Kanauss Kevin, Schatz Philip, Puente Antonio E
Department of Psychology, Saint Joseph's University, 222 Post Hall, Philadelphia, PA 19131, USA.
Arch Clin Neuropsychol. 2005 May;20(3):341-53. doi: 10.1016/j.acn.2004.09.002.
Professional members of the National Academy of Neuropsychology (NAN) completed a survey focusing on clinicians' time requirements for activities, number of yearly claims to funding sources, average reimbursement rates, reimbursement rates associated with specific current procedural terminology (CPT) codes, managed care tolerance, hourly reimbursement rates, and other relevant practice issues such as incident-to. Clinicians continue to offer neuropsychological services through traditional assessment and evaluation activities, receive referrals from other healthcare professionals (i.e., neurologists, other medical specialists), and answer traditional referral questions related to patient diagnoses and determination of neuropsychological deficits. Two-thirds of respondents disapprove of managed care, and clinicians engage in activities which appear to minimize the ongoing changes in, and detrimental effects of, managed-care-based funding, in the form of dropping managed care panels, opting for fee-for-service, requiring self-pay patients, or spending more time in clinical activities for which there is a higher percentage of time approved such as forensic evaluations and evaluations for private practice. Clinicians continue to rely on managed care for their referrals even though they are only being reimbursed at about 50%. Overall, across service providers, clinicians are only receiving 60% of their hourly rate, and only 22% report receiving full compensation for their hourly rate. These results suggest that the effects of managed care have, for better or worse, altered the practice of clinical neuropsychology.
美国国家神经心理学学会（NAN）的专业会员完成了一项调查，该调查聚焦于临床医生在各项活动上的时间需求、每年向资金来源方提出的申请数量、平均报销率、与特定现行程序编码（CPT）相关的报销率、管理式医疗的容忍度、小时报销率以及其他相关的执业问题，如附带服务。临床医生继续通过传统的评估活动提供神经心理学服务，接收其他医疗专业人员（即神经科医生、其他医学专家）的转诊，并回答与患者诊断和神经心理学缺陷判定相关的传统转诊问题。三分之二的受访者不赞成管理式医疗，临床医生通过放弃管理式医疗小组、选择按服务收费、要求自费患者或在诸如法医评估和私人执业评估等有更高比例时间获批的临床活动上花费更多时间等方式，开展一些似乎能尽量减少基于管理式医疗的资金持续变化及其不利影响的活动。尽管临床医生从管理式医疗获得的报销仅约为50%，但他们仍继续依赖管理式医疗进行转诊。总体而言，在所有服务提供者中，临床医生每小时仅获得其费率的60%，只有22%的人报告称其每小时费率得到了全额补偿。这些结果表明，无论好坏，管理式医疗的影响已经改变了临床神经心理学的执业方式。
