it's the people. It's the SLP. It's the SLP that's going to take the hit because they can't take it from administrative costs, those contract therapy companies aren't going to take a hit.
Jeanette Benigas:It's us. We're the ones that are going to take a hit, and that's why this isn't just a business owner issue or a pediatric issue. And we've been trying really hard to communicate that. I think in some populations, we've got it, and in other populations, people are just starting to wake up. But if you're an employed SLP and you think, I don't know how to practice.
Jeanette Benigas:Medicare isn't my problem. It can absolutely become your problem. Because if the reimbursement isn't supporting the cost of employing the clinician, what choices do the employers have? They're going to reduce benefits. If they didn't completely eliminate them in 2008, know, health care expenses will go up for us.
Jeanette Benigas:They're going to increase productivity expenses to the point where we will be forced to choose if we're going to commit fraud. We talked a lot about productivity on the hill. They're going to reduce staffing. They're going to stop accepting certain insurances, especially Medicaid, where the payout is the lowest. They're going to reduce the number of patients that people can see.
Jeanette Benigas:What happens to those kids and adults who have to get dropped off the back end? Or, they're going to close their doors completely. Or someone like Emily could decide, I can't keep the doors open with 30 employees, but I can continue to operate as a single owner LLC. So then everybody gets laid off, and Emily carries on, and I'm not saying that's her plan. I'm just using that as an example.
Jeanette Benigas:She still has a job. She's making less money. There's a lot of kids without services. SLP wages have already experienced enormous pressure over a long period of time I've shared on this podcast before. I started out of school as a PRNSLP in nursing homes at $50 an hour.
Jeanette Benigas:Twenty years later, I'm making $55 an hour. That's a pay cut. That's not an increase. You know, with the cost of living, inflation every year, I'm making less money now than I was then. And all of my expenses have gone up: health care, insurance, cost of licensing.
Jeanette Benigas:If you buy the certificate, that's gone up. So, you cannot continually increase the education, the productivity, the administrative demands on a profession while reimbursement fails to keep pace and then assume there's no workforce consequence. At some point, people leave, and they're already doing that. So, if we make this worse, how many more people are going to leave the field? And then, our students.
Jeanette Benigas:Folks coming out of high school look at the cost of becoming an SLP, and they decide not to enter the profession because there's no return in investment. You have to have an ROI. If people want to go into nonprofit work, they can go into nonprofit work without spending money on six years of college, right? Our experienced clinicians like me and Emily say, I can make more money doing something else with significantly less responsibility and stress, and this becomes an access to care issue for the people that we serve. So, we needed data, right?
Jeanette Benigas:We needed data to talk about this.
Emily Watkins:And that leads us really right into why we needed to collect data. And it became a huge part of why the SPEAK Project was established.
Jeanette Benigas:I walked out of the AMA meeting saying, If we would have had data, this fight would have been a little easier. And on an early podcast before the rates were announced or right after the rates were announced, I mentioned I'd really like to give it a try what North Carolina did to collect data on their Medicaid reimbursement rates. And very quickly, those fabulous ladies reached out to me. They got us set up with Ritchie May and Cody, who was the CPA who ended up doing the SPEAK project with us. That's who they worked with.
Jeanette Benigas:We had planned on establishing some kind of C3 or C6 or something, and then doing the project months down the road to support all of this. But we started taking meetings because we thought, well, we need to talk to people who know how to do this and do it right. And the very first legal strategy and lobbying firm that we met with said, You can do everything right. You can have 200,000 people submit letters to CMS, but unless you have data, nothing is going to change. And we were like, Well, we were thinking of doing this project and we explained what went on in North Carolina, and they said, Not only do you need to do that, you need to do it right now.
Jeanette Benigas:Right now, before the end of the comment period, if you have the means to do this now, you need to start tonight. Okay? So, the reason they were saying that is because saying these rates feel too low isn't enough. Us saying that we think the work RVU or the expense prep, you know, all these RVUs in this formula that some of us are starting to understand, and some people, they still look dizzy when we talk about it, understanding those formulas or saying those formulas are flawed isn't enough, even when you have thousands and thousands of SLPs writing to CMS and saying, This will hurt us, that by itself isn't enough. The policymakers need evidence, and the evidence that was provided was provided by the RUC committee through the AMA process that ASHA was a part of.
Jeanette Benigas:And these organizations put a lot of stock into the membership associations because those are the only groups that they have the opportunity to work with that they know should have the numbers that they need. And something that we've explained over and over again on the hill because the question always comes up is, Where's ASHA on this? Listen, every graduating class has someone at the top of the class and someone at the bottom of the class. And ASHA is the lowest 1% of the class when it comes to membership associations because they've never been held accountable. They've always been able to do what they want to do because they get their members by default through a proprietary product that wraps membership up into it without telling the consumer that you're paying for both or giving them a clear way to opt out.
Jeanette Benigas:And minds are blown at that point, just at the start of the conversation. So people started... These people we were talking with started to see and understand and hear why we would be crazy enough to do this in the first place. So, the evidence is now being accepted from us. We asked practices across the country to give their actual financial and operational data.
Jeanette Benigas:We hired an independent third party advisor to collect the data, to analyze it, to store the data. We were completely blinded to who submitted and what their numbers said. All we saw at the end of it was the aggregated results in, like, a bulleted list just to make sure we knew what was going into the white paper. We didn't make changes, it was just sent to us. And then the white paper with the results.
Jeanette Benigas:No opinion, just fact based results with as many assumptions eliminated as possible, and we used that to fight with. Fix SLP didn't sit down with a calculator and manufacture numbers like we wanted. Emily and Jeanette and the Speak Project didn't sit down and manufacture numbers. The participating organizations submitted their information for independent analysis. And because we hired a firm with a track record in this, they knew generally what the numbers should look like.
Jeanette Benigas:So, there was a screening process. We knew what would eliminate a practice from submitting. And so, what we are comfortable sharing right now is that the final economic analysis included 138 independent outpatient organizations treating pediatric and adults across 49 states, and 1,290,897 reimbursed CPT 92,507 service events furnished in 2025. So that is almost 1,300,000 actual paid service events from speech pathology.
