Friday, August 22, 2014

New CMS Regulations May Silence Thousands

UPDATE: CMS has pushed the implementation date for these changes to December 1, 2014.  However, the Congressional Letter must be signed by next Friday, September 5! 
Please ask your representatives to read and join the Dear Colleague Letter.

On September 1, bureaucrats at the Centers for Medicare & Medicaid Services (CMS) will change the rules surrounding "Speech Generating Devices" or SGDs.  These changes make the devices less useful, more expensive to the taxpayer, and explicitly remove them from patients when they are admitted to hospitals, nursing facilities and (horrifically) hospice care.

Please consider joining us in trying to prevent them from going into effect and harming our neighbors with ALS, Autism, genetic disorders, stroke and more.

This decision offends me on so many levels its hard to list them.   The most insulting is the idea that we would choose to remove a device from someone who is entering a hospice facility.  Imagine this scenario for a moment.
Alice is 67 years old and suffers a stroke that impacts her ability to speak.  After months of rehab, she has learned to use an SGD to communicate with her family.  The device (funded by Medicare) has been "trained" for her: her rehab team has adjusted it to fit her needs by attaching switches and setting up the vocabulary and she's worked for days and weeks to get where she can at least have some control over her life and a margin of independence.  She can welcome her visitors and tell her family she loves them.
Sadly, Alice has a setback: perhaps another stroke, perhaps cancer, but for whatever reason, her prognosis dims to the point where hospitalization and eventually hospice care are needed.  This is likely the moment in her life when her words are the most valuable. Her family will cherish anything she says, and she will get to say goodbye.
Under these new rules, Alice would have to turn in her SGD upon admission.  The argument goes that, like walkers and feeding pumps, SGDs are Durable Medical Equipment and "should be provided by the facility."  But, unlike walkers and feeding pumps, this is Alice's device.  It has been configured and modified specifically for her and she, in many ways, has been trained to use it - it has become unique.  Even if the hospice facility has an SGD available, placing it in Alice's hands and asking her to speak with it will produce nothing but justifiable rage and frustration.

New Audible Speech Limitations

Another change coming is the elimination of devices that do anything but produce audible speech.  A bit of technical background is helpful here to understand why a techie like me is infuriated by this.  Bear with me, I think it's worth understanding.

Over the last few years, most SGD manufacturers have moved to a platform like Android (or Windows or iOS) that already has the basics functions of handling the touch-screen, powering the speaker, etc. "baked in."  Speech-specific software and hardware like hardened case and switch ports are then added to make the SGD.  You can see a similar trend in E-Readers.  Your Kindle or Nook is actually an Android tablet that Amazon or Barnes and Noble have added their software and (perhaps) nice paper-white screen to let you read their books.

SGDs based on platforms like Android are more powerful: they can access the internet, send text messages and emails, post to blogs and download updates to their software over the internet.  They are also less expensive: manufactures don't have to develop the low-level functions nor do they have to constantly improve them - they can just update their Android version and focus on making their speech software and hardware great.

Under these new rules, any device that is capable of doing anything other than producing audible speech is no longer allowed.  Even if that other functionality is disabled or hidden, the device will not be funded.

Consider the real-world impact of this change:
Betty is a 19 year old student with autism.  She uses her SGD (funded by Medicaid)  to speak and with the new LAMP-style systems can now express herself, not just make requests and answer questions.  She has opinions, irritations, joys and a point of view understandably very different than you or I.  She's learning at a young age that she's going to need to be a self-advocate, and she's able to do that through her device.  
She has spent years getting to this point and her family is incredibly proud of her. 
However, she is also like most teenagers in that the majority of her communication is silent.  She likes it that way--she likes the privacy.  She uses her device to send text messages and to post to Facebook.  Because the device is based on Android, those modes of communication are possible, but so are so many other things: she uses the built-in camera to share a smile with her dad when he's out of town and reads her books on the Kindle app.
After these changes, Betty will have to trade in her device for one that is dumbed down, and incredibly, more expensive to build.  This isn't hyperbole or a possible outcome, Saltillo, an excellent SGD manufacturer, has created (at great expense) stripped-down versions of their devices that they have had to gut until they only generated audible speech.  You can see both the normal and  Medicare/Medicaid versions here.

I seethe when I think about what that means: Betty, who has finally found a way to express herself after years of work, has just been silenced.  If she wants to talk to her dad, she'll laughably have to hold her SGD up to her cell phone so he can hear it!

Frustrated doesn't begin to describe it.

What does that mean about the value we place on the views of people like Betty?

