ADVANCED CLINICAL NEUROPSYCHOLOGY
WEEK 1
ARTIKEL 1 – ADVANCING CLINICAL NEUROPSYCHOLOGY WITH
APPROPRIATE OUTCOME STUDIES AND DEMONSTRATED CLINICAL
SKILLS
INTRODUCTION
Financial reimbursement – major challenge for clinical
neuropsychologists.
Two types of evidence are essential for clinical neuropsychology:
- Evidence-based outcome research – demonstrates the
effectiveness and costs of neuropsychological
assessments/interventions.
- Clear demonstration of clinical value – from practitioners to
physicians.
Potential consequences if failure to provide these two forms of
evidence:
- Services being offered only on a fee-for-service basis (many
cannot afford)
- Patients missing out on needed assessments > delayed
diagnosis/poor treatment
Professional identity of neuropsychologists
- Strong technical and scientific knowledge is essential but not enough
on its own.
- Neuropsychologists must be able to translate scientific findings into
practical information that reduces patient suffering and improves
medical care.
- Scientist-practitioners – balance science with patient and family
needs.
Scope of practice
- Broad scope of practice (infants to old age)
- Increased focus on managing neuropsychological disorders, treating
cognitive and behavioral impairments.
FOCUSED GOALS (of this paper)
1. Clarify the two types of data needed for the field of
neuropsychology to flourish
2. Describe types of outcome studies that continue to form the
foundation of the scientific basis of out practice.
3. Identify the clinical and professional skills that need to be
developed by clinicians and should be integrated into training.
PREVIOUS AND CONTINUING EFFORTS
Well-designed outcome studies – measure functional change caused
by an intervention, must show:
- Objective value – scientific validity and economic benefit
- Subjective value – satisfaction and perceived usefulness to
patients, families, physicians.
Cost-effectiveness studies – compare benefits relative to costs.
,FUTURE EFFORTS
Outcome studies
- Key role of neuropsychologists – determining whether subjective
complaints match objective brain functioning.
o Differentiating neurological vs psychiatric conditions.
o Rehabilitation planning and patient management
Predict how long patients need to reach rehabilitation
goals
Educate family members
o Provide objective evaluations (in legal cases)
Predict fall risk in older adults
- Outcome studies are needed to:
o Show that combining neuropsychological testing with
neuroimaging improves patient care.
Reduce surgical complication, decrease post-surgical
speech and language therapy.
o Demonstrate that intervention programs lead to real cognitive
and behavioral improvements.
o Show that neuropsychological rehab reduces disability,
improves quality of life, increases return to work rates.
Reduced caregiver burden
o Demonstrate the economic cost of delayed or denied
neuropsychological care.
DEVELOPING THE CLINICAL AND PROFESSIONAL SKILLS OF
NEUROPSYCHOLOGISTS
Primary clinical skills
1. Capacity to review the medical and psychosocial history of a patient
and identify key variables that bear on the neuropsychological
interview and the examination procedures.
2. Capacity to carefully interview the patient and family and briefly
reveal the complexity of the problem.
3. Capacity to establish a therapeutic alliance with the patient and
family member
4. Capacity to examine (via various neuropsychological tests or
procedures) a broad range of abilities that are necessary to refine
the diagnosis, clarify the patient’s strengths and weaknesses, and
develop possible interventions
5. Capacity to give verbal feedback regarding the test findings to the
patient and family that is understandable and acceptable. The
patient and family should have a clear understanding of what was
found and the rationale for the interpretations that were arrived at
6. Capacity to write reports that are concise (not necessarily short) and
clear, which identify the next step in the patient’s care and provide
practical suggestions
7. Capacity to perform cognitive rehabilitation as a method of either
compensation or restoration of function
, 8. Capacity to conduct psychotherapeutic interventions to help the
patient struggle with his or her personal losses
9. Capacity to educate the patient, family, and physician regarding how
the underlying brain disorder impacts neuropsychological
functioning
10. Capacity to elucidate the next step in the patient’s care
Professional skills – that make a difference for de viability of the
profession of neuropsychology with other professions and the public at
large.
1. Acknowledgement of the limits of our knowledge with the capacity to
advocate for the patient given the knowledge that is available
2. Capacity to negotiate conflicts within and between professions
3. Steadfastness in learning one’s profession over several years
4. Seeking out fair reimbursement for our services, but never putting
economic gain over patient needs
5. Self-monitoring of our personal and professional behavior (including
our appearance, our office space, and how we talk to and relate to
other healthcare providers)
6. Demonstrated capacity to conduct ongoing clinical research to check
on the validity of our clinical assumptions, even though the time
needed to do this may not be financially reimbursed by an employer
or a granting agency
FINAL POINTS
1. Find your professional niche – doing something that meets your
professional needs while meeting the needs of others.
2. Recognize that neuropsychologists are not mini neurologists,
psychiatrists or radiologists. Keep identity as psychologist
interested in brain behavior relationships.