Emily Watkins:-And when you think about that, it's incredible amount of information to collect, okay, just in general. But when you say, oh, we only had two weeks or two and a half weeks or we started this August 4, the entire project, We explained that when we were on the hill, when we were in our meetings, and every one of them said that '20... In 2026, and we said yes. It also is a testament to how engaged the SLP community is. Jeanette talked a lot about that, how engaged people are.
Emily Watkins:It's just a testament to how much everybody who listens to this podcast has learned, has listened, has engaged, has said, I'm gonna spend time submitting data. And I just wanna tell you thank you because it was... You were part of those meetings. And and whether it was in a small, a big, large way, every single person who submitted data and every person who has been engaged from a donation to data collection, you were acknowledged in those meetings. Mhmm.
Jeanette Benigas:And jaws were really hitting the ground. When we when we said who we hired, what we did, what the process was all over Capitol Hill and CMS, jaws were hitting the ground when we told the story of the data, which was so affirming. And I'm getting goosebumps right now, and I wish all of you could have been in those rooms for that part of the meeting because it's listen, Emily and I went into the Capitol Hill CMS meetings feeling kind of low. I think I felt lower than Emily because my glass is always, like, half off the table, crushed on the ground. Like, it's not even half empty, it's just, like, flooding the room, right, through glass shards.
Jeanette Benigas:So we both had different levels of energy and confidence going into these meetings, but it was that kind of feedback where people were... People who matter were like, This is incredible that you have done this, and this is what we need to make these decisions. We left Capitol Hill and CMS and DC with completely opposite thoughts about what could happen for our field. So we are now cautiously optimistic, and that's a lot coming from me. I am not very often cautiously optimistic, okay?
Jeanette Benigas:So really, as a PhD and a researcher, it's an incredible amount of data, and again, it's across all ages, all diagnoses, all socioeconomic statuses, and when all of this comes to a close, the white paper will eventually be made public. For now, it is not the same thing that North Carolina is doing. This is being used for a reason, for advocacy, so we have to keep it close to the vest. We did include some preliminary data in the CMS comment submitted by Fix SLP. You can go to thespeakproject.net to read it it's up there.
Jeanette Benigas:But we will share a couple things as we go through. So, I think the one thing we're probably comfortable saying is the weighted average cost of the ninety two thousand five hundred seven event was $81.86 and the national average for ninety two thousand five hundred seven is $76.15 So that right there is showing on average we are operating at a $5 per event loss even before January 1 comes. And that spoke a lot to the people we were talking to, because we could say, we've always said, we're not making enough money, we're undervalued, we're all of these things, but now we have a number to put in front of people to prove it. And that is so important, because remember what I just said about where you cut expenses when reimbursement decreases. Three quarters of the cost is already labor related.
Jeanette Benigas:Three quarters. We talked... We collected labor and wage data in this study. There were practices that spent ten hours filling this thing out. We're like, Oh, it'll take two to three hours.
Jeanette Benigas:Uh-uh. No. Thank you, practices that put in the time for this, because it made a difference. Again, we're gonna keep saying that. So, three quarters of that is already going to labor.
Jeanette Benigas:Our practice owners, our businesses are paying us every single thing they can. They are not hoarding money in a bank account overseas to retire rich, okay? The money is going out just as fast as it's coming in. The analysis also looked at the actual time involved in providing a 92,507 service event, not just the minutes that the patient happens to be sitting directly in front of the clinician, but all of it, because healthcare doesn't work that way, right? We've got preparation, we've got treatment, documentation, there's coordination, you have to educate families, or doctors, or CNAs.
Jeanette Benigas:There's everything that happens before and after, plus the middle. So, we packaged that in a way that took the data for the total work, it identified work time, and there was a range of treatment time, again, depending on the setting and the age of the patient. But what that gave us was something to say instead of SLPs feel underpaid. We walked into the room and said, Here's what it actually costs to provide this service. Here's what labor costs.
Jeanette Benigas:Here's how much time the service requires. And here is nearly 1,300,000 service events underlying this analysis that shows you we're not making this up, that this 22, on average, 22% cut is going to close businesses?
Emily Watkins:Yeah. It took opinion and feeling and and and took that out and added data and fact that's indisputable. And that's exactly what our aim was when we set out from the beginning of this when we approached Richie Mae is to say, we know opinion wise that this is going to be true. We just have to get the facts. We have to get the data to prove it.
Emily Watkins:And once we do that, I really... And I felt from the beginning at the outset, as long as we could have enough data, that we have a fighting chance to actually make some change in our profession. So let's talk now about the other thing that people have questions about, the lobbying firm.
Jeanette Benigas:This has been a pendulum swing of emotions for Emily and I, especially because we want to be as transparent as possible with all of you. We want you... Listen, if we could have a camera in the room with us during all of this, we would. So, let's talk about the lobbying. At the very beginning of this, I was told by a very well meaning individual that that person didn't think I understood how lobbying works, except I do.
Jeanette Benigas:And that's why I knew we needed a lobbyist or a lawyer or even both to get the job done. Because lobbying at its core is professional advocacy, and one of the reasons I know what lobbying is and how it works is because occasionally I have toed the line as a lobbyist in Michigan, in Delaware, and in some of these other states where Fix SLP has done some work. So, I have been very cognizant. Do I need to register as a lobbyist if I'm not a stakeholder in the state? And so I've been cognizant of that all along, so I understand what it is.
Jeanette Benigas:Okay? A good lobbying and public policy team understands how government works, who has actual jurisdiction over issues, who has influence over that issue, when to approach those people, what information they need, when what to ask is realistic, how to move that ask into someone's ears and then through a system, that is extraordinarily complicated. And we're talking about the government right now. We're talking about CMS, Health and Human Services, the American Medical Association. These are extraordinarily complicated, bureaucratic organizations that are hard to crack.
Jeanette Benigas:And so we started at the top, and we had multiple meetings with multiple firms. Some we knew from the beginning we might not get. There were others we thought we would get, and then there were conflicts. Like, one was a registered lobbyist for UnitedHealthcare. Guess why they couldn't take us?
