I can’t read the word “capitation” now without thinking of the word “decapitation.”  As a Speech Language Pathologist that works primarily from the neck up (Swallowing, speaking, cognition, and language) this image always used to make me chuckle but less so now.  Capitation was designed to curb the upward trending costs of healthcare by paying groups and organizations a fixed amount irrespective of the amount of care provided.  Essentially, “capping” the payments associated to physicians, facilities and other medical providers.

In 2018, about 33 percent of seniors elected to use Medicare Advantage plan.  Today there are a total of 3,998 plans nationwide, an increase of 6% from last year, more than 28 million seniors, 48 percent of the eligible population are currently enrolled.  A growing number of these individuals are in dual eligible plans, meaning that these plans cover both the Medicare and Medicaid eligible population.   

Each managed care plan comes with its own set of stipulations and restrictions.  Some plans follow traditional payment structures only with reduced rates while others will capitate the duration of service (i.e., Facility will be paid for one week of skilled speech therapy services).  So, in essence, facilities will be reimbursed less for the same amount of work. They have to work faster to reach patient goals in order to remain fiscally solvent.  This is all happening in a time when skilled nursing facilities residents are arriving at our doors more acutely ill with more pronounced co-morbidities.  Nurses and therapists will have to hustle, document better and faster and see more patients in less time. Burnout anyone?

As clinicians, we are obligated to help our clients.  We were taught that money follows care.  It would be great if we lived in an environment that continued that mantra to include, good money follows good care, but we do not.  Today we need to stay current. Not only as to what the latest evidence-based outcomes recommend for course of treatment, but which payor allows for important treatments.  Examples include group therapy and instrumental exams, such as FEES.  I understand the need for cost containment. Medicare and Medicaid are not profit centers for the government & were never meant to be. 

About the Author:

Michael Webb, CCC-SLP, is the CEO of Language Fundamentals & a practicing FEES clinician. Michael has instructed graduate students in FEES at the Communication Disorders Department at SUNY New Paltz. He also served as a member of the department chair search committee for the newly developed State University of New York at Stony Brook University Communication Disorders program and was since appointed to the position of Clinical Instructor in the School of Health Technology and Management.