The Business of Neuropsychology (Oxford Workshop Series: American Academy of Clinical Neuropsychology)

238 Pages·2010·2.13 MB·English

by  Mark Barisa

THE BUSINESS OF NEUROPSYCHOLOGY
OXFORD WORKSHOP SERIES:
AMERICAN ACADEMY OF CLINICAL NEUROPSYCHOLOGY
Series Editors
SusanMcPherson,Editor-in-Chief
IdaSueBaron
RichardKaplan
SandraKoffler
GregJ.Lamberty
JerrySweet
Volumes in the Series
TheBusinessofNeuropsychology
MarkT.Barisa
NeuropsychologyofEpilepsyandEpilepsySurgery
GregoryP.Lee
AdultLearningDisabilitiesandADHD
RobertL.Mapou
BoardCertificationinClinicalNeuropsychology
KiraE.Armstrong,DeanW.Beebe,RobinC.Hilsabeck,
MichaelW.Kirkwood
UnderstandingSomatizationinthePracticeofClinicalNeuropsychology
GregJ.Lamberty
MildTraumaticBrainInjuryandPostconcussionSyndrome
MichaelA.McCrea
EthicalDecisionMakinginClinicalNeuropsychology
ShaneS.Bush
THE BUSINESS OF NEUROPSYCHOLOGY:
A PRACTICAL GUIDE
Mark T. Barisa, PhD, ABPP
&&&
OXFORD WORKSHOP SERIES
1
2010
1
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LibraryofCongressCataloging-in-PublicationData
Barisa,MarkT.
Thebusinessofneuropsychology:apracticalguide/MarkT.Barisa.
p. ; cm.—(Oxfordworkshopseries)
Includesbibliographicalreferences.
ISBN:978-0-19-538018-7
1. Clinicalneuropsychology—Practice. 2. Clinicalneuropsychology—Economicaspects.
I. AmericanAcademyofClinicalNeuropsychology. II. Title. III. Series:Oxfordworkshopseries.
[DNLM:1. Neuropsychology—economics. 2. Neuropsychology—organization&administration.
3. PracticeManagement,Medical—organization&administration.
WL21B253b2010]
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2009035254
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Acknowledgments
The information presented here represents a conglomeration of years of
advice,guidance,cooperation,collaboration,andmentoringfromnumerous
individualsworkinginavarietyofsettingsincludingclinicalpractice,hospital
administration, corporate compliance, managed care administration, quality
improvement, physician relations, and even consumers/patients. As such,
manyoftheideasandconceptspresentedaretheresultofmultipleperspec-
tivescombinedinamannerthathopefullyblendsinformationintoa‘‘usable’’
productforthereader.Thecollaborativeandblendednatureoftheinforma-
tionpresentedhereattimesmadeitimpossibletocitespecificreferencesfor
allaspectsofthistext.Sufficeittosaythatdespitethe‘‘singleauthor’’natureof
this text, the information presented within reflects the knowledge and gui-
danceofmultipleindividuals,withoutwhomthistextwouldnotbepossible.
I would like to express my gratitude to Susan McPherson and other
members of the AACN conference program committee for allowing me the
opportunity to present at what has become one of the strongest neuropsy-
chology conferences and for the honor of translating this presentation into
bookform.Ithasbeenachallengingundertaking,butitalsohasbeenavery
rewardingexperience.ShelleyReinhardt,JoanBossert,AaronvanDorn,and
other staff at Oxford University Press have been very helpful and made this
process, which was new to me, smooth and worry-free. Additionally, the
reviewers provided excellent insight and their recommendations truly
improvedthevalueandoverallqualityofthistext.