Jeanette Benigas:Probably because we may have a UnitedHealthcare conflict of interest, right? So, we finally ended up retaining K and L Gates. That is on our website. Everything about them that you see on our website has to be run through their general counsel. So, we started with our lawyers and lobbyists and our legal team saying, Yeah, we'd love to do that.
Jeanette Benigas:Yes, do this, do this. And then they ran some of it through their PR advisors, and then ultimately everything ends up on their general counsel's desk, and general counsel has shut down a lot when it comes to what we're doing and our website. We retained K and L Gates because this isn't something we could solve with an Instagram campaign. We needed them to help us, because they understand CMS. One of the professionals on our team, as a lobbyist and a lawyer, used to work in the CMS building where we went.
Jeanette Benigas:We needed people who understood Congress. We needed people who understand the physician fee schedule, and all of the legal and regulatory expertise. We have someone working on legal that used to work for a hospital membership organization. We have big names and people with a lot of experience who are helping us to know how these pieces interact, and there's not one person out there to hire who can do all of that. We have, at the core, at least five people on our team, but then they've been pulling in others to help with some of these issues as we've met and strategized and worked through all of this.
Emily Watkins:And not to mention, we're working on this on an insane timeline that they understand because they understand the physician fee schedule and all of the open comment period and rulemaking period. So they understand this and that is why they are moving as fast as they are as well. And so I would like to explain to people really how quickly all of this happened from the point where we had the first strategy meeting with the first firm that we interviewed to where we are sitting in congressional offices was seven weeks and one day. That is remarkable. Honestly, it's almost impossible.
Jeanette Benigas:Fifty days.
Emily Watkins:Yeah. It's something that I don't know has ever been... Has ever happened with any sort of a non membership association grassroots movement. It's never been done.
Jeanette Benigas:I mean, let's let's be honest. Everyone... And this is why JAWS were hitting the ground because we came in with this professional paper. We've said SLPs are funding this. Like, We've raised all of this money to be here and to pay...
Jeanette Benigas:K and L Gates is no joke. Everybody knows them. Even the lawyer here in Ohio that helps me with the process of Fix SLP and all of the legal work I've
Emily Watkins:been doing behind the scenes, he knew K and L Gates. He's like, everybody knows K and L Gates. Right? Like, jaws on ground. Right?
Emily Watkins:This... Truly, we're not making this up. And it is not easy. This is not an easy time to schedule meetings. If you think about it...
Emily Watkins:And they told us that. And and and they were able to do turnarounds of one, two weeks in getting these scheduled. You've got congressional calendars that are extremely complicated under normal circumstances, but you add everything else going on in Washington. You've got, you know, competing legislative priorities, votes, travel schedules, committee work, district schedules, and it's an election year. So a lot of focus right now on a lot of people are on getting reelected, not, you know, hey, we wanna talk about Medicare reimbursement for speech language pathology.
Emily Watkins:They're like, oh, okay. And I'll meet with you, you know, what you think is, oh, what's super important to us and is our entire world, you know, when you step back, they... They're trying to get reelected. So, you know, put us right at the top of the calendar. Right?
Jeanette Benigas:Yeah. They're not like, okay. Cancel everything. There's two cute girls trying to schedule a meeting with us in speech pathology, and they ran a study. You know?
Jeanette Benigas:Like, it's not like they've seen the white paper yet. Right? They're like these girls called, everybody, make way. Roll out the red carpet. No.
Jeanette Benigas:That's not how it works. We already knew going into this that we are a minority profession who doesn't serve a lot of people, who, you know, that it's just, it's why relationships are important, and I think that's one of the greatest things that this money is going towards right now, is that we are paying K and L Gates for the right relationships. The relationships that they have spent decades growing as one of the oldest, largest firms in DC, but also as an international firm. Anybody can call and request a meeting or walk into an office and ask for a favor, and we've seen that. You know, people in the SLP community right now are calling and they're getting meetings with their congressional representatives' offices.
Jeanette Benigas:That's not what we're talking about. When you're calling and getting those meetings, a lot of times you're meeting with general staff or interns or, you know, just very general people from those offices. And probably even locally, a lot of times they're not even located in D. C. Because all of these people have local offices in the congressional districts, and then they have offices in D.
Jeanette Benigas:C. A lot of times that's where their technical staff are housed if they have technical staff. So we've learned a lot during this process. So the people we need to talk to have technical staff because they're on the committees that matter for CMS and for policy and budgetary issues and all of those things that this physician fee schedule impacts. And so in Washington, they operate on relationships and trust.
Jeanette Benigas:And that is why we have been asked to no longer share what offices or committees we are meeting with online. Our firm wasn't thrilled about the yellow post we made about two weeks ago. We didn't get in trouble, but we did get called into the office and had to have a little conversation about it. The representatives don't like that. They like to do their own kind of PR.
Jeanette Benigas:Some like it more than others. Some don't want it at all. Some don't care, and we would have no way of knowing. And while are... And L Gates is working with us right now, they have, again, spent decades forming these relationships, and they'll go on to maintain these relationships for other organizations like us, so we have to be really careful about protecting their relationships and our strategy, and there's a lot that's going into that.
Jeanette Benigas:So, that's why you haven't seen us say who we met with or any more about who we are meeting with. Because if someone whose judgment you respect calls and says, I think you should take a meeting, or I think you should do this, you do. So, if K and L Gates calls and says there's a legitimate policy issue here that you need to understand that we have some data to back up, people are going to listen. So that's why we hired this experienced, reputable lobbying firm for policy and strategy. You can Google the name of a congressional office.
Jeanette Benigas:Anybody can send an email, like I said. You can get a meeting with staff. But it isn't the same as knowing exactly which person inside an office or a committee really needs to understand what we're saying, why it matters, why that person matters, what information they need. We were given bios at, like, two a. M.