3. Evaluate the concept of value in healthcare economics – both
objective and subjective markers of value
ARTIKEL 2 – RETURN ON INVESTMENT AND VALUE RESEARCH IN
NEUROPSYCHOLOGY: A CALL TO ARMS.
INTRODUCTION
Why this topic matters
- Healthcare costs are rising
- Insurance systems are moving from fee for service to performance-
based payment.
- Neuropsychology has strong clinical evidence, but less research
shows financial value or cost savings.
Clinical value of neuropsychological evaluation
- Clinical value – how well neuropsychological assessments help
patients.
- Research shows neuropsychological assessments:
o Improve diagnosis and prognosis
o Help with treatment planning and outcome prediction
, o Predict functional, financial and psychological outcomes
o Are useful across various conditions.
- Incremental value – what neuropsychological assessment adds
beyond other methods.
o Strong evidence in MCI, dementia and TBI
o Moderate in stroke, epilepsy, MS, ADHD
- Economic value and return on investment (ROI) – whether
neuropsychological services save money or reduce healthcare use.
o Reduced medical errors, slower disease progression, lower
healthcare utilization, overall cost savings.
- Value added services – making a service more attractive or
beneficial within a system.
o E.g. having an in-house neuropsychologist may increase
referrals to neurology clinics, improve patient satisfaction
scores.
- Challenges in studying ROI
o Neuropsychologists often lack training in economics, cost-
effectiveness research.
o Neuropsychology outcomes are not always easily measured in
dollars
o Different research language in healthcare economics
- Cost-efficiency studies – achieving a goal at the lowest cost.
- Cost-benefit studies – both costs and benefits are converted into
money, each outcome is given a financial value
o Hard in NP because cognitive outcomes are hard to express in
dollars
o CAN show: cost of NP evaluation is less than or money saved
later.
- ROI – measures profitability or feasibility, from investors perspective
(hospital, health system, payer)
o Net financial gain/cost of service x 100
o Limitations:
May miss social and psychological benefit
Benefit may occur later
- Cost-effectiveness studies – costs are measured in money,
outcomes in non-monetary units.
- Cost-utility studies – special type of cost-effectiveness study.
o Main outcome – incremental cost-effectiveness ratio (ICER)
o ICER – cost of intervention/difference in quality-adjusted life
years.
- Cost-consequence analysis – compares costs with all outcomes,
listed in natural (non-monetary) terms.
Outcome measures commonly used in ROI research
- System related outcomes – focus on healthcare system costs and
usage.
o Emergency room visits, inpatient admissions, hospital costs,
etc.
- Patient-related outcomes – focus on patient functioning and
satisfaction.
WEEK 1
ARTIKEL 1 – ADVANCING CLINICAL NEUROPSYCHOLOGY WITH
APPROPRIATE OUTCOME STUDIES AND DEMONSTRATED CLINICAL
SKILLS
INTRODUCTION
Financial reimbursement – major challenge for clinical
neuropsychologists.
Two types of evidence are essential for clinical neuropsychology:
- Evidence-based outcome research – demonstrates the
effectiveness and costs of neuropsychological
assessments/interventions.
- Clear demonstration of clinical value – from practitioners to
physicians.
Potential consequences if failure to provide these two forms of
evidence:
- Services being offered only on a fee-for-service basis (many
cannot afford)
- Patients missing out on needed assessments > delayed
diagnosis/poor treatment
Professional identity of neuropsychologists
- Strong technical and scientific knowledge is essential but not enough
on its own.
- Neuropsychologists must be able to translate scientific findings into
practical information that reduces patient suffering and improves
medical care.
- Scientist-practitioners – balance science with patient and family
needs.
Scope of practice
- Broad scope of practice (infants to old age)
- Increased focus on managing neuropsychological disorders, treating
cognitive and behavioral impairments.
FOCUSED GOALS (of this paper)
1. Clarify the two types of data needed for the field of
neuropsychology to flourish
2. Describe types of outcome studies that continue to form the
foundation of the scientific basis of out practice.
3. Identify the clinical and professional skills that need to be
developed by clinicians and should be integrated into training.
PREVIOUS AND CONTINUING EFFORTS
Well-designed outcome studies – measure functional change caused
by an intervention, must show:
- Objective value – scientific validity and economic benefit
- Subjective value – satisfaction and perceived usefulness to
patients, families, physicians.
Cost-effectiveness studies – compare benefits relative to costs.
,FUTURE EFFORTS
Outcome studies
- Key role of neuropsychologists – determining whether subjective
complaints match objective brain functioning.
o Differentiating neurological vs psychiatric conditions.
o Rehabilitation planning and patient management
Predict how long patients need to reach rehabilitation
goals
Educate family members
o Provide objective evaluations (in legal cases)
Predict fall risk in older adults
- Outcome studies are needed to:
o Show that combining neuropsychological testing with
neuroimaging improves patient care.
Reduce surgical complication, decrease post-surgical
speech and language therapy.
o Demonstrate that intervention programs lead to real cognitive
and behavioral improvements.
o Show that neuropsychological rehab reduces disability,
improves quality of life, increases return to work rates.
