PhD/PsyD Neuropsych testing

[PikminOC]

There are a few psychologists in the area who have hired on staff and run private practice Neuropsychological testing.

It seems they are cleaning up. Can anyone here please help me understand this business model? Insurance reimbursement? Time involved by the psychologist in these cases?

Also, I have patients I want to refer, but it seems they do different types of testing. How do I navigate this the best for my patient needs?
Thanks

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[PikminOC]

Isn't a lot of this computer based now too? The paper tests seem so expensive and inefficient

 

[PsyDr]

1) insurance reimbursement, cpt is time dependent. It's really not a great income and doing e/m codes is gonna give you more per hour. It's not something that can be added to a practice because of the time code. Would be a great way to get audited though. Median income is like $130k.

2) differences in general are: peds, adults. Within those are diagnostic vs descriptive. Many different schools of thought. The best way to get what you need from testing is to provide a specific referal question. "Neuropsych testing" is gonna get vague results. "Determine laterality of ictus" is more specific.

3) computerized testing is essentially broadcasting to the world that one does not know what they are doing.

for the time and effort neuropsych testing isn't worth it for a physician. As someone with a duty of care, engaging in a practice with zero training is rei ipsa medical malpractice.

 

[PikminOC]

I'm not looking to do it myself. I'm busy enough. Looking for additional income streams with minimal malpractice risk. I don't want to hire therapists to do therapy. Maybe I will look into psychologists to do this testing. The private practice psychologists around me doing this are doing well. I don't think they take insurance either

 

[PsyDr]

The important thing is to hire someone whose training conforms to the "Houston Conference Guidelines" or is board certified. Shorthand for "did the required extra 2 year training to become a neuropsychologist".

 

[PikminOC]

Thanks for you feedback. I appreciate it. What's the malpractice climate for this? These practices here make way over 130. They hire PsyD students and ma too.

 

[PikminOC]

I'm looking at their websites and not seeing credentials you are referring to. And I don't want to hire more Psychiatrist

 

[deleted343839]

Looking for additional income streams with minimal malpractice risk. I don't want to hire therapists to do therapy. Maybe I will look into psychologists to do this testing.

This is not a common practice model, at least in my area.

 

[PikminOC]

Always looking for new things!

 

[deleted343839]

Always looking for new things!

If you pursue this it's probably best to focus on a niche area (eg, ADHD) that your local market will support. I know a few assessment-focused psychologists who share a practice location with a psychiatrist and each refers to the other, but they're still independent entities. Not to say that what you're proposing can't be done, but with the unique training and skill set a neuropsychologist has there are fewer incentives to be a private practice employee (unlike, say, therapists who might be looking for income security in a saturated market).

 

[PsyDr]

Thanks for you feedback. I appreciate it. What's the malpractice climate for this? These practices here make way over 130. They hire PsyD students and ma too.

Just reporting the research. Happen to be one of the maxs in the one of the ranges. But if you have better info, feel free to ask them. Might want to ask why such ballers don't participate in the research.

The malpractice climate is potentially high. Depends on the state, practice, and approach the neuropsychologist takes. Good ones know how to limit their exposure. Misdiagnose a pattern of consistent with a tumor as adhd and you could be screwed.

I'm sure you're familiar with how cms feels about billing for students work.

 

[PikminOC]

They don't take insurance so I'm not sure about cms involvement. And to that point, I notice alot of therapists employ students.

Here there are groups. Usually 2 psychologists, 2 ma, 2 students

 

[PSYDNEUROGUY]

They don't take insurance so I'm not sure about cms involvement. And to that point, I notice alot of therapists employ students.

Here there are groups. Usually 2 psychologists, 2 ma, 2 students

There are a good deal of professionals who function like this; at least from my experience, the way this is set up is like this:

1. Master's level practitioners function as technicians (i.e., they administer the neuropsych tests and depending on their education and experience, will also score and write up results). After the tests have been completed by the technician, the neuropsychologist must be the official person who has the last review and will check their work before meeting with the patient to discuss results. Also, when using a technician, the supervising neuropsychologist will bill the insurance under the code for "technician" vs. "psychologist."

2. When a private practice is using students, they are graduate students (most of the time doctoral students, sometimes master's level students). Their exposure to patients and testing are typically on par of a technician, but a lot of their time might be spent doing biopsychosocial intakes and other tasks before getting into more intense activities such as administering full neuropsych batteries.

Either way, technicians and students are supervised by a neuropsychologist who often times provide training on the job or, they are providing supplemental exposure to psychometric testing, structured interviewing, etc. that is essential for developing student neuropsychologists. Technicians are a great way for a private practice to take on more patients to expand revenue since the neuropsychologist is more free to write up opinions, results and to spend more time with the patient to discuss those results.

Neuropsychologists are a mixed bunch; many bill insurance and many are moving away from that. The private practice I worked at billed insurance (medicare and medicaid were more profitable in most cases). Several private insurance companies may not pay the full cost of neuropsych. testing, so this is a reason why several neuropsychologists might be dissuaded from using them. There is a very successful neuropsychology practice in Miami (he actually has two locations now) who enjoys pediatric neuropsychological testing since most of the tests are paid for out of pocket by the parent(s), so he is able to be more profitable in terms of return on investment (adult vs. pediatric testing).

 

[PikminOC]

Yes. This is the same in my area.