Jeanette Benigas:Before our meetings, and then minutes before walking into these meetings, we were given a brief of who they are, what committee they sit on, why they matter, and what part of our story and data they needed to hear, because these meetings were scheduled that fast. Like, things were changing by the minute as we are traveling to DC because, again, seven weeks is not a lot of time. They told us, we asked them, on average, how far out do you start thinking about scheduling these types of meetings for people? And they said, we need a month at minimum. At minimum.
Jeanette Benigas:A month ago, we hadn't even hired them yet. I think we had our first meeting with them on September sixth or seventh, so we didn't even know them a month ago. So they know what can realistically be done, how we can make the ask, You know, sometimes it's we're not going to make the ask in this office, or the lawyer lobbyist who represented us and was in the room with us will make the ask at the end, or you guys can make the ask. Just feel it out. So, all of this is strategy, right?
Jeanette Benigas:All of this is strategy, and that's why we have hired them, that's why we are trusting them, and that's why we are listening when they say don't post something or talk about it publicly. It's also why you will not hear from the firm on the podcast, which we were devastated about. PR said yes, general counsel said no. And I know that she is also disappointed because she's a mom. She's got kids.
Jeanette Benigas:She is fully behind this issue, and she's working her tail off for us, and she said, you know, maybe we can find some other creative ways. We haven't had a chance to even discuss that yet, because we've been fighting the good fight. So we know you said you were gonna hear from that person. That is why you have not, not because we're fabricating or lying or whatever. It's because their general counsel shut it down the day before we were ready to record.
Emily Watkins:Yep. And I think it's important too for people to understand, you know, like, you hire a lobbyist, and it's not just we hire a lobbyist and they go meet with all these people on our behalf. You know, it's not that. It's the experiences they prepare you a lot. They help you understand really who you're meeting with, like Jeanette said, why it matters, what jurisdiction they have, what we should emphasize because that changed every meeting, what we should not get distracted by because that also happens in meetings.
Emily Watkins:And and the most important thing, which is what is the ask? And why that's important is because every meeting was different. The person you're meeting with has different influence on CMS or a committee or comp... You know, congressional members, or maybe they're closer with the executive branch of the government, and the executive branch really listens to them. And, again, we don't know that.
Emily Watkins:We we would just be going there and seeing what sticks on the wall, but they do because they are in Washington cultivating these relationships, which goes back to why they don't just blast on a podcast who they get all these meetings with. It is just not looked at very, professional in Washington, which, again, when we're looking at it, again, this is our whole world. This is... The the the place is burning down. Why wouldn't you wanna get, you know, all of it out there?
Emily Watkins:And they have... You have to remember that they are representing a vast majority of clients, and they have to remain professional in how they get meetings with people in this... It's a mutual respect, and it is a very, very relational world in Washington. Even though you wouldn't think so, it very much is relational and not nearly as transactional as you think. So it's super important that they communicate with us and prep us on all of these things.
Emily Watkins:If there's a committee connection, you know, again, who has influence, what information will move these people, and then also what's the next step. And that's completely different level of strategy than if we just were to try to just broadly go get meetings with district offices, congressional members, and we don't understand the web of influence that Washington really is. And to me, the biggest piece of this is we had is what I call the CMS guru with us all day Wednesday and all day Thursday. And she is a... She...
Emily Watkins:I mean, and we... The other thing I loved about it is... So we're with her all day. We're in between meetings as we're walking. All we talked about was strategy.
Emily Watkins:Okay. Who are we going to next? How is this affecting CMS? Is there anybody else? I may know this person.
Emily Watkins:Well, what about this meeting? Do we ever try to get that one? I mean, we did not stop talking about how we can move this forward or how this person could influence this. I mean, our brains just did nothing but political, relational, you know, communication, all of these things for two full days. And so I I do have to say that shout out to K and L Gates.
Emily Watkins:I mean, they didn't just say, have fun. Good luck. They were with us. She was in a meeting. Every one of them prepping us, but also introducing us.
Emily Watkins:So we didn't have to have that awkward, like, how do we start this? No. She did. And then she kept up with the time. She took the notes.
Emily Watkins:That's another big thing. She took all the notes, and she asked the follow-up questions if we if we weren't able to. I'm telling you, it is it is a different perspective of what I thought we were going into of the support that we were given the two full days we were there. I was really blown away, I was really impressed, honestly.
Jeanette Benigas:And I think... I'm gonna I'm gonna toot our own horn for a second. Okay? I think we also impressed them. Yeah.
Jeanette Benigas:Because we knew what our white paper said. We were very articulate. If you watched the AMA meeting, you saw an example of how I can be articulate when talking about important issues. Emily was equally as articulate, but what I loved is they told us, and they kept telling us, too, that you are going to have different experiences in different offices, and some people are going to be warm and friendly and inviting, and it's going to feel like all fuzzy because that's how they are, and then there will be other meetings where you wondered if you killed someone's grandmother because the look on their face is that, okay? And so the one meeting, we did...
Jeanette Benigas:The woman didn't look happy. Like, she didn't look like she wanted to be meeting with us or like she wanted her job in particular, and the first twenty minutes were a little rough in there. By the end, we had her smiling, we were laughing with her, she didn't have a ton of advice for us, but we got into a pretty interesting conversation. She knows someone in the speech pathology world, and we're like, That woman either hates us or loves us, and if she didn't donate, send her to the page, right? So, you know, we're joking, and we walked out of there, and the person who was with us, I couldn't hear what she was saying to Emily, but I saw that her eyes were wide, and she had a look of shock on her face, and I thought, Oh my gosh, we did something wrong.
Jeanette Benigas:Because remember, my glasses shattered on the floor. And then when I finally caught up and heard what they were talking about, she said, I have never seen that woman smile, let alone laugh, and I've been doing this for over, what, like a decade or And I was like, It's because we got it. Like, we know what we're talking about, we know the issues, and we are extremely articulate and can interact with these people in a way that they can understand us. I think that happened in nearly every office. And so I think by the time we got to the CMS meeting, they were like, Go do your thing, girl.
Jeanette Benigas:You got this. Right? And I don't think that's the experience they have with everyone. They did tell us, We don't even take some clients to see certain people because we just know it's not going to go well. And they did not hold back with who they took us to and who they didn't.
