Photo by igor Rodrigues. Man in Wheelchair

This morning, I read an article in the Washington Post titled, “Low Prices of Some Lifesaving Drugs Make Them Impossible to Get,” by Laurie McGinley. I found myself drawing concerning parallels to recent conversations I’ve had with my rehabilitation colleagues.

The parallels between some critical drug shortages and the shortages of highly experienced speech-language pathologists who help adults is a problem that seems to be worsening. Most families are unaware of the fact that Medicare regulations have forced numerous constraints on how speech-language pathologists (SLPs) can train students in graduate programs as well as how experienced SLPs can run their businesses.

Fewer graduate programs in the communicative disorders field are able to offer meaningful externships so students can learn how to help adults improve communication and cognitive skills after experiencing a debilitating event such as a stroke or receiving the diagnosis of a degenerative disease.

I encounter the ramifications of this regulation just about every day in my private practice. I do not offer a “Medicare reimbursable service.” However, did you know that if I did provide a “Medicare reimbursable service” as part of my private practice, I could not accept private pay after Medicare funding (which is bundled with PT benefits) ran out? I would be forced to discharge the client, even if they had untapped potential to improve their life with my help!

If a family chooses to come to my practice rather than another speech therapy providers, or if there is a long waiting list for time sensitive “Medicare reimbursable services,” families cannot lawfully seek those services in my practice.

Many SLPs, including myself, are unable to opt-out of Medicare and provide a “Medicare reimbursable speech therapy service.” Something is wrong with this system. As the aging population expands, this problem will only get worse.

It’s critical that we protect elderly and disabled individuals so they don’t become prey to others who may try to take advantage of them. I get that. It’s why I do what I do! My entire career is devoted to helping individuals of all ages with communication and learning differences. However, when did it become ok for society to limit the choice of families regarding how they choose to spend their hard earned money? Shouldn’t they have the ability to decide where they go for help?

If your grandparent, father, or spouse had a stroke and experienced aphasia (loss of language), dysarthria (slurred speech), apraxia (muscular coordination issues), or a cognitive loss and wanted to get the best help possible so that they could maximize recovery and afford to pay for more than Medicare is willing to reimburse, shouldn’t they have that choice? The current rules discriminate against Medicare-eligible patients and clients.

Current federal regulations are creating a severe problem under the guise of protecting the elderly. We have taken away a person’s right to choose how they spend their money. Options for speech therapy for the elderly are now greatly diminished.

Back in 2008, the Medicare Improvements for Patients and Providers Act (MIPPA) was passed, which included a provision that permitted speech-language pathologists in private practice to directly bill the Medicare program.

It opened many doors for families to have more choice in terms of where they chose to obtain services. However, the current federal Social Security Act requires audiologists and SLPs to enroll in and bill Medicare when they provide any covered services to a Medicare beneficiary.

This law was created to set standards to ensure the quality of providers, but in my opinion, is backfiring and causing shortages. Physicians may establish “boutique” practices, but SLPs cannot. Not if they want to treat adults over 65 who have Medicare. It just doesn’t make sense.

Today’s Washington Post article resonated quite a bit with recent fears of mine. Many private SLP practitioners have decided that it is just too difficult to make a living by offering high caliber services helping seniors over 65 who have Medicare. Shouldn’t they be permitted to “opt-out” like physicians?

Have you noticed that speech-language pathologists who help the elderly are very difficult to find? The vast majority of new SLPs who are interested in private practice often work with children so they can make ends meet. What can be done to change this? I believe that increasing awareness is the first step, and I hope that I’ve done that by writing this post. To learn more about how SLPs are told to comply, visit