Reduced caregiver burden
o Demonstrate the economic cost of delayed or denied
neuropsychological care.
DEVELOPING THE CLINICAL AND PROFESSIONAL SKILLS OF
NEUROPSYCHOLOGISTS
Primary clinical skills
1. Capacity to review the medical and psychosocial history of a patient
and identify key variables that bear on the neuropsychological
interview and the examination procedures.
2. Capacity to carefully interview the patient and family and briefly
reveal the complexity of the problem.
3. Capacity to establish a therapeutic alliance with the patient and
family member
4. Capacity to examine (via various neuropsychological tests or
procedures) a broad range of abilities that are necessary to refine
the diagnosis, clarify the patient’s strengths and weaknesses, and
develop possible interventions
5. Capacity to give verbal feedback regarding the test findings to the
patient and family that is understandable and acceptable. The
patient and family should have a clear understanding of what was
found and the rationale for the interpretations that were arrived at
6. Capacity to write reports that are concise (not necessarily short) and
clear, which identify the next step in the patient’s care and provide
practical suggestions
7. Capacity to perform cognitive rehabilitation as a method of either
compensation or restoration of function
, 8. Capacity to conduct psychotherapeutic interventions to help the
patient struggle with his or her personal losses
9. Capacity to educate the patient, family, and physician regarding how
the underlying brain disorder impacts neuropsychological
functioning
10. Capacity to elucidate the next step in the patient’s care
Professional skills – that make a difference for de viability of the
profession of neuropsychology with other professions and the public at
large.
1. Acknowledgement of the limits of our knowledge with the capacity to
advocate for the patient given the knowledge that is available
2. Capacity to negotiate conflicts within and between professions
3. Steadfastness in learning one’s profession over several years
4. Seeking out fair reimbursement for our services, but never putting
economic gain over patient needs
5. Self-monitoring of our personal and professional behavior (including
our appearance, our office space, and how we talk to and relate to
other healthcare providers)
6. Demonstrated capacity to conduct ongoing clinical research to check
on the validity of our clinical assumptions, even though the time
needed to do this may not be financially reimbursed by an employer
or a granting agency
FINAL POINTS
1. Find your professional niche – doing something that meets your
professional needs while meeting the needs of others.
2. Recognize that neuropsychologists are not mini neurologists,
psychiatrists or radiologists. Keep identity as psychologist
interested in brain behavior relationships.
3. Evaluate the concept of value in healthcare economics – both
objective and subjective markers of value
ARTIKEL 2 – RETURN ON INVESTMENT AND VALUE RESEARCH IN
NEUROPSYCHOLOGY: A CALL TO ARMS.
INTRODUCTION
Why this topic matters
- Healthcare costs are rising
- Insurance systems are moving from fee for service to performance-
based payment.
- Neuropsychology has strong clinical evidence, but less research
shows financial value or cost savings.
Clinical value of neuropsychological evaluation
- Clinical value – how well neuropsychological assessments help
patients.
- Research shows neuropsychological assessments:
o Improve diagnosis and prognosis
o Help with treatment planning and outcome prediction
, o Predict functional, financial and psychological outcomes
o Are useful across various conditions.
- Incremental value – what neuropsychological assessment adds
beyond other methods.
o Strong evidence in MCI, dementia and TBI
o Moderate in stroke, epilepsy, MS, ADHD
- Economic value and return on investment (ROI) – whether
neuropsychological services save money or reduce healthcare use.
o Reduced medical errors, slower disease progression, lower
healthcare utilization, overall cost savings.
- Value added services – making a service more attractive or
beneficial within a system.
o E.g. having an in-house neuropsychologist may increase
referrals to neurology clinics, improve patient satisfaction
scores.
- Challenges in studying ROI
o Neuropsychologists often lack training in economics, cost-
effectiveness research.
o Neuropsychology outcomes are not always easily measured in
dollars
o Different research language in healthcare economics
- Cost-efficiency studies – achieving a goal at the lowest cost.
- Cost-benefit studies – both costs and benefits are converted into
money, each outcome is given a financial value
o Hard in NP because cognitive outcomes are hard to express in
dollars
o CAN show: cost of NP evaluation is less than or money saved
later.
- ROI – measures profitability or feasibility, from investors perspective
(hospital, health system, payer)
o Net financial gain/cost of service x 100
o Limitations:
May miss social and psychological benefit
Benefit may occur later
- Cost-effectiveness studies – costs are measured in money,
outcomes in non-monetary units.
- Cost-utility studies – special type of cost-effectiveness study.
o Main outcome – incremental cost-effectiveness ratio (ICER)
o ICER – cost of intervention/difference in quality-adjusted life
years.
- Cost-consequence analysis – compares costs with all outcomes,
listed in natural (non-monetary) terms.
Outcome measures commonly used in ROI research
- System related outcomes – focus on healthcare system costs and
usage.
o Emergency room visits, inpatient admissions, hospital costs,
etc.
- Patient-related outcomes – focus on patient functioning and
satisfaction.