Jeanette Benigas:So, that was a huge compliment. Emily, good job.
Emily Watkins:So...: You too.
Jeanette Benigas:It good.: Yeah. We did good, I guess. Okay. So, while we would love to tell you who the lady is that doesn't smile and where we were, what was said, we need to be really responsible in protecting their relationships and protecting our strategy. So again, that's why we can't tell everybody exactly what happened in every meeting now.
Jeanette Benigas:There were questions in meetings, these letters that you've been sending. We're using those letters. We are following up with some people are getting a ton of them, some of them are getting select ones, and then there were some. One of them asked for opinions from the hospital system, the most known hospital system in that state. Well, guess what?
Jeanette Benigas:We don't have any letters from there. So, we said, Yeah, we'll pull those for you. And then as soon as I was in the car on the way back to Ohio, I started calling people from that hospital system or for the connection. So, of you know, like, Hey, we met with your person. They want to hear from you.
Jeanette Benigas:Can you send us some letters you heard from us? If it was important like that. But otherwise, we didn't share, and can't share, a whole lot, because again, my natural inclination is transparency. Fix SLP was built on that. If I know something affects SLPs, especially if you're donating, I want to tell SLPs.
Jeanette Benigas:But transparency and strategy are not mutually exclusive. Right? And that's... This is really hard for me, and I do think Emily and I had... Again, before we hit record, we had some discussion on, like, when this is all over, this, like, follow-up we're sending on Tuesday is one we could probably share, and some things like that.
Jeanette Benigas:So, on the other side of this... Now, that's on the other side of this, if something happens, like we see rates go up, because cautiously optimistic, the rates might not go up, and then we have to continue this fight. That was something nice that we were able to discuss while we were in these hallways, too, is if nothing changes, because there really are no examples that anyone can prove of advocacy like this having an immediate effect during a current physician fee schedule, but we are creating relationships, and I think we're probably going to end by like, Where is this going? And hopefully we wrap up soon. There is still strategy to be had moving forward if we don't get the result we want.
Jeanette Benigas:So the end of this might not be November 2 or November 10. The end of this might be November second or tenth of twenty twenty eight. That's right. And and and one thing to mention, is that, you know, our team explained that congressional offices value the ability to have these candid conversations. Particularly
Emily Watkins:when you're dealing with health care, it's emotionally charged. It is financially complicated. And so people, they need to be able to ask questions without us going directly to a podcast and saying, certain states said this and this state said this, and and it just becomes because we're in a world of social media. And the social media world has created a little bit more of this kind of we need to be more responsible, And and and offices are very aware. And DC is traditional.
Emily Watkins:I mean, they value tradition. And that is another thing our lobby team said is that you're gonna learn. They wanna meet face to face. They don't wanna be finding out their name on a podcast. And so that is why we're being very responsible.
Emily Watkins:And I I I just ask that you give us the grace for that and you give us the space for that because we are just following what they are saying. And if we're gonna spend the amount of money that we're spending a month, I think it's wise to follow the people who know what they're talking about. I would rather just go and be able to tell y'all all of the great things because I thought we had 10 out of 10 meetings, you know, or 12 out of 10. Some of them were really awesome. And so I wish I could because I'm so proud of the work we've done, and I'm so proud of the work that y'all were able to do to allow us to be there.
Emily Watkins:Just give us time. I would say give us time because we will share everything at some point. And I'm hoping it'll be soon. I'm hoping it'll be sooner than later. I hope it's not in two years.
Emily Watkins:I hope it is in, you know, a month or two or three. And I think it's gonna... You're gonna go, okay. That makes sense. They said that, and and this makes sense as to why.
Emily Watkins:So just give us grace and a promise in due time, it
Jeanette Benigas:will all make more sense. The other thing that it just popped into my head is from the beginning here, CPAs and lawyers have consistently told me there is no template for what you're doing. You operate like a five zero one(three), you're kind of like a five zero one(six), which is a membership organization, but you're also doing lobbying. You could very easily register as a lobbyist, but you're a constituent, so there's room there, and you're funded through donations, but as a single owner LLC you still have to pay taxes, and there's no template. And so many people have told me that there's no template for what you're doing, and you're just...
Jeanette Benigas:We're all just gonna have to figure out as we go how this works. That applies here, too. There is no template for a grassroots social media firm with 65 or 70,000 followers paying a ton of donations to make this happen, submitting 1,300,000 points of data, there's no template on how this works on social media, which has driven this to this point. And that's where this just gets, in my head, just feels very constricting, like almost like I'm in a straight jacket. Just know, it's as frustrating for me to not open my big mouth as it is for you to not always know what's going on.
Jeanette Benigas:So, as Emily said, grace. And I will also say this, because I don't know that we're going to have somewhere else to plug this in. In terms of the transparency, we have been posting invoices on the website. K and L Gates has requested that we not post their invoices. Instead, by law, every quarter, they have to report what they were paid.
Jeanette Benigas:So we haven't... We're recording this on October 4. We have not been billed yet for the September work, but they will have to post, I'm pretty sure, q three earnings from us. And And so once that is posted, we can post the link to their legal reporting, and that's where you will see that. So I don't know if they have to do that within so many weeks or days or whatever, but just know you'll see that every quarter.
Jeanette Benigas:So you'll see one number, and then you probably won't see something again until January. That doesn't mean they're not working for us, it just means take whatever you see for September. No, it wasn't a full month. Multiply it by three, and that's probably what we're going to have to pay them for Q4. That's what you'll see in terms of reporting from them.
Jeanette Benigas:Before we start moving to what's ahead, I want to talk a little bit about the CMS meeting. We are in what's called a rule making period. Meetings are very difficult to get during a rule making period. This is why we announced we were going to DC, I actually did go to DC, Some of the meetings got canceled. Some of them got moved.
Jeanette Benigas:I had one meeting and then came back. It's why Emily didn't go because I was driving and we didn't want to have to pay for a plane ticket. I could just, you know, pay for gas at $5 a gallon because, of course, that was the minute it went up was the minute I left my garage. When you request a meeting with CMS, especially during a rulemaking period, you come when they say. So that's how we ended up there this week.
