Rural neuropsychology practice
I’ve been struggling with what I want to be the focus on my blog. I’ve decided that with the new year, I am going to try to devote the majority of this blog to issues related to having a private practice in psychological and neuropsychological testing in a rural setting. I have seen almost nothing written on this topic and I believe that practicing in this kind of setting comes with its own challenges and rewards. I hope that this topic will be of interest to others and will spark some interesting discussions.
As it’s New Year’s Day I have thoughts and questions about what 2011 will bring to my practice as well as to my field more generally. Many of the federal health reform provisions take effect this year. Additionally, our governor has made it clear that “payment reform” is a priority for Massachusetts in the next few years. It is not yet clear what form this payment reform will take. It is true that our current healthcare system, statewide and nationally, is quite broken and changes are needed. However, I have concerns about instituting the kind of changes being suggested at our state level, which mostly pertain to the establishment of Accountable Care Organizations (“ACOs”). In this kind of system, the primary care doctor is the hub for a patient’s medical care and receives a lump payment from the insurer for that patient’s care. Then it is up to the doctor to decide when (and whether) to refer the patient out for any additional services. Every time the patient is referred out, the money for the specialist is deducted from the primary care doctor’s lump sum payment. Therefore, this system creates an incentive for the primary care doctor not to refer out for services. I have concerns about the pressure this may put on the primary care doctor to restrict external services. It is not clear yet whether mental health services will be included in this system or not. Most mental health services don’t lend themselves very well to a system that is based on controlling or managing episodes of medical illness. So in short, I have many concerns and unanswered questions. It also worries me that many of my colleagues do not seem to be aware that these changes are in the works.
More next time…. happy new year to all!