Why would we do this as a society?

This is not "fraud prevention," as CMS has produced no evidence of widespread fraud after repeated requests.  The program has stringent definitions of "medically necessary" and the device must be prescribed by a doctor or SLP. 

It's not "cost cutting" because there's no incentive for SGD manufacturers to reduce their prices - in fact, it will increase them!  The only way this saves money is to remove devices from the hands of people who need them.  Plus, even if you chose to de-fund every device you'd save a few million dollars while silencing thousands of citizens--how can that be effective?

At first, I thought there might be "cronyism" behind this, where one vendor was effectively cornering the market.  However, every vendor I've spoken to, from the high-tech SGDs like Tobii/Dynavox and PRC/Saltillo to the low-tech SGDs that LessonPix.com can make templates for think this is awful.  It's unanimous, and there are no winners here.

The only slightly plausible argument I've heard is that politicians and administration officials don't want to be "seen as giving away free iPads."  First, the lives of these people is more important than political "optics."  But, if that's what your worried about, strengthen the "medical necessity" requirements, don't dumb-down the devices..

Help Us Stop This!

Please help us try to stop this before they go into effect (or roll them back quickly).  There really are things you can do, and they really can make a difference.

Tara Rudnicki from ATIA and Tobii/Dynavox has written a great post of how you can involve your elected representatives.  Senators and Representatives from both parties have written a "Dear Colleague" letter to gather support within the legislature to put the brakes on these awful regulations while they are reviewed.

With the proper motivation from the citizens in their districts, this can happen.  Here are some tips:
  1. Find your House Member and Senators and write or call them all.  If you do nothing else, ask them to sign the Dear Colleague letter titled “Ensure ALS Patients Retain Access to Critical Communication Tools Ensure; Join letter to CMS urging clarification of recent Speech Generating Device policies.” (They will know how to find it & sign it)
  2. Tell them about people you know personally or that you admire who use AAC and SGD devices and how their views have impacted you. 
  3. Tell them this is a perfect example of government at its worst: bureaucrats making decisions that hurt the vulnerable and benefit no one.
  4. If your representatives lean conservative, point out that this does nothing to reduce spending and that by NOT reigning in these policies they are complicit in silencing those few that government should be helping and that the changes will spend our tax dollars less effectively.
  5. If your representatives lean liberal, point out that the views of a minority who have rights and points of view are being silenced.  We should be celebrating that these technical improvements have given them a voice in our society and listening to them, not limiting them based on regulations with no up-side.
Thank you for your patience and for reading this rant.  Thank you even more for your help.  If you know of any way we can do more, please reach out to me directly at bill@lessonpix.com or @LessonPix on Twitter.

Sincerely

Bill Binko
LessonPix.com


Thursday, May 1, 2014

#SLPVendors Unite! Still Partyin' with the #SLPeeps


Still Partyin' After All These Years

In 2012, right after LessonPix really took off, I was delighted to work with some of the best vendors in the speech and language area.  They were all active on Twitter, engaged with the #SLPeeps group and generally were loved and valued by their customers.

It was right before the ASHA National Convention, and we wanted some reason to drive traffic to our booths.  Something people would look for, be a part of, and generally have fun with.

A couple of blog posts (and lots of Tweets) later, we had a group of 16 vendors that you could feel proud to patronize (and in our case partner with).

Lori and I generated Bingo Cards complete with QR Codes and Pediastaff made their #SLPeeps booth headquarters for "Party With The #SLPeeps!"

It was an amazing thing to walk in our first ASHA convention and have a dozen people in the empty exhibit hall that you already "knew", who were happy you were there, interested in your product and happy to send (non-competing) traffic to your booth.  It was one of the best experiences I've had since starting LessonPix.

We didn't do that at ASHA 2013, mainly because it was a ton of work (and I'm not good at recruiting or delegating!) and it was really missed.  I'm pretty sure we'll do it this year, especially since ASHA is in our neighborhood and we'll be hosting an off-site.

So, what's new? Where's the Party?

Well, LessonPix and Tactus Therapy Solutions  have teamed up to create Soundable™: a sound-based social word game, much like Scrabble® or Words With Friends®, but using the International Phonetic Alphabet (IPA).  It will be released over the next week or two as our gift to the SLP community for Better Speech and Hearing Month (#BHSM).

This is a great way to learn the IPA, and it's a lot of fun!  In fact, my 15 year old daughter has completely taught herself the IPA using this game (she uses it for her Italian opera practice).  It's amazing!

