Private Practice Owners and Independent Contractors For additional information, please contact Jeanette Janota, Surveys & Information Team American Speech-Language-Hearing Association Rockville, MD 20850 800-498-2071, ext. 8738 jjanota@asha.org
Contents Executive Summary...1 Who They Are...2 Highest Degree...2 Sex...2 Age...2 Years of Experience...3 Facility...3 Geographic Region...3 Population Density...3 Their Practices...4 Full-Time, Part-Time...4 Additional Job...4 Activities...5 Electronic Medical Records...5 Who They Treat...6 Pediatric...6 Autism...6 Early Intervention...6 Insurance Denials...7 Adults...7 Interns...7 What They Earn: Annual Salaries...8 What They Earn: Hourly Wages...8 Facility...8 Region of the Country...8 Population Density...8 What They Earn: Per Visit...9 Medicare Provider...9 Source of Payments...9 Facility...10 ii
Region of the Country...10 Population Density...10 What They Say About ASHA...11 ASHA Offerings...11 Cultural and Linguistic Diversity...11 Survey Notes and Methodology...12 Response Rate...12 Survey Reports...12 Suggested Citation...13 Supplemental Sources...13 Thank You...13 Additional Information...13 Figures Figure 1: Sex of Owners/Contractors...2 Figure 2: Employed Full- or Part-Time...4 Figure 3: Activities...5 Figure 4: Electronic Medical Record System...5 Figure 5: 2009 and 2010 Denials From Health Plans...7 Figure 6: Medicare Provider...9 Figure 7: Payment Sources...10 Figure 8: Items Rated Very Important...11 iii
Executive Summary The American Speech-Language-Hearing Association (ASHA) conducted a survey of speech-language pathologists (SLPs) in the spring of 2011. The survey was designed to provide information about health care based service delivery and to update and expand information gathered during previous SLP Health Care Surveys. The results are presented in a series of reports. This report is based on responses from SLPs who were private practice owners or independent contractors in six types of health care facilities: general medical hospitals, rehabilitation hospitals, pediatric hospitals, skilled nursing facilities (SNFs), home health agencies and clients homes, and outpatient clinics and offices. Highlights: 96% held master s degrees. 95% were female. Median age was 42; mean age was 45. Median number of years of experience was 15. 41% worked in outpatient clinics or offices. 38% worked in the South. 49% worked in suburban areas. 61% worked part-time. 21% always use an electronic medical records system. 40% of treatment time with pediatric patients was in the area of language. 32% of treatment time with adults was in the area of swallowing. Private pay was the most common payment source (79%). 68% said ASHA was doing an excellent or good job serving its health care members. 1
Who They Are Highest Degree The data in this report were gathered from the 665 speech-language pathologists who indicated on ASHA s 2011 SLP Health Care Survey that they were independent contractors or owners or coowners of a private practice. The number of respondents is less than 665 for those questions that some participants chose not to answer. Of the SLPs who were owners or contractors (n = 659): 96% had a master s as their highest degree, 4% had a doctoral degree. Sex Of the SLPs who were owners or contractors, most were female (see Figure 1). Figure 1. Sex of Owners/Contractors 5% Male Female 95% n = 656 Age Of the SLPs who were owners or contractors (n = 661): the median age was 42, the mean age was 45, the modal age was 35. 2
Years of Experience Years of experience influenced the likelihood of owning a private practice or being an independent contractor (p =.000). For example, of SLPs who had 1 3 years of experience, 19% were owners/ contractors; of SLPs with 31 or more years of experience, 59% were owners/contractors. The median number of years of experience for the SLPs who were owners/contractors was 15 (n = 660). The median number of years of experience for those who were not owners/contractors was 10 (n = 1,102). Facility Of the SLPs who were owners or contractors (n = 652): 1% worked in pediatric hospitals, 3% in rehabilitation hospitals, 8% in general medical hospitals, 10% in skilled nursing facilities (SNFs), 37% in home health agencies or clients homes, 41% in outpatient clinics or offices. Geographic Region Of the SLPs who were owners or contractors (n = 663): 17% worked in the Midwest, 19% in the West, 26% in the Northeast, 38% in the South. Population Density Of the SLPs who were owners or contractors (n = 647): 18% worked in rural areas, 33% worked in metropolitan/urban areas, 49% worked in suburban areas. 3
Their Practices Full-Time, Part-Time SLPs were more likely to work part-time than full-time as private practice owners or independent contractors (see Figure 2). Figure 2. Employed Full- or Part-Time 39% 61% Full-time Part-time n = 665 Owners/contractors in outpatient clinics and offices (50%) and home health agencies or clients homes (41%) were more likely than those in other types of facilities to be employed full-time (p =.000). Region of the country (p =.096) and population density (p =.271) had no effect on whether owners/contractors worked full- or parttime. Additional Job Half (52%) of the part-time owners/contractors reported that they held an additional job in the profession. An additional job was reported by 94% of the part-time owners/contractors in rehabilitation hospitals, 88% of those in pediatric hospitals, 87% in general medical hospitals, and 79% in SNFs, but only 40% in outpatient clinics and offices and 34% in home health agencies and clients homes (n = 383; p =.000). 4
