PhD/PsyD Productivity model of neuropsychology: 1hr battery or less, thoughts?

[thisisjustatest]

I recently went to an APPCN didactic on productivity model of NP. People are giving 1hr or less, 2hrs top, for testing battery. What do you think should be included in a 1 hr battery for typical outpatient clinic?

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[Sanman]

That would really depend on the referral given the limited time.

 

[thisisjustatest]

referrals: memory change. Don’t normally get more than that anyway… no focal lesion, white matter changes related to vascular stuff, HLP, HTN

 

[AcronymAllergy]

I'm assuming this is interview + 1-2 hours of testing, rather than 1-2 hours for the entire evaluation? If so, I wouldn't want to discuss a specific battery on a public forum, but I imagine you could do a decent, uncomplicated outpatient eval in that span to rule out memory and/or vascular-type impairment, with the potential for follow-up testing if needed. There wouldn't be much redundancy, but you could likely tap the major domains.

 

[RxPsych]

The AMC where I'm currently completing external practicum regularly does 2.5 hour evals (1 hour interview plus 1.5 hour testing tops) for longitudinal re-evals, mostly vascular and amnestic etiologies. Though they don't include many tests that I would personally like to include, but to each their own.

 

[PsyDr]

1) I remember this. This is the Luria Nebraska, right? Are back to that?
2) Tell me administrators want to get rid of psychometrists without telling me.
3) This is a bad concept of production.
a. If production means seeing as many patients as possible: what is the clinical purpose of seeing volume? You're not going to be able to calculate reliable change on a 1hr test, or get meaningful statistics. You're going to miss things, including psychological factors. That is kind of a big deal, since we are psychologists. Then there is the paperwork. Go write 4 full size reports. Now go write 10 thee page reports. Keep in mind that you're going to have some days where you have lower productivity. It's ~80% of the same writing time. About 50% more liability.
b. If production means earnings: it's a ploy to get you to do all the testing. Get as many of those intake hours in a week, as they are worth 3.71RVUs. Cue admin noticing psychometrists are doing nothing. Since you are only doing an hour of testing, can't you just do it yourself (3.30 RVUs)?
c. If we no longer ask about emotions, ask about personality, assess for effort, or have psychometric utility: we become very very very crappy approximations of a neurologist who has the worst reimbursement out there, and can't order labs. Guess how that plays out, longer term?

 

[WisNeuro]

My typical batteries are not defined by "outpatient." The battery is defined by the context of the case and referral question. A battery for a straightforward dementia case can be 1-2 hours, sure. Make that complicated and add some less common rule-outs, and I'll need more time. Once you start scheduling patients that tightly and with "preset" batteries, you run into problems. Then, you either leave things out that you need to assess, or you have to make the patient come back for more testing. Neither are ideal in any sense.

 

[thisisjustatest]

1) I remember this. This is the Luria Nebraska, right? Are back to that?
2) Tell me administrators want to get rid of psychometrists without telling me.
3) This is a bad concept of production.
a. If production means seeing as many patients as possible: what is the clinical purpose of seeing volume? You're not going to be able to calculate reliable change on a 1hr test, or get meaningful statistics. You're going to miss things, including psychological factors. That is kind of a big deal, since we are psychologists. Then there is the paperwork. Go write 4 full size reports. Now go write 10 thee page reports. Keep in mind that you're going to have some days where you have lower productivity. It's ~80% of the same writing time. About 50% more liability.
b. If production means earnings: it's a ploy to get you to do all the testing. Get as many of those intake hours in a week, as they are worth 3.71RVUs. Cue admin noticing psychometrists are doing nothing. Since you are only doing an hour of testing, can't you just do it yourself (3.30 RVUs)?
c. If we no longer ask about emotions, ask about personality, assess for effort, or have psychometric utility: we become very very very crappy approximations of a neurologist who has the worst reimbursement out there, and can't order labs. Guess how that plays out, longer term?

I do feel psychomotrices are doing nothing in my clinic since the battery is short. Off topic but what do people think about 1) digital neuropsychology to replace psychometrists? 2) And what do folk think about some neurologists hires psychometrist then be neuropsychologist themselves?

 

[AcronymAllergy]

I do feel psychomotrices are doing nothing in my clinic since the battery is short. Off topic but what do people think about 1) digital neuropsychology to replace psychometrists? 2) And what do folk think about some neurologists hires psychometrist then be neuropsychologist themselves?

