Memory Testing Procedure
Who Does the Testing?
Our evaluations are all supervised by a clinical neuropsychologist; i.e., a psychologist who specializes in brain/behavior relationships or geropsychologist who specializes in seniors.
Drs. Eggleston and Elovitz supervises the NP testing at Limbic Resources, Inc. While they both often do testing personally, the majority of our evaluations are performed by psychometrists. These are skilled folks who specialize in administering standardized testing. Typically they are doctoral level (or doctoral candidates) staff members, who bring a wide array of skills to the table. Note that all test analyses and diagnosing is done by the supervising psychologist on your case, but the face-to-face services are managed by our psychometry staff for most cases.
What is the Procedure?
Usually your primary care provider (PCP) or neurologist will refer you to us. They send us a fax with their referral questions along with a copy of your last medical visit note. Craig, our Hyannis office manager, will then call you or your family. He describes the procedures, confirms insurance and sets up an appointment. Currently, we ask that only one family member to accompany a patient. We see patients at either of our offices (in Hyannis or Buzzrd’s Bay) for interviewing and testing, takes about 2.5 to 3 hours. Appointments are available every day at about 9:00 AM and 1:30 PM.
We don’t send questionnaires in advance to you which avoids a hassle in paperwork. Instead, we prefer to take information in person and we already have medical notes about your from the referring doctor. It is helpful if you bring all your medication bottles and any over-the-counter things you take like vitamins, sleep aides, etc. with you. Just put it all in a bag or box and bring it along. The lists we get are usually incomplete and often incorrect, so we ask you to just bring everything you take with you. Sometimes we count pills to make sure they are taken accurately… You get the idea? Forget lists, just bring all your medications and supplements with you. We often find over-the-counter pills (especially those for sleep and allergies) to be contributing or causing memory loss!
The Report
We follow-up with a 6-7 page report of findings, diagnostic impressions and recommendations. We can mail (email is not HIPAA allowed) the report to you, family, different doctors, etc. if you bring their mail addresses. We strive to get reports out to you within two weeks of your appointment. IMPORTANT: Set up an appointment with the PCP who referred you to us about a month after the testing date to review the results with them as part of your overall workup and treatment plan. The report’s recommendations are linked to more information at AgeSure.com.
Why So Long for an Appointment?
We are usually backlogged a several months, as we accept Medicare and most other insurances which continue to cut the NP reimbursement. The reimbursement rate has been reduced by over 40% over the last several years, so there are very few clinicians left doing this type of testing for Medicare. In Boston in can take many months just to get an appointment, and you may see a student in a large hospital-based training program and the report may arrive three months after your appointment. So please be patient with us.
Why is the Medicare Reimbursement so Low?
Medicare is entirely paid for by the payroll tax (FICA) the federal deduction that came out of your paycheck all your working life. FICA is split with 7.65% of your gross pay is withheld from every paycheck. You might not realize it but your employer matched that, having to also pay 7.65% of your pay to the government. If you were self employed, maybe a plumber or a private accountant, you got a double hit having pay 15.3% of your gross income since you had no employer to match your contribution. OK, of that 15% everyone pays (put to about $170,000 income per yer), 12.4% goes into funding Social Security and 2.9% goes to fund Medicare. This isn’t a bad thing when you realize that over 14% of retirees rely on SS for almost of their retirement income, while over 40% depending on it for more than half their income.
So how does this result in NP testing reimbursement being reduced every year by Medicare? Well, first of all recognize it is all mental health spending (psychiatry, counseling, and psychological testing) that is getting reduced. There is no way FICA can get more funding without increasing both individual payroll taxes on working Americans and on their employers and at over 7% that is already high. It takes an act of Congress to increase taxes, and the last time that happened was in 2013 when Medicare portion was increased to 2.35% on folks making ≥ $200,000 per year. Tax increases are not likely, although it was just reported that in six years (2032) SS will only be able to fund 78% of scheduled benefits. Some new revenue source will be required to fund SS (seniors vote!) but any money will go to the SS portion, not Medicare.
So How Does Limbic Resources do it?
Anyway, consider that Medicare is now “gatekeeper” driven, as you need referrals for almost any procedure by your PCP before your insurance will pay for it. That means when your PCP (e.g., your family doctor) threatens to drop out of Medicare unless their reimbursement is increased, Medicare must find a way to satisfy them. Since Medicare is revenue neutral (they can’t raise more money) they must reduce rates for someone in the system to increase the rates for the gatekeepers, and the weakest providers are us mental health specialists. So we tend to get hit the hardest when “specialist” rates are reduced to increase the generalist gatekeepers. It’s just that simple, and I think we’ve convinced you it won’t get better in the future.
So, how do we manage to survive? We make a tiny percentage profit on each testing, but we have a high volume of folks thanks to using our psychometrists to do the direct testing. Our outfit on Cape Cod, to the best of our knowledge, is the largest provider of Medicare-paid NP testing in the US. Which makes sense when you realize Barnstable County (Cape Cod) is a retirement capital in the US, with a median age of 56 well above the national median of 39 – we’re even older, by about seven years, then Pinellas County (Tampa, Clearwater, etc.) in Florida!
Do You do Home Visits or Video (Zoom) Meetings?
We can only do NP testing in person. And, no, there is no AI involved with out process. After the COVID-19 crisis we became focused on in-office visits to maintain proper sanitation. We have offices in Hyannis near the hospital and in Buzzard’s Bay just over the Bourne bridge. On some occasions we can