Activities Regardless of whether they were employed full- or part-time, private practice owners/contractors spent the overwhelming majority of their time providing direct treatment to individuals or groups (see Figure 3). Figure 3. Activities 100% 75% 72% 75% 50% 25% 0% 3% 3% 18% 18% 8% 5% Full-time Part-time n = 581 Electronic Medical Records Slightly fewer than half of the owners/contractors reported using an electronic medical record system for documenting clinical activities (see Figure 4). Figure 4. Electronic Medical Record System 21% 55% Always Sometimes Never 24% n = 644 5
Who They Treat The ages of populations served by private practice owners/ contractors were fairly evenly distributed: 28% of their services were delivered to infants and toddlers, 23% to preschoolers, 21% to school-age children, 28% to adults. Pediatric Of those who treated pediatric patients (n = 489), 2% of their time was spent on prevention/wellness, 2% on voice/resonance, 4% on fluency, 5% on augmentative and alternative communication (AAC), 7% on cognitive communication, 10% on swallowing and feeding, 29% on articulation-phonology, 40% on language, 2% on other areas. Autism Children with autism accounted for a median of 20% of the caseload of owners/contractors who worked in home health agencies and clients homes or outpatient clinics and offices. Early Intervention Nearly half (45%) of the owners/contractors said that they provide early intervention (EI) services to children between birth and 3 years of age under the direction of an individualized family service plan. SLPs in SNFs were least likely (19%) to provide EI services, while those in home health agencies and clients homes were most likely (69%; p =.000). 6
Insurance Denials During 2010, 27% of the owners/contractors received denials from health plans for speech-language services for children because the plans claimed that public schools provided those services. An additional 50% did not receive denials, and the remaining 24% did not know. Half did not know how denials in 2010 compared to the previous year (see Figure 5). Figure 5. 2009 and 2010 Denials From Health Plans 3% 51% 25% Fewer in 2010 No change More in 2010 Don't Know 21% n = 546 Adults Interns Of the private practice owners/contractors who treated adult patients (n = 282), 3% of their time was spent on accent modification/ communication effectiveness, 4% on AAC, 8% on cognitive communication: traumatic brain injury, 8% on cognitive communication: dementia, 4% on cognitive communication: other, 9% on motor speech, 9% on voice/resonance, 17% on aphasia, 32% on swallowing, 6% on other areas. The mean number of graduate student interns in 2010 was 2; the median was 1. Half (51%) of the owners/contractors indicated that there was no change in this number compared to 2009, but 7% said that there were more, 7% said fewer, and 35% did not know. 7
What They Earn: Annual Salaries The salaries in this report are median salaries (the one in the middle when salaries are ordered from lowest to highest). Salaries are presented only when there are sufficient cases for the category, that is, a minimum of 25 respondents. Only 78 private practice owners/contractors, mostly in outpatient clinics or offices (n = 58), worked for an annual salary. Their median salary was $65,000. What They Earn: Hourly Wages The median number of weekly hours worked by owners/ contractors who received an hourly wage was 20, with a range from 1 to 53 hours. Owners/contractors who worked up through 20 hours per week (n = 194) earned a median hourly wage of $60.00. Those who worked more than 20 hours (n = 115) received a median hourly wage of $50.00. Facility Private practice owners/contractors in outpatient clinics or offices (n = 148) earned a median hourly wage of $65.00, while those working in home health agencies or clients homes earned $67.89 (n = 71), those in general medical hospitals earned $46.33 (n = 34), and those in SNFs earned $46.20 (n = 53). Too few owners/contractors worked in rehabilitation hospitals or pediatric hospitals to report their results. Region of the Country Owners/contractors in the Northeast earned $72.10 (n = 81). Medians were lower in other areas: $55.86 in the West (n = 66), $50.00 in the South (n = 122), $47.96 in the Midwest (n = 52). Population Density The median hourly wage was $60.00 in the suburbs (n = 151), $58.30 in metropolitan/urban areas (n = 99), and $52.53 in rural areas (n = 66). 8
What They Earn: Per Visit A total of 166 private practice owners/contractors reported receiving a per visit wage. Their median wage was $66.24. Nearly all (n = 143) of them were employed in a home health agency or client s home, where their per visit wage was $67.06. Medicare Provider Fewer than one quarter of the owners/contractors have enrolled as Medicare providers (see Figure 6). Figure 6. Medicare Provider 22% Yes No 78% n = 638 The type of facility where the SLPs worked had no effect on whether they had enrolled as a Medicare provider (p =.850). Source of Payments Owners/contractors were invited to select from a list of five sources of payments for services. The most common source was private pay, followed by agency or school contract. Fewer SLPs selected Medicare than any other source of payment (see Figure 7). 9
