Preliminary Measurement Considerations in Clinical Neuropsychological Assessment

Abstract

As the name implies, clinical neuropsychology draws from more than just one discipline. Looking at the name alone, however, gives a somewhat simplified view because more than just simply neurology and psychology comprise modern clinical neuropsychological practice. Current influences include behavioral therapy and assessment, internal medicine, rehabilitation, endocrinology, aphasiology, and public health, among others. Other sources of influence exist because clinical neuropsychology exists in a context of social and cultural variables. The development of clinical neuropsychological assessment techniques is influenced by referral, and to an increasing extent, reimbursement sources. The rise of managed care has affected the amount of time allowed for a neuropsychological evaluation as well as the procedures allowed. When the clinical neuropsychologist is given precertification for time periods less than he or she would like to use, the question faced is whether to truncate the evaluation using shorter procedures or to absorb the cost of nonreimbursed time. More focused instruments requiring less time become more heavily used. When the managed care reviewer denies certain tests as not being covered, the clinical neuropsychologist must either find an acceptable alternative or absorb the cost once again. There is a clear need to educate managed care professionals, and research regarding reliability and validity becomes even more important.