Managed care experiences of clinical neuropsychologists

Although the eventual outcomes of what has become known as 'health care reform' are still far from clear, it is essential that clinical neuropsychologists begin to evaluate and respond, individually and as a discipline, to the evolving changes in national health care. With timely information regarding the impact of these changes in health care management, neuropsychologists can proactively develop, distribute, and implement expectations regarding appropriate standards of care among policy makers and reimbursement sources. Within this context, the results of a brief national survey of beliefs, experiences, and concerns of 259 clinical neuropsychologists are discussed. In sum, the majority of clinical neuropsychologists believe that health care 'reform', will have a negative effect on their practice, and many report serious difficulties already experienced under managed care systems. At least one third of clinical neuropsychologists sampled have experienced reductions in income levels, hourly reimbursement, referral sources, and overall number of referrals secondary to working within a managed care system, and more than half report having been excluded as providers from managed care systems. Additional concerns include increased paperwork and administrative time, loss of control over decisions essential to designing appropriate neuropsychological batteries, lack of appropriate representation, and diminished patient care. Proactive recommendations for dealing with these health care economic changes are presented.