Whileitwouldbeimpossibletoacknowledgeeverypersonwhoassistedin
thedevelopmentofthistext,afewnotableindividualsarerecognizedforthe
significantcontributionstheyhavemaderegardingtheinformationcontained
herein,aswellasassistinginmyownpersonalandprofessionaldevelopment
inthisarea.ChuckCallahan’sknowledgeandinfluenceservedasthecatalyst
for my initial interest and subsequent passion for the business aspects of
clinical practice. It was his mentorship that started the journey which lead
tothistextandhisinfluencecanbeseenacrossmanyareasofthistext.Igreatly
appreciatealloftheknowledgeandinfluencehehasprovidedovertheyears
andtrulybelievethathadInothadtheopportunitytoworkwithhim,Iwould
notbewhereIamtoday.JonThompsonwasinvaluableasweworkedtogether
atSt.VincentHospitaltoputtheconceptspresentedinthistextintopractice
aswepartneredtoredeveloptheprocessandsystemswithinourowndepart-
ment.Hisworkonmanyoftheforms,documentationtemplates,andfinancial
spreadsheetspresentedhereincertainlyhelpedraisethebarastotheuseful-
nessofthistext.RobinStickneyandhisguidanceandworkondepartmental
processdevelopment,implementation,andqualityauditingprovidedamodel
fordepartmentalprocessdevelopmentaswellasaddingtothequalityassess-
ment aspects of this text. Multiple others provided valuable insights and
activitiesthathelpedtomakethistextareality,includingIndiaBrown,Kim
Springer,andLydiaBallwhowereinstrumentalintheinitialdevelopmentand
‘‘trialruns’’andmodificationsoftheofficeprocessesdescribedinthesechap-
ters. Hopefully, the growing pains we felt along the way will minimize the
trialsandtribulationsothersmayfaceastheytrytoimprovetheirownoffice
processesbyusingthesuggestionsinthistext.
Numerous others helped along the way, providing insight, commentary,
reviews, andsuggestionsduring thedevelopmentoftheAACN presentation
and subsequent transition to a book format. Shelley McDaniel served as a
primaryreviewer,providingfrankandhonestfeedback;makingthisabetter
book than it would have been otherwise. Others who provided insight,
commentary, and review include David Christian, Christopher Bassin, Ann
MarieWarren,andthemultipleinternsandresidentswhohavehadtolistento
meendlesslydiscussthevarioussubjectareaswithinthistextovertheyears.
Finally,Idon’tbelievethatweexpressenoughgratitudeandappreciationfor
the work of Antonio Puente, Neil Pliskin, and the many others who have
contributedtimeandenergythroughtheNAN/PAIO,AACNLeadership,APA
PracticeDirectorate,APADivisions40&22,andthemanyotherindividuals
andprofessionalgroupsthatworktirelesslyonourbehalftotrytokeepusin
business.
Inclosing,Iwouldliketoexpressmysincerestgratitudetomywife,Mary;
mysons,BrianandZachary;andevenourdog,Elvis,whosawlessofmewhile
I saw more of my computer during the preparation of this text. Their love,
support,patience,andunderstandingthroughthisprocesshavebeenimmea-
surable,andIhopethatIcandemonstratethesameforthemoverthecoming
years.
vi Acknowledgments
Introduction
Onthesurface,thepremiseofthistextmayseempeculiar toneuropsychol-
ogistswhoareaccustomedtoreadingbooksdesignedtoprovideinsightand
information to enhance clinical practice. Graduate school catalogs and
trainingprogrambrochuresrevealabroadarrayofeducationalopportunities
designedtopreparefutureprofessionalsforindependentpracticeinneurop-
sychology. However, little is offered to prepare neuropsychologists for the
businessrealitiesthatawaitthemintheworkplace.Theexpectationthatthey
will simply see patients and do quality clinical work is often constrained by
institutionalgoals ofmakingmoneysothatthedoorscanremainopen. The
result can be a cataclysmic ‘‘crash’’ when altruistic ideals meet capitalistic
needs.Theconceptsof‘‘cashisking’’and‘‘nomargin,nomission’’areforeign
to most neuropsychologists until our own fiscal bottom line is affected. It is
thatreality–ourownfiscalbottomline–thatsetsthestageforthistext.
DuringthepreparationofthistextandtheCEUpresentationattheAACN
conferenceinBoston,MAin2008,IhadcommentedtocolleaguesthatIwas
concerned that the basic business theories and ideas presented in this book
would be less than intriguing to neuropsychologists. I assumed that the
popularity of the presentation and this subsequent text would lie in the
fiscal aspects of the information rather than the process that gets us there. I
had planned several Tom Cruise ‘‘Show me the money!’’ lines to try to keep
audience and reader interested, but these colleagues advised against this,
stating thatitwouldnotbenecessary.Theyassuredmethatthe‘‘howtoget
there’’aspectwasgoingtobejustaspopularasthe‘‘wheredowegofromhere.’’