More importantly for those same great #SLPVendors, it's a great way to get your products put in front of hundreds (if not thousands) of SLPs and other Speech Professionals.  You see, the app is 100% free, supported by ads, and we're choosing to set aside dedicated space in the rotation for SLP vendors we know and love.

Sure, you'll see lots of ads for LessonPix and Tactus Therapy Solutions: that's the primary driver for the game--to get our names associated with a) Great IPA-Based tools like the Soundfinder and b) Great apps like the whole Tactus Therapy suite.  But there's plenty of room for more ads and they will be much more compelling if there's a selection of ads from vendors they know and trust!

At this point, we're prepping for launch, and we're ready to start setting up the ads.  We've got room for banner ads at the bottom and interstitial ads that fill the screen when you start and leave the game.

So, if you were a part of that great #SLPVendors group, you can expect to hear from me soon!  And if you're working with a great vendor who takes care of their customers and would like to put their products in front of an engaged set of current and future speech professionals, please reach out to me (quickly) at bill@lessonpix.com or info@soundablegame.com

Bill

Saturday, April 19, 2014

Please excuse the interruption!

Lessonpix.com will be down for a few hours while perform some much needed maintenance.  We try very hard to avoid this type of outage, but we  need to update some server hardware as well as upgrade our system to ensure we are not impacted by the heartbleed bug.

I realize that this is an inconvenience for our users (especially if you've just signed up) and I assure you this is a rare occurrence. In fact our last total outage has been over a year ago. 

I will update this post as the progress continues.  

UPDATE 1: we are about 35% of the way through the upgrade with no major issues. 

UPDATE 2: well there have been a few kinks in the update and we expect to be down for a while longer. Again we apologize and I'll give details on our changes when it's done

FINAL UPDATE: We're happy to say that LessonPix.com is back up and running.  If you have any troubles, please contact us at support@lessonpix.com  We will post an update to the blog explaining the changes that were made (and unfortunately, those yet to come) tomorrow or Monday.

Enjoy your Easter!
Bill

Sunday, February 23, 2014

Low-tech Communication Board Help Needed!

WOW, it's been way too long since we've posted!  I'm sorry and will get back on track!

As I've learned at ATIA, lots of SLPs and AT Specialists use our Picture Card template to make low-tech communication boards.  It makes sense: you can quickly layout from 1-48 cards on a page and it's quick and easy.

But it kinda stinks!  The pages are portrait, not landscape, there's not enough room between the cells, there's no way to spread across two pages or use legal paper, etc.

So, we're hoping the folks in the #SLPeeps and #ATChat communities can help us build a great new template set just for communication boards!  Tell us what you use today, what's great about it, what stinks, how you lay things out, and we'll try very hard to make our Material Wizard generate them quickly and easily (and of course, affordably!).

I (Bill) will be doing this work this week, and here's what I know so far:

  1. Thanks to @atklingensmith and @SLP_Echo I know that background-colors are a MUST
  2. @PrAACticalAAC taught me that I need the colors for the Fitzgerald and Goossens color coding schemes
  3. Many #SLPeeps tell me that there's not enough space between the cells and some want rounded corners on the cells (but I don't know if that's good or bad or a personal choice!)
  4. We need a version that easily will convert into book form (space for binding on left/right/top/bottom
  5. This 2008 AAC Institute Article gives me some great guidelines but doesn't show me what people are needing in practice.
So, I would LOVE some help here, #SLPeeps and #ATChat folks: you've got my full attention, and I'll make it do what you ask (within reason, of course).

Tell me what you're looking for in terms of low-tech communication boards?  Post pictures of your favorite layouts and tell me how they could be even better!  

You can leave comments below, or just share them via Twitter and include @LessonPix in the post - I'll see them!

Thanks everyone, and I can't wait to see what you suggest!

Bill Binko
LessonPix.com

Tuesday, December 10, 2013

Announcing the winners of the #SLPTunes Uncommon Christmas Music Contest!

We have our Winners!

The #SLPeeps on Twitter and Facebook have dug deep and pulled out the old vinyl to get our best Uncommon Christmas Music… and we have our winners!

@SLPTanya's BNL submission came in first
@GrayMatterTX tied with @emilywailes for second with Sufjan's Christmas album and David Bowie/Bing Crosby respectively.

The entire collection can be viewed below with great YouTube videos to accompany them!

You can also listen to the #SLPTunes Pandora Channel to get not just these tunes, but other "inspired" by them!  Click Here to listen!

What did they win?