Jeanette Benigas:They said, We can give you a meeting on this day at this time, and we dropped everything and said, Okay, we're coming. And then that's why our meeting schedule with the senators and the congresspeople were moved and changed around and changing by the minute because we didn't know when CMS was going to say, Here's your time. One thing that we didn't mention is that we did meet with tech staff. The one thing I'm really disappointed that we didn't get to do was meet with the actual senators and congresspeople themselves. That typically can happen with a lobbyist.
Jeanette Benigas:Everyone was out of session while we were there, which was really disappointing. But again, we couldn't choose when we were going. All of the tech staff related to healthcare were still on the hill for reasons like this, because there are still meetings to be had. It is very likely we will have to go back again before November 1, and in those cases, if they are able to land us meetings with actual senators or congresspeople, we will be back on the hill. We are not going to take those online because that in person interaction is so valuable.
Jeanette Benigas:But we did get that meeting with CMS. If they take a meeting with anyone, again, typically it's with lower level staff, in our case, we got to meet with two of some of the most senior people at CMS. Not just on this topic, but like over everything. So this was a big deal. And we had some security issues, so we were even walking in there late, not because we showed up late, we were like early, but there are so many levels of security on this pro...
Jeanette Benigas:We went to Baltimore, Maryland for this. And you know, it just... It was what it was. It's like going through the airport. So that made us even more nervous.
Jeanette Benigas:We were rattled, but we walked in there like the bosses that we were, and we laid it all on the line. We were prepared that typically nothing happens. We were prepared that this is really close to the end of the rulemaking process. It's supposed to wrap up by November 1. We were also told that meetings like this are called listening sessions.
Jeanette Benigas:This is not conversation. That we walk in there, we say what we think they need to hear, and then they thank us and go. The importance of this was the Fix SLP comment was the predecessor for the white paper because the white paper wasn't done being drafted by the time the comment was due. But we had to get the existence of the white paper on record because anything on record, they have to consider. They also have to listen to Congress if Congress gets in.
Jeanette Benigas:So, we got us and the white paper on record through the comment period. This is another reason why this project is being run through Fix SLP. Every strategist that we met with, from the beginning all the way up to hiring K and L Gates, said, SLP was in the AMA meeting. They are the established entity, the known entity, and so the comment should be put in by Fix SLP. Not the SPEAK project, not Jeanette, not Emily, but the official comment is submitted by Fix SLP.
Jeanette Benigas:The CMS was in that AMA meeting. They've already seen me talk. They've already heard Fix SLP. They've already gotten that communication. So, presenting yourself as a new entity was not good strategy.
Jeanette Benigas:We got that on record. Also, anyone who submitted a comment through our portal, at the bottom, you talked about supporting the effort that, you know, Fix SLP would be submitting. Then, as part of the strategy, we have had more than one person from Congress submit the white paper to CMS. So it is on the, I mean, officially unofficial record because it... They wouldn't have to consider it at all if it came from us.
Jeanette Benigas:But if they don't consider it from Congress, there's a problem. So it was important for us to walk in there and show our faces and talk about the data, which is what we did. We also handed them copies of the white paper to have in their hands so we know they got it. It wasn't an electronic transmission. We talked about the data.
Jeanette Benigas:We put it in front of them at the end so they weren't distracted looking through it while we were talking, and it's going to be sent electronically through K and L Gates to them so they have the electronic version for distribution, or if that's how they prefer to read it. So that's why it was so important that we went. At the end, we got the spiel. You know, typically you're not going to hear back from us. This is how this process works.
Jeanette Benigas:But then there was a conversation, and it was another one of those, we have never seen this happen before. And that, I think, is... That I feel... I get so emotional over all of this. That's what I wish all of you could have heard the most, because I will say our community is being seen, and we are being heard, and it is what made me leave cautiously optimistic.
Jeanette Benigas:I don't know if they were blowing smoke up our asses, and I would think not, because they've got the upper hand. Right? They've got the upper hand. They could have said, Thank you, ladies. You can read about the result in November.
Jeanette Benigas:But they didn't, and these were the people who matter. Again, it wasn't lower level staff. If lower level staff would have said this to us, I still wouldn't have been as cautiously optimistic as I am now. There's probably going to be some follow-up. I don't know if we're going to go again.
Jeanette Benigas:I don't know if they're going to contact us. They're not really supposed to in a rulemaking period, but K and L Gates told us when we left, be prepared to come back here. And they couldn't really tell us what to expect either, because, one of the women with us used to work there, and they've never really seen what happened happen before. So, over the next few days, Emily and I are meeting to provide them with some follow-up, and then we don't know where it goes from there, but I would say it's not over yet. No.
Jeanette Benigas:Like, it's not over until it's over, and I think that that meeting made all of the difference. And so that's why at this point, we are going to ask everyone to stop building new roads. We need you to stop. I think this is what SLPs need to hear right now. Everyone wants to make a difference.
Jeanette Benigas:The difference potentially has already been made. Okay? And on Tuesday, we might finalize that difference. Probably the day you're hearing this. And then if we get a callback or something happens, we don't know, and we don't know if we can share that with you right now.
Jeanette Benigas:But we need everybody to stop.
Emily Watkins:Yeah. I mean, timing and coordination matters in all of this, especially when you have sixty days between the time the rates come out and it's finalized. So you have to understand that there is a strategy. It's clearly working. Trust the process, but also trust the people who are in Washington.
Emily Watkins:They do this for a living, and they've either worked there. Like, our... I call her Garcia the mess guru or the other guru of policy... Health care policy who knows how these things get changed and affected because she does done this for almost twenty years. So that is the biggest thing is I just don't want to have conflicting messages that then we have to go behind the scenes.
Emily Watkins:And quite frankly, I just don't wanna spend money on that because then that's money away from the actual mission. I would rather just spend money on the strategy moving forward than having to go and dispel conflicting messages from different offices because we have a very clear path and strategy that we are supposed to be following. And, again, I can't just spell all of that out, and there are reasons behind that. But what I can tell you is that it's working. What we're doing is working, and it is moving very quickly.
