A Million Thumbtacks and a Piece of Twine

I Have More for You

It was 2009 when I heard God say, “I have more for you.” I knew what He was asking me to do, and I didn't want to do it, but I took the step anyway and got the PhD.

One of my favorite songs has always been “Hands and Feet” by Audio Adrenaline. The whole premise of the song is essentially: I'll go where you send me. I'll be your hands and feet. I don't think I realized then just how much that would end up describing my life.

I only recently realized that I have been an advocate my entire life. I just didn't know it.

Nearly no one in my life knows or remembers that at 13, I became a Youth Service Fund representative for the East Ohio United Methodist Conference Council on Youth Ministries. We managed grant applications and money raised by youth, spent by youth, to benefit youth. I served in that capacity until I graduated from high school. At 16, I went to Mexico without anyone I knew to serve in the mission field for a week. At 17, I went to Italy to do the same for a month. At 18, I helped coordinate a week-long fundraiser for two brothers at my school who had Duchenne muscular dystrophy and needed a new van. At 19, I became the philanthropy chair of my sorority. There isn’t even enough space to list the rest over the last 20+ years. You get the picture.

I have served and advocated for people who haven't been heard, haven't been seen, have been forgotten, or who just plain needed help for as long as I can remember. Not for the glory, and not because I wanted anyone to know I was doing it. In fact, you probably don't know any of those things about me because I never tell you. It's just in me.

That conversation with God in 2009 changed the course of my career forever.

Fourteen years. FOURTEEN LONG YEARS. I stepped on the stones going upstream through the river, wondering where all of this was going. Looking back, my life feels like one of those maps with a million thumbtacks connected by twine. It makes sense now, but I had no idea at the time what the world's longest boot camp was preparing me for. I didn’t always love it, but I was faithful.

Every single thing I did professionally, and many of the things that happened personally, led somewhere. I moved. I changed jobs. I spoke up when I didn't want to. I made decisions that seemed risky. I made bad decisions and recovered from them. I learned. I grew. I walked through the doors that swung open, used my big toe to push the ones that were cracked open a little wider, and, most of the time, God had to push me out hard and slam the door against my back because I have a really hard time letting go.

And then, in September 2023, I found out.

I was part of the duo that founded Fix SLP, and it was IMMEDIATELY apparent to me that this could be part of the plan... or even THE plan. Over the last three years, I have started joking that if this isn’t IT, I don’t even want to know, because THIS is a lot. I have done my best to stay grounded as I have made decisions about how to advocate for my field. I have tried to stay extremely humble as I watched my podcast hit #67 on the Apple Top 100 Business chart, something that is basically unheard of for a niche podcast in a profession this small, and as my community of “Fearless Fixers” has grown to nearly 70,000 followers in a field of only about 200,000 people.

I have watched God provide for my family after I lost my career in academia over this. I have kept praying, following, learning, and trying to figure out what the next right thing is. I'm not perfect, and I haven't done everything right, but I HAVE trusted that this is part of the plan, at least for now.

The things Fix SLP has accomplished in nearly three years have been insane. We have changed laws. We have changed insurance regulations. We have beaten the odds over and over and accomplished things I could have never even come up with myself. Through all of it, I have tried to stay faithful. I have consistently sought wise counsel, trusted the process, and tried to make decisions that benefit the greatest number of people.

This has not always been easy. I have lost friends. I have lost the respect of people who don't agree with me. I have been beaten to hell on the internet by keyboard warriors, and I have questioned more than once whether I am even sane. I have zero training for most of what I am doing. Most of the time I have zero idea what the next step is that I will have to take in three days. There isn’t a business plan, or a nonbusiness plan, or any kind of plan at all.

But I have had God.

The first week of this past February, I was given the opportunity to fight against an extremely serious threat to the way speech-language pathologists (SLPs) bill for their services and gain reimbursement. It was a rare opportunity to write an application to the American Medical Association (AMA) and then defend it before a panel of 20+ doctors. The advisors we were working with could only come up with two other examples of when this had been done before, and only one of them won. We lost that fight, but it wasn't over.

A few weeks ago, the Centers for Medicare and Medicaid Services (CMS) published the proposed reimbursement rates for speech-language pathology, and they were just as bad as we had anticipated it would be back in February. I had an idea to try to accomplish something that might be insurmountable: to fight one more time. As I tried to talk myself out of it, I kept thinking, "But this is WHY I founded Fix SLP." It's a place for organized advocacy to run through in the field of SLP, outside of our snaky, self-serving membership organization.

I founded The Speech Pathology Education, Advocacy and Knowledge (SPEAK) Project, a national effort to prove what it actually costs to provide speech, language, cognitive, and swallowing care and use that evidence to fight for adequate reimbursement so patients don't lose access to those services. SLPs are facing reimbursement cuts that could be devastating beginning January 1, and our national membership association isn't fighting this.

