“I'm a neuropsychologist, not a business tycoon.” Speaking personally, that belief kept me from thinking creatively about my professional reality for a long time, and provided a rationalization for dismissing rather than reacting adaptively to the often difficult transition from the world of student to that of self-sustaining professional. Although it can be convenient to hide behind statements such as, “this isn't why I went to graduate school,” when faced with the economic realities of working life, Mark T. Barisa's The Business of Neuropsychology helps the business averse among us to face and learn to befriend the elephant in the room.
The author describes The Business of Neuropsychology (Oxford Workshop Series) as the outcome of his American Academy of Clinical Neuropsychology workshop presentation presented a few years before release of this volume. He stated that the goal for the text was to apply a private practice model to various settings to promote fiscal responsibility in any setting. Although the business aspects of neuropsychology have always been important to the private practitioner, never in the history of neuropsychology has the economic side of the field been so explicitly emphasized in areas outside of private practice.
The text is divided into three sections. The first section provides basic business principles and definitions. The author begins by describing how mission statements, profit analysis, and the concept of process enhance business. Barisa emphasizes a prospective approach to management of neuropsychology, and this section is especially vital for someone who is contemplating opening a private practice. The level of detail presented in financial and process analyses is likely beyond what most of us will find practical, but the concepts presented have the potential to become part of our practices in the future. In addition, this section contains a condensed description of many terms and concepts that can help one interpret “administrator speak.”
The second section encompasses the majority of the book and applies the previously discussed business principles to the practice of neuropsychology. The author effectively shows how the concept of process can help us refine our neuropsychology practice. The author also provides several job descriptions for office staff, which will be helpful to those involved in the hiring process. This section includes a sample checklist of the office steps, beginning with receiving a referral and concluding with filing the report in the patient's medical record. The Health Insurance Portability and Accountability Act of 1996 and other aspects of record keeping are discussed, and while similar information is frequently discussed on neuropsychology list servers, this volume provides a condensed reference of relevant aspects of this part of practice. Likewise, billing codes and their associated controversies are explored and the author provides a blueprint for proper billing procedures.
Barisa emphasizes the importance of Medicare by referencing the Congressional Budget Office's estimate that by 2015, Medicare will represent approximately 50% of all healthcare payments in the United States. The basic structure of Medicare and the pros and cons of being provider based are considered. The chapter on healthcare reimbursement begins by encouraging the reader to think of preauthorization formalities, denials of service, and reimbursement hassles as a game rather than a source of dread. This reframing can help the practitioner to think adaptively when encountering roadblocks in the reimbursement process. The section would have been strengthened if specific strategies that the author has found effective in “learning to play the game” were included.
The chapter on business development and marketing encourages the reader to think flexibly about how we spend our professional time. For example, a contrast between the advantages and disadvantages of conducting traditional neuropsychological assessments is provided, for example, for presurgical epilepsy patients to assessments that may fall outside of our normal scope of practice such as presurgical liver transplant evaluations. The author provides excellent ideas in this chapter but offers only a few specific suggestions; the reader will be left wanting more.
While the previous sections of the book focused on the bottom line, the final section begins by encouraging the clinician to attend to and promote the “value added” services provided by neuropsychology, i.e., those services for which we are unable to bill. For example, conducting outcome or cost-effectiveness studies can be an ideal bridge between clinical work and more basic neuropsychology research. Such studies can lead to publication, but can also provide vital information to administration when attempting to illustrate neuropsychology's greater value within an organization. This section would have benefitted from the author providing specific examples of data that have proven particularly effective to others in promoting neuropsychology.
The section on development of the new professional is quite good and should be required reading for neuropsychology residents who are preparing for their transition to independent professional. Barisa takes the reader from preparing for licensure to issues that one will face when beginning a new job. Aspects of ongoing professional development are also discussed as are considerations as one begins to approach retirement.
We are all busy in our clinical practices and most of us do not have time to master sophisticated business practices. However, improving the process we follow to complete clinical examinations or upgrading our marketing strategy will likely help us to improve our private or institutional practices. The Business of Neuropsychology is an excellent foundation of business principles that are most important to neuropsychology, and also serves as a springboard to learning more about specific aspects of business that relate to our individual practices.