Emily Watkins:And just trust the process, and we're gonna be able to give an update because we're less than thirty days out from the rulemaking period. So if you hang tight, we're gonna try to give as many updates as we possibly can. I can I can promise you that? I will tell you what we can.
Jeanette Benigas:And so I I really do think this is the most important part of this whole episode is that we have paved the roads. They're paved. They're paved. The yellow lines are painted down the middle. We don't need anyone else making appointments with their congress people or sending letters or making phone calls.
Jeanette Benigas:SLPs are advocates. That's what I keep telling everyone, that we have an incredible community of advocates, and all of you are listening and you're hearing us say Congress needs to know, and then you're going and finding email addresses and phone numbers, and there's this massive grassroots advocacy effort happening, and that's what we have needed to this point, but we have done it. So stop making contacts with Congress and CMS. We will... May need to come to you again and say, Okay, go.
Jeanette Benigas:Ready? Go. But right now, this is a different phase. We have a lobbying team with very specific congressional strategy, and there have been one or two people that they have had to undo some things because of SLP's kind of getting in there, too. That's a distraction, and honestly, it makes us, all of us, look like we don't know what we're talking about.
Jeanette Benigas:Okay? We don't need any more meetings. In fact, I think we were prepared that they might still get us some meetings with tech staff. I don't even think that's going to happen at this point based on what happened at CMS. They said they only need two or three people weighing in from Congress to get CMS moving.
Jeanette Benigas:We already know. We already know two letters have gone in. And from the meetings this week, more are going to be sent, and so we have more than we need from the right people and the right committees. And I know everybody wants to help, but that help isn't useful at this point. What we could still use is all of you, number one, getting your beneficiaries to send letters through our portal, because we are still using those letters.
Jeanette Benigas:They're very important, and they are very useful. We're talking patients themselves, even if they're eight years old. Parents, care partners, anyone who has benefited from our service can go answer those five questions. It's really important. The right people have submitted the data.
Jeanette Benigas:There's a consistent message. Everyone has been briefed. They understand the problem. They understand the data. They're considering what needs to be communicated and what needs to happen next, and so they don't need to hear all of these different percentages or these issues or, you know, UnitedHealthcare, RUC, ASHA, da da da da da.
Jeanette Benigas:No. We've got it in, We're following up, and we're hoping we are cautiously optimistic that we will make change. Confusion is not advocacy. Congressional staff are dealing with hundreds of issues right now, a lot from doctors. And we are the little people.
Jeanette Benigas:We got in there. We punched them kindly in the face with numbers and facts, and they... We know they hurt us. The biggest thing that's super important for people to understand is advocacy is not, let's get a meeting on Monday and everything is solved Tuesday. And that is one of
Emily Watkins:the things that our our lobby firm said too is this is a this is a a marathon, not a sprint. That doesn't mean that that cannot be changed in a rulemaking period. It's just that it's not fixed in forty eight hours. That is unreasonable and unrealistic. So I do wanna explain that we made impact.
Emily Watkins:We put credible economic data in front of the people who needed to understand it, and that was the most important thing about Washington. If you really wanna know is that we were... We went and put information in front of people that can actually vouch on our behalf. And we got in front of the right people at CMS. And all of that was done because of the lobby firm.
Emily Watkins:And all of that was done because of the money that you have donated and the time that you spent also submitting your data. So, again, there is a will in a way, and there is a did it work and and what is my money going towards? And that's it. In a very, very succinct statement, it's the lobby firm that was able to get us those meetings.
Jeanette Benigas:And I would say, I I could see some people think, well, isn't more better? Can't I do my part? Not necessarily at every stage. More isn't always better. The right attention is better.
Jeanette Benigas:And so if the goal is influencing CMS payment decision, we need people who have the right jurisdiction and relationships and committee positions and healthcare staff and credibility to engage CMS effectively, and that's what the lobbying firm got us. They got us that public policy strategy. They got us in front of those people or their technical staff who actually, we've learned, can do way more than we thought. Like, when you think somebody's sending a letter, it's not the congressman sending the letter. It's the tech staff.
Emily Watkins:It's that health policy adviser. It's the health policy adviser. They run it through the congressman a lot of times. And a lot of times, it's really good to have patient letters to go with that. And the congressman says, well, what are my constituents saying?
Emily Watkins:Because that's exactly how that happens. That's why the patient letters are so important. So if you want... If you kinda understand... I hope I hope this has explained how all the pieces that we've asked for go together and are making a difference when we went to Washington.
Jeanette Benigas:And even, I mean, I was shocked to learn this too, that even when the tech staff is like, Yes, we're pretty sure so and so will send the letter. Could you help us draft something? -Happened to all of us? -Could you help us draft... Yes, sir, I can do that.
Jeanette Benigas:I can help you draft everything all day. So that's why we also know what's being communicated to CMS, because we're making a draft, and then our firm is looking at it, and then they're passing it on, and so that's... We know every single thing that's going into CMS, because they're the ones who ultimately make the change. So, it's all linking together. So, again, you can get us more letters.
Jeanette Benigas:We need those. We are using them. And and I don't think we need to be afraid to say too, Emily, you can also donate money. Yeah. $10, $25, a $100.
Jeanette Benigas:It's all being used, and this isn't over, and there's never going to be enough money to finish this. I can't imagine 100 that when those rates are published, every all five codes or the G code or wherever is all going to be back to 7,015. There's probably still going to be work to do after this, including cognition. And so, in some miracle that there is money left over, the SPEAK project continues. There is still work to be done for our coding and reimbursement, and the SPEAK project is being established to continue this work indefinitely.
Jeanette Benigas:Because ASH is not doing it someone has to, and we told K and L Gates, We will retain you for as long as possible, and it's not going to be hundreds of thousands of dollars every month. A retainer can be low just to keep them on retainer, and then you ramp it back up when you're ready to deal with the policy or the code or whatever that you have to deal with. So, getting a meeting isn't the finish line. I don't think I fully appreciated this at the beginning of all this. I knew we need people who know what they're doing, Emily's and been learning along the way.