Well, @SLPTanya will have first choice, then @EmilyWailes (since she submitted early!) and then @GrayMatterTX.  They get to choose from…
  1.  A one-year LessonPix Gift Certificate (also good at renewal!)
  2. Their choice of any Tactus Therapy Solutions TherAppy Apps!
  3. A set of Lively Letters Mini Cards and matching CD from Reading With TLC!
Winners, please contact me on Twitter (@LessonPix) to claim your prizes!

Thursday, December 5, 2013

Uncommon Holiday Music with the #SLPeeps

It's that time of year--time for Holiday Music on every channel, in every store and stuck in your head. But if you're anything like us, there are tunes that nobody knows that are your favorites… and now you get to share them!

It's time for….

The #SLPeeps Uncommon Holiday Music Contest!

Here's how it works… 
  1. Pick your favorite Uncommon Holiday Music - you can enter up to three times and it doesn't matter whether it's a song, album, video - as long as it's Holiday Music
  2. Post it to Twitter using the hashtag #SLPTunes on Google Moderator or post it in the comments below.  Make sure to provide a way for us to hear/see it!  Links to YouTube, iTunes, or the tool of your choice are great as well as a way to identify you (if you want a prize!).
  3. Every day, we'll add the new submissions to the Moderator page and remind folks to vote for their favorites.
  4. This Sunday (Dec. 8) evening, we'll tally the votes and the top winners will get prizes!  
UPDATE: We have more prizes!  Our top three winners will get one of:
  • A one-year Lessonpix.com membership
  • Their choice of any Tactus Therapy Solutions Apps
  • A Reading With TLC gift pack of one Lively Letters CD and a set of Mini cards
If you're a vendor and want to donate a prize, contact us here or at @LessonPix on Twitter

What counts as Uncommon Christmas Music?

The #1 rule is,  it can't be boring!  If we've all heard it, it's OUT!  

Also, it should be something that's publicly available--your kid's Christmas show might be great, but we can't add it to our Playlist for Christmas Future.

Finally, keep it clean… not squeaky clean, just PG-rated or better.  Chances are good that some of these will be played in classrooms! :-)

Any questions? Leave them in the classroom or on Twitter!

Enjoy!
Bill

Tuesday, December 3, 2013

The #SLPeeps Top 10 SLP Gifts

What does your SLP really want this year?

The answer may surprise you: it did me!  We wanted to build the semi-official Top 10 SLP Gift List, so we put the question to the #SLPeeps on Twitter.  We used Google Moderate to let them add their own ideas and vote on their favorites. 

Drumroll, Please!
After a week of "moderating" (fermenting? festering?), 22 #SLPeeps suggested 27 ideas and cast 111 votes to choose their favorites.

Many thanks to those who participated and gave us the very original ideas!  We've combined a couple of very similar suggestions, done the number crunching, and we have winners!

So, at long last, here's this year's Top 10 SLP Gifts for the Holiday Season!

Monday, September 16, 2013

#SayARR! with LessonPix this International Talk Like A Pirate Day!

It's Pirate Time again!

ARRR! 'Tis Pirate Time Agin!

Last year we had a ball with Cap'n Slappy and his crew bringing International Talk Like A Pirate day to the classroom and therapy setting.

In fact, Last Year's Post is still one of our most popular and has great ideas for bringing fun and excitement to your classroom and therapy. If you haven't already: check out all the pirate ideas!

We've added even more Pirate plunder in the past year, with great Pirate Symbols a new Treasure Map material and a whole article just full of  Pirate Ideas!

This year, we're holding a Sharing & Photo Contest to celebrate the day!

How it Works - #SayARR!

First, we want to get a bunch of pre-made Pirate Materials out there for free!

So, if you're already a LessonPix member, share your best Pirate-Themed materials to the Sharing Center and let us know via the comments below, Twitter or Facebook and we'll mark them as Free Samples so that everyone can enjoy them (even if they're not a paid member).

We'll tag them as TLAPD (Talk Like A Pirate Day) so everyone can find them! Click the image of the map to see the latest submissions.

Second, we want to see you all having fun with your kiddos on Pirate Day!  So, take a picture on Thursday of you and your students having a ball with your Pirate theme and post them to Twitter with the hashtag "#SayARR" or share them with us on our Facebook Page.  We'll review & discuss them and one lucky winner will win a 1 year subscription to LessonPix (or a renewal if they're already a member)!

We'll choose a winner over the weekend and announce them on Monday, September 23 here and on Twitter and Facebook.

So get your materials cranked out and shoot some great pix - most importantly, Have Fun!