Integrating technology into testing is something neuropsychology will need to do moving forward. There are benefits. But there are also benefits to having a person in the room and interacting with you throughout testing. I don't see the personal component going away anytime soon (nor do I think neuropsychologists should be pushing for a removal of the human component).

A neurologist is not a neuropsychologist (and vice versa). Many are aware of what we do and have passing familiarity with the general idea of our testing. I don't know that I've met any neurologists who have in-depth knowledge of the testing. It also doesn't really benefit them economically to either take on the liability of pretending to know something they don't, or taking the time to learn a lot about it. A neuropsychologist can often, with some training, do a basic neuro exam, much as a neurologist could give a MoCA. I probably wouldn't want most neuropsychologists administering and interpreting an EEG, and I wouldn't want neurologists administering and interpreting a full neuropsych battery.

 

[WisNeuro]

I do feel psychomotrices are doing nothing in my clinic since the battery is short. Off topic but what do people think about 1) digital neuropsychology to replace psychometrists? 2) And what do folk think about some neurologists hires psychometrist then be neuropsychologist themselves?

Having had to explain basic statistics to more than one neurologist, I am not concerned about this.

 

[PsyDr]

I do feel psychomotrices are doing nothing in my clinic since the battery is short. Off topic but what do people think about 1) digital neuropsychology to replace psychometrists? 2) And what do folk think about some neurologists hires psychometrist then be neuropsychologist themselves?

1) I think some digital stuff will become standard. However, the legal requirements for supervision mean you must physically be in the same office as the patient. (Uh oh, sounds like people are breaking the law). I also think that Pearson et al will AGAIN attempt to make the calculations and norms "proprietary". This would mean that we are not allowed to see the norms or regression formulas. If the field was every foolish enough to accept this proposition, the entire assessment field is over and done with. We become technicians, who can be replaced with anyone including teachers. This also makes our testing inadmissible to any court. Downstream, this means programs teach less of psychometrics because it is less useful. Then we have no one to develop tests, outside of a select group of corporations. Be sure, this is what most of the AI space wants in healthcare. Patients walk in, report their symptoms, AI gives a diagnosis and treatment plan, company finds a way around the requirement for professional licenses. It will likely happen in optometry first. Any younger psychologist should evaluate the likelihood of this, and maybe consider that testing will not be a viable career in 20 years. Or consider I am full of it.

2) Neurologists try this from time to time. There are two big problems with this:
a. It's not lucrative enough for them from a time:income ratio. They can see 3-4 EM code patients/hr for $350/hr. Suspected dementia? Throw some aricept and/or memantine at them with zero testing. Alternatively, they can do telemetry, remote EEGs, or sleep medicine interpretation from their home. Compared to hiring a psychometrician, administering tests for $100/hr, then writing some BS note, and they must be physically in the office while NP testing is performed? It's just not worth it.
b. Neurologists are not trained in psychometrics. As the standard of care requires education in psychometrics, it is literal negligence for them to do this.
c . There is a lot of hassle that comes with NP testing. Record keeping . Billing is complicated. They don't know what they are doing. Patients act up. No one likes hearing they are demented, or that their neuro symptoms are psychiatric in nature. The medications for AZ dementia are extremely limited. Same for PD, HD, PSP, etc. It's just not worth it.

 

[thisisjustatest]

1) I think some digital stuff will become standard. However, the legal requirements for supervision mean you must physically be in the same office as the patient. (Uh oh, sounds like people are breaking the law). I also think that Pearson et al will AGAIN attempt to make the calculations and norms "proprietary". This would mean that we are not allowed to see the norms or regression formulas. If the field was every foolish enough to accept this proposition, the entire assessment field is over and done with. We become technicians, who can be replaced with anyone including teachers. This also makes our testing inadmissible to any court. Downstream, this means programs teach less of psychometrics because it is less useful. Then we have no one to develop tests, outside of a select group of corporations. Be sure, this is what most of the AI space wants in healthcare. Patients walk in, report their symptoms, AI gives a diagnosis and treatment plan, company finds a way around the requirement for professional licenses. It will likely happen in optometry first. Any younger psychologist should evaluate the likelihood of this, and maybe consider that testing will not be a viable career in 20 years. Or consider I am full of it.