Jeanette Benigas:Getting a meeting isn't the finish line. It's just the beginning. What happens after the meeting is the most important. We've followed up with the data, or we've provided it. We've followed up by providing more or more letters.
Jeanette Benigas:They've been able to ask additional questions. We've drafted language to be submitted through these offices. We've gotten connections with other offices or people. The technical staff is involved, they're the ones who advise. This is actual policy work rather than awareness work, which is, you know, meeting in a local office or with general staff, that's awareness work.
Jeanette Benigas:This is like the actual policy work. And so, I have read a little bit, too, that ASHA has said, Well, this is this branch, and this is this branch, or maybe it wasn't ASHA, but it was out there somewhere that Congress can't really do anything. Yes, they can, and they are. They are. Which is why I think CMS responded to us in the way that they did, because we were taking virtual meetings before we went and got letters in.
Jeanette Benigas:I just think it's all falling into place now For this phase, follow the paved road. We have the data. We have the policy team. We have the congressional interest. We've spoken to CMS.
Jeanette Benigas:We have the strategy now, so let's execute it. And that means everybody stop. The firm has said continue the letters. So keep getting us letters, keep sending in money or finding people to help donate, and then we go from there.
Emily Watkins:And really the main thing is is our lobby firm, you know, laid out a strategy, and it's a multilayer, multifaceted. And they said, we're gonna attack this from all three angles that we know have worked in the past. And that's exactly what we've done, and we have moved very quick. And they've been very impressed. I mean, the number of comments to CMS, the number of patient letters, and that is what Jeanette was just talking about.
Emily Watkins:Get the letters in. That's a patient letter, beneficiary letter, constituent letter from, you know, your state. And so, again, all of these things working in tandem together is what is exactly going to push and roll this ball forward and move the needle. It... It's the best fighting chance we have is the strategy that they've laid out, and it's all these pieces we keep talking about.
Emily Watkins:And it doesn't deal with reaching out to district offices. What it does deal with is getting patient letters, letting us have these meetings, letting us focus. I mean, our work is just beginning. I thought we had a lot of work. I thought we did a lot of work in the last month, but the...
Emily Watkins:Our work is really just beginning this month because of the of the foundation that we just laid in Washington. So I'm excited. I'm excited on where we're going. I'm excited on a lot of the the progress we're gonna make in in the next thirty days. So
Jeanette Benigas:-I feel like we've learned an enormous amount through this process. I've learned more about the AMA and RUC and codes and policy and federal policy in the last few months than I have ever intended to know, right? I thought I was going into speech pathology to treat children with autism, and I am. So far from that, it's incredible. But there's a bigger lesson here, I think, for our profession, and it's SLPs have power when we have evidence.
Jeanette Benigas:For years, years and years, we've been saying, This isn't fair. We're underpaid. We're burned out. Our productivity expectations are unreasonable. My caseload is too high.
Jeanette Benigas:We don't have enough time. I have moral injury. And all of these things are true, but policymakers don't make billion dollar health care decisions based solely on whether something seems unfair. We have to quantify those things, like what does the service cost, and how long does it take, and how much goes into labor, and what happens to capacity if this decreases, and what do the wait list look like? Like, there's so many things.
Jeanette Benigas:And so, this last seven weeks is what Speak is trying to build for a long term seat at the table, because if you're not at the table, you're on the menu. And I really do think that that's how we ended up here. We were on the menu because we weren't at the table, and we didn't know to pay attention, and we didn't have a voice back by evidence, but now we do. Now we do. So, you're not going to see us sitting around waiting.
Jeanette Benigas:We're not abandoning any issues. If you're not hearing from us, it's because we are actively working. Like, there are letters to be drafted. We have meetings every single day. We have a roundtable in fifteen hours from now for some strategy stuff.
Jeanette Benigas:We've got drafts to send, CMS to follow-up with. There's a lot happening over the next week or two, and some of this may necessitate us going back to DC. So, we're not sitting around and waiting. We're going all in. We put in a request for a very different meeting.
Jeanette Benigas:That is like a backup to the backup. Like, we're hitting every base whether we think we need it or not. We're doing all the things all at once because probably that final rule is published in a month from us recording this.
Emily Watkins:We're going all in.
Jeanette Benigas:Yeah, and we think the responsible thing we can say right now is the work is happening. We'll tell you what we can, when we can. I know that's different for Fix SLP, but we're playing in a different arena right now. It's much bigger. We're dealing with federal agencies and congressional offices and federal policies and a global law and lobbying firm and national economic data, and I get like...
Jeanette Benigas:How did I get here? There are times when being effective really just, I think, requires discipline. So I'd rather explain on the back end than have to explain ourselves out of a situation that we've caused. So what's the bottom line, Emily?
Emily Watkins:Bottom line is that did Washington work? I can tell you from the extent of the reactions in the meetings in our lobby firm, yes, For the intention that we went there, which was to lay the foundation for change.
Jeanette Benigas:Mhmm. Yep. Okay. So we're gonna keep pushing. When it's time to mobilize everyone again, we'll tell you.
Jeanette Benigas:For now, the beneficiary letters and money are the two things, and we have a lot of following up to do, and then we'll see where we land. There probably won't be a lot of graphics, because what can we say? Not a lot.: Yeah. So, just trust that quiet doesn't mean inactive. Remember how we got here.
Jeanette Benigas:You've all shared data and letters. Families are sharing stories, hopefully still. People have donated time and money and expertise, and right now we're in this transition where we're bringing it all together and getting it all to the right places. We've made a national economic case for what it actually costs to provide our services. I think that's very powerful.
Jeanette Benigas:This started because we refused to accept that the only choices were to complain about numbers or live with them. We chose another option, prove that the numbers don't work, and we're taking that proof to where it goes. Our data, our voice, our profession, we're not done. So, as always, I'm just going to say thanks for fixing it. And we're to keep fixing it too, and we'll be back at you the next time we have something to say.
Jeanette Benigas:Thanks for listening to the Fix SLP 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 Fix SLP team. Don't just listen, be a part of the change. Share this episode and our social media content, and let's keep fixing the field one fight at a time.