Someone had to.

That someone is me.

I'm not sure why I am surprised anymore, but the SLP community has rallied. They are SHOWING UP. Together with my friend Emily Watkins, help from some lovely ladies who did this on a much smaller scale in North Carolina, and the Richie May CPA firm (shout-out to our CPA Cody, a legit hero without a cape), we have collected well over 1.25 million data points from SLP practices across the country.

Business owners have spent three, five, sometimes eight or more hours contributing their practices' incredibly sensitive financial data to this project because they understand what is at stake. That data will be analyzed, and I will write a report that our lawyers and lobbyists can put into the hands of the right people at CMS. Our lobbying team will also work to get us into the room with key people at CMS who actually have the power to change these rates before January 1.

And somehow, in 15 days, we have raised $73,000 of the $175,000 we need. 🤯

I only need $90,000 right now to fund the next phase.

So, if you have made it this far, can I ask you for some help?

First, pray. Not just for me, and not just for SLPs, but for the kids, adults, families, and people we serve. Pray that NO MATTER WHAT happens with this fight, they will be seen, held, and helped.

Pray for me, Emily, Cody, the people we are hiring, the people I am seeking mentorship and wise counsel from, and the people who will receive the information we provide. We don't know how this fight ends, but I keep thinking about Hebrews 11. Person after person trusted God without necessarily knowing how the story would turn out: Abel, Enoch, Noah, Abraham and Sarah, Isaac, Jacob, Joseph, Moses, Rahab, and so many others. Some of them saw extraordinary victories. Some of them didn't.

Those people already ran their race, and here we are doing our best to “run with endurance the race that lies before us, keeping our eyes on Jesus” (Hebrews 12:1–2). We are running down a very long road without a full understanding of where we are going, how it will end, or even the full purpose of being called to do this in the first place. But I see a team of people coming together, all with faith in Jesus Christ, even when I didn’t know it. That tells me we are in a war bigger than us.

Second, if you or someone you love has received speech therapy, please tell us your story. We want those stories to reach the government officials who can make a difference. Who exactly are those people? I don't actually know yet, and I'm okay admitting that. Next week, we will officially hire and begin strategizing with our legal and lobbying team. They know. They will help identify exactly who needs to hear these stories, and we will make sure they get there, whether that means delivering them electronically or putting them directly into someone's hands.

We have made this incredibly simple. You open a JotForm, tell us who you are, and answer five questions. You can even talk-to-text your answers. The software we coded takes what you tell us and creates a unique letter from your story. You can submit yours here.

Third, if you are able, please donate to this fight. There are a lot of moving pieces behind what we are doing, and they are expensive. The software for the letters costs money. The CPA firm costs money. A team of four or five lobbyists, lawyers, and policy experts costs a LOT of money. But every piece is necessary if we are going to do this right. Donate generously here.

And if we lose this battle, the consequences are not theoretical. Speech-language pathologists WILL take devastating reimbursement cuts. Some practices will close. Some will stop accepting insurance completely because they simply cannot afford to provide services for what insurance pays them. Waitlists will get longer, and children and adults will have a harder time accessing the care they need when they need it.

This isn't hyperbole. The billing codes have already been accepted and approved. The rates can still change. That is what we are fighting for.

If you can give $5, give $5. If you can give $25, give $25. If you are in a position to give significantly more, we need you, too. You can donate here.

You can learn more about everything we are doing with the SPEAK Project here. HUGE thank you and acknowledgment to my friend and colleague Taylor Kae Hahn, who has donated the hours she doesn't have to make that beautiful website. I told her "do it" with very little direction, and she brought to life everything I communicated via Morse code, smoke signals, and brainwaves. She's literally THE BEST.

I have no idea how this story ends. Maybe someday I will look back at this moment and see another thumbtack on that giant map with a piece of twine connecting it to something I can't even see yet.

What I do know is that in 2009, I heard, “I have more for you.” I didn't get a roadmap. I didn't know it would take 14 years to find out what it was. I certainly didn't know it would eventually involve Fix SLP, tens of thousands of followers, the AMA, CMS, 1.25 million data points, CPAs, lawyers, lobbyists, or raising $175,000.

I just kept stepping on the next stone, even when it was slippery.

And right now, this is the stone in front of me.

I don't know if we win. I don't know exactly where this road goes next week. But I know what I am supposed to do today, and I'm going to keep doing the next right thing until God tells me otherwise.

Thank you for reading. Thank you for sharing. Thank you for donating. And, most of all, thank you for praying.

Love,

Your friend, wife, mom, daughter, sister, niece, SLP, colleague, former professor, advocate, favorite podcast host, Facebook friend… or maybe just some random person on the internet you don’t know,

Jeanette