Measuring Value vs. Creating It: Evidence-Based Tactics

Ok, so we’ve already waded through the alphabet soup of MIPS, MVPs, and PROMs. We talked about why we have to measure value to survive the multi-trillion-dollar macroeconomic nightmare of modern healthcare.

But measuring value and creating value are two different things. We know this in our heart of hearts, don’t we?

Now, let’s talk about how we move beyond simply checking the boxes for compliance and actually make a difference in the lives of those we serve…

Here is what adding real, measurable value looks like, along with the practical tactics you can implement tomorrow.

The first thing we need to figure out is what actually works. And the best way to do that is by understanding the research. There are TONs of amazing resources out there for doing a thorough lit review, so we won’t get into that here, but it’s always best to ask yourself whether or not what you’re doing is grounded in the literature. 

Pause from reading for a quick second and go to the ASHA evidence maps. Look up your most frequently used approach to managing dysphagia. Did the results surprise you? Did it have enough evidence to support doing it as often as you do? Did this activity change your mind about using that intervention again in the future?

New research is constantly being published, and best practice is an evolving concept that will inevitably change from year to year. Which is why it is SO important to stay on top of the latest research by going to conferences, speaking with your colleagues, and occasionally searching through the archives (Start with a few minutes a day and build from there. We already know the productivity Gods are watching!). 

Once we have greater command of the literature, we can start modifying our approaches that were once written in stone (and maybe during the stone ages), but now need a facelift to keep up with newly published literature. Let’s take thickened liquids for example…

We once thought that thickened liquids should be used for anyone and everyone who was coughing at the bedside. Not only did we think that thickened liquids were a one-size-fits-all tool for everyone, but we also thought that the thicker the liquid, the better it was.

Newer research tells us now that this isn’t necessarily true. 

In fact, thickening liquids got a scathing review in this 2019 article on the topic titled, “Things we do for no reason.” Yikes, just the title gives me a shiver. Of course, it’s not true that there is NO reason to thicken liquids. They may be important for some patients, but they aren’t for everyone, and they come with risks, like dehydration and possibly even aspiration pneumonia. That’s because the thicker a substance is, the harder it is to clear from the lungs. 

So we adjust. We perform an instrumental swallowing evaluation first to ensure the patient benefits from thickened liquids, and we use them temporarily, repeating the exam as soon as appropriate. Finally, we move the patient back to thin liquids as soon as the patient is ready because long-term use carries additional risks. 

Here’s another example of using the literature to adjust our therapeutic approaches, but in language treatment. 

Using The Environment to Treat the Patient:

Say you are working with a stroke survivor who has severe aphasia. The traditional approach would be to sit in a quiet clinic room for 45 minutes running through questions from your old trusty Workbook of Activities for Language and Cognition or using standardized flashcards that have been passed down from 3 generations ago.

These activities can be beneficial if targeted appropriately, but what happens when the patient is discharged and goes home to a spouse who has no idea how to communicate with them?

The Tactic: Communication Partner Training

To truly add value, the SLP must look beyond the individual patient. Exceptional SLPs use co-design and respectful partnerships to implement Communication Partner Training (CPT) programs, grounding their interventions in the patient's lived, everyday experience. When a patient is getting ready for discharge, we don’t want the value of our therapy to end along with our therapy.

Our goal is to literally work ourselves out of a job… at least for that particular patient. By training family members and caregivers, the SLP ensures the therapy continues long after the session ends. 

And what happens when the research doesn't perfectly fit the patient sitting in front of you?

It almost never does, right? Well, then you adapt. SLPs can add value by generating their own Practice-Based Evidence (PBE)—systematically collecting data on their treatment efficacy to evaluate what is working and what isn't, and adjusting exercise dosage accordingly.

It’s a two-way road after all. The evidence is important in the literature, but so is our clinical experience in the front lines.

I did this once in a hospital to determine the risk factors of aspiration pneumonia, as well as the most effective risk management strategies. It was an absolute game changer. 

Interdisciplinary Care

At the end of the day, the single biggest way we add value is by refusing to work in silos.

Interdisciplinary care eliminates duplicate services, reduces fragmentation, boosts patient satisfaction, and directly reduces healthcare costs.

We are the ultimate antidote to the "low-value medical orders" (LVMOs) that are bankrupting our system—habit-driven, unnecessary tests and procedures that offer zero clinical benefit. We are the providers who actually see the patient, figure out what they need to live a functional life, and help them achieve it.

We don't need to count our billable minutes to know our worth. We just need to execute on these tactics, track our outcomes, and let the results speak for themselves.