Imustadmitthattheywereright.ThepositivecommentsIreceivedfollowing
the AACN presentation focused much more on the ‘‘process’’ aspects of my
presentation and less so on the ‘‘profit.’’ To this end, this text will take on a
similarapproachtothatnotedintheinitialworkshop.
The purpose of this text is to provide an overview of basic business
principles and how they can be used to enhance the stability and fiscal
responsibility of neuropsychological practice. The principles discussed are
presentedinafashionthat willincludeanoverviewofconceptsas wellas a
practicalapproachtopromoteapplicationoftheinformation.Itisdesignedto
benefit professionals at varying levels of practice regardless of their work
setting, but focuses primarily on the issues related to neuropsychological
practice. Additionally, administrators that oversee neuropsychological prac-
ticemayfindthistextusefultogainabetterunderstandingoftheinteraction
betweenclinicalactivitiesandthefiscalresponsibilityoftheirdepartment.The
readerwillbeexposedtoavarietyofbasicbusiness principles inawaythat
will increase understanding of business process and system variables asso-
ciatedwiththepracticeofneuropsychology;basicbudgetandfiscaltracking
abilities;andcommunicationstrategiesthatarehelpfulinconveyingdepart-
mental information effectively to internal and external stakeholders.
Additionally, practice development and organization needs are discussed,
including the basics of front and back office flow and processes; accurate
and consistent billing, coding, and documentation activities; marketing and
referralrelationshipdevelopment;andstaffgrowthanddevelopment.Issues
relatedtobalancingtheneedsoftrainingprogramswithfiscalresponsibilities
ofdepartmentsarepresentedbrieflyalongwithsomeotherthreatstothefiscal
bottomline.Thetextcloseswithdiscussionsofprofessionalrolesbasedonthe
professional’slevelofexperience.
Thetextisdividedintothreesections.Afterinitialchapterspresentsome
basicbusinessprinciplesandsystemprocessesthatareapplicableregardless
of setting, the second section focuses on applying the business principles
within the practice of neuropsychology. Where applicable, differentiation
between private and institutional settings is delineated along with specific
issues related to private, institutional, and government-based settings.
Throughout this text, there is an emphasis on applying a ‘‘private practice’’
model to the various settings in an effort to promote consistency and fiscal
responsibility,regardlessofsetting.Manychaptersincludepracticalexamples
andtoolstoprovideeasyapplicationoftheinformationpresented.Thefinal
sectionofthetextfocusesonissuesrelatedtoprofessionaldevelopmentbased
on level of experience in the field of neuropsychology. Within this section
thereisinformationfornewprofessionalsfocusingonsecuringtheirfirstjob,
including tips on professional development. The chapter aimed at the more
experiencedneuropsychologist’sprofessionaldevelopmentincludesadiscus-
sion of increasing financial stature, diversifying practice referrals including
medico-legal sources, professional diversification, consideration of adminis-
trativeroles,andend-of-careerissues.
The goal of this text is to provide a unique resource to bridge the gap
between clinical practice and institutional/practice demands. As the
viii Introduction
economicsofpsychologicalandneuropsychologicalpracticearebeingnega-
tively impacted by changes in reimbursement, new (and not necessarily
improved) rules for billing and documentation, insurance reimbursement
reductions,nationaleconomictrends,hospitalbudgetarystrains,andcompe-
titionfromwithinaswellasoutsideprofessionals,theneedforgreaterunder-
standing of business principles has become essential. This is demonstrated
throughthegrowing popularity oflectures, seminars, andothereducational
opportunities that touch on these issues at local, national, and international
conferences. Similar presentations are consistently well-received, demon-
strating the broad interest in this area as financial and business demands
creep into clinical practice. While the idea of learning business concepts
mayseemdauntingtomanyneuropsychologists,itishopedthattheinforma-
tionprovidedinthisbookispresentedinsuchawaythatitiseasilyunder-
stood and more importantly, applicable in daily practice. In essence, it is
designedtoeasethepainofacquiringnewconceptsandstimulateadesirefor
further learning by providing information insuch away to promoteaneasy
transitionfromknowledgetoaction.
Introduction ix