Figure 7. Payment Sources 79% 64% 59% 46% 20% 100% 75% 50% 25% 0% n 382 Facility Region of the Country Population Density Payment sources varied by several characteristics. By type of facility: Patient private pay ranged from 53% in SNFs to 90% in outpatient clinics and offices (p =.000). Private health insurance ranged from 26% in SNFs to 67% in outpatient clinics (p =.000). Medicaid was reported as a source by as few as 20% of owners/ contractors in pediatric hospitals and up to 51% of those in home health agencies or clients homes (p =.009). By region of the country: Reimbursement from an agency or school contract ranged from 57% in the South to 74% in the Northeast (p =.022). Private health insurance ranged from 39% in the Northeast to 68% in the South and Midwest (p =.000). Medicaid was reported as a source by 19% of owners/ contractors in the Northeast, 32% in the West, 42% in the Midwest, and 65% in the South (p =.000). Medicare was a source of payment for 13% of owners/ contractors in the Midwest and 28% in the South (p =.018). Population density affected two payment sources: Reimbursement from an agency or school contract ranged from 53% in metropolitan areas to 79% in rural areas (p =.000). Medicaid ranged from 38% in metropolitan areas to 43% in suburban areas to 63% in rural areas (p =.002). 10
What They Say About ASHA The first question on the SLP Health Care Survey asked about the kind of job the Association is doing in serving its health care members. A few owners/contractors (4%) said poor, nearly one third (29%) said fair, more than half (55%) said good, and 13% said excellent (n = 637). Region of the country (p =.656) and population density (p =.140) had no effect on their responses, and both type of facility and years of experience had too few respondents at each level to be able to test for differences. ASHA Offerings SLPs were presented with a list of five ASHA programs, products, and services and asked to rate the importance of each on a 5-point scale. More owners/contractors gave the highest rating (i.e., Very important) to ASHA continuing education programs than to any of the other items (see Figure 8). Figure 8. Items Rated Very Important 50% 47% 40% 30% 32% 28% 20% 10% 13% 8% 0% ASHA CE programs ASHA policy documents ASHA web pages Professional consultation ASHA products n 640 Cultural and Linguistic Diversity When owners/contractors were asked how qualified they were, on a 5-point scale, to address cultural and linguistic influences on service delivery and outcomes, 10% said they were very qualified. When very qualified was merged with the next response category, 33% identified themselves as qualified. Too little data were available in some facility categories to test whether responses varied by type of facility. 11
Survey Notes and Methodology The SLP Health Care Survey has been fielded in odd-numbered years since 2005 to gather information of interest to the profession. Members, volunteer leaders, and staff rely on data from the survey to better understand the priorities and needs of SLPs. Response Rate The survey was mailed in February 2011 to a random sample of 4,000 ASHA-certified SLPs who were employed in health care settings in the United States. Second (March) and third (April) mailings followed, at approximately 3- or 4-week intervals, to individuals who had not responded to earlier mailings. The sample was a random sample, stratified by type of facility and by private practice. Small groups, such as pediatric hospitals, were oversampled. Therefore, weighting was used when presenting data to reflect the actual distribution of SLPs in each type of facility within ASHA. Of the original 4,000 SLPs in the sample, 1 was deceased, 1 was retired, 10 had bad addresses, 2 were not employed in the field, and 63 were employed in other types of facilities, leaving 3,923 possible respondents. The actual number of respondents was 2,451, resulting in a 62.5% response rate. The results presented in this report are based on responses from those 2,451 individuals. Survey Reports Results from the 2011 SLP Health Care Survey are presented in a series of reports: Survey Summary Report Caseload Characteristics Workforce and Work Conditions Annual Salary Report Hourly and Per Visit Salary Report Private Practice Owners and Independent Contractors Survey Methodology, Respondent Demographics, and Glossary 12
Suggested Citation American Speech-Language-Hearing Association. (2011). ASHA SLP Health Care Survey 2011: Private practice owners and independent contractors. Available from www.asha.org. Supplemental Sources Medicare and SLPs in private practice. www.asha.org/practice/ reimbursement/medicare/slpprivatepractice.htm. Private practice resources. www.asha.org/slp/ppresources.htm. Additional Information For additional information regarding the 2011 SLP Health Care Survey, please contact Amy Hasselkus, Associate Director of Health Care Services, at 800-498-2071, ext. 5686, ahasselkus@asha.org, or Janet Brown, Director of Health Care Services, at ext. 5679, jbrown@asha.org. To learn more about resources for ASHA members working in health care, visit ASHA s website at www.asha.org/slp/healthcare. Thank You ASHA would like to thank the SLPs who completed the 2011 SLP Health Care Survey. Reports like this one are possible only because people like you participated. Is this information valuable to you? If so, please accept invitations to participate in other ASHA-sponsored surveys and focus groups. You are the experts, and we rely on you to provide data to share with your fellow members. ASHA surveys benefit you. 8/9/11 13