2) Neurologists try this from time to time. There are two big problems with this:
a. It's not lucrative enough for them from a time:income ratio. They can see 3-4 EM code patients/hr for $350/hr. Suspected dementia? Throw some aricept and/or memantine at them with zero testing. Alternatively, they can do telemetry, remote EEGs, or sleep medicine interpretation from their home. Compared to hiring a psychometrician, administering tests for $100/hr, then writing some BS note, and they must be physically in the office while NP testing is performed? It's just not worth it.
b. Neurologists are not trained in psychometrics. As the standard of care requires education in psychometrics, it is literal negligence for them to do this.
c . There is a lot of hassle that comes with NP testing. Record keeping . Billing is complicated. They don't know what they are doing. Patients act up. No one likes hearing they are demented, or that their neuro symptoms are psychiatric in nature. The medications for AZ dementia are extremely limited. Same for PD, HD, PSP, etc. It's just not worth it.

What do you we should do going forward with digital NP and combat the schemes of the large corporations?

 

[PsyDr]

What do you we should do going forward with digital NP and combat the schemes of the large corporations?

Broad strokes: Don't accept it. I think everyone should demand access to norms, and refuse to buy any product which won't allow you to see the professional components (eg., norms, formulas, etc). That is not just for the field, but also for liability. Do you really want to go to court, and say, "The computer said it was good, so...."? Keep in mind, that if elementary school teachers could interpret tests, Pearson could sell a LOT more protocols.

Shame unqualified people who are attempting to do something they are not trained to do.

I expect there will quickly be a day where there are job offers for psychologists who simply sign off on AI generated reports that were administered completely by AI. Refuse those job offers and shame anyone who takes such jobs.

Start discussing psychological tests in the same way physicians discuss lab tests.

 

[thisisjustatest]

So do not make them easily understandable 😁. I think we should take charge of the digital/AI revolution ourselves. Open source and crowd funding instead of letting large corporations control us! Institutions develop tests and publish norms->open source digital platform digitize and decimate -> and collect data to train AI-> only licensed and trained neuropsychologists are allowed to interpret data or AI results (because we raised the AI baby) -> but we can be faster, so NP is a yearly checkup for everyone age 65+

 

[psych.meout]

So do not make them easily understandable 😁. I think we should take charge of the digital/AI revolution ourselves. Open source and crowd funding instead of letting large corporations control us! Institutions develop tests and publish norms->open source digital platform digitize and decimate -> and collect data to train AI-> only licensed and trained neuropsychologists are allowed to interpret data or AI results (because we raised the AI baby) -> but we can be faster, so NP is a yearly checkup for everyone age 65+

Why?

 

[WisNeuro]

Why?

Yeah, we probably don't need yearly screenings if there are no concerns. We don't really need to run the risk of increasing false positives and diagnosis threat. I already see too many providers misinterpreting screeners and diagnosing dementia when it isn't there.

 

[PsyDr]

So do not make them easily understandable 😁. I think we should take charge of the digital/AI revolution ourselves. Open source and crowd funding instead of letting large corporations control us! Institutions develop tests and publish norms->open source digital platform digitize and decimate -> and collect data to train AI-> only licensed and trained neuropsychologists are allowed to interpret data or AI results (because we raised the AI baby) -> but we can be faster, so NP is a yearly checkup for everyone age 65+

Exactly who is going to put in the 40000 pro bono hours to do this? Explain why anyone would do this? Sell this to me, compared to the alternative. I could go work for Microsoft and make millions for this effort. Or I could just do what I do and lose no money or effort. Why would I, and why would a huge group of peopel do this? Why would an IT team not sell out?

This type of “someone should do something” really isn’t actionable.

 

[thisisjustatest]

Exactly who is going to put in the 40000 pro bono hours to do this? Explain why anyone would do this? Sell this to me, compared to the alternative. I could go work for Microsoft and make millions for this effort. Or I could just do what I do and lose no money or effort. Why would I, and why would a huge group of peopel do this? Why would an IT team not sell out?

This type of “someone should do something” really isn’t actionable.

I said nothing about pro bono. Wait, you don’t understand what open source means in the tech world. That’s why people will and always have been controlled by big companies. Sell out what? No one own anything in open source.

 

[WisNeuro]

I said nothing about pro bono. Wait, you don’t understand what open source means in the tech world. That’s why people will and always have been controlled by big companies. Sell out what? No one own anything in open source.

Pro bono in that a relatively small number of people would be doing a large amount of work, and not be generally compensated for it.

 

[Sanman]

I said nothing about pro bono. Wait, you don’t understand what open source means in the tech world. That’s why people will and always have been controlled by big companies. Sell out what? No one own anything in open source.

There is nothing to digitize unless someone releases their data to an open source platform for free rather than choosing to charge for it. So, who is doing all of this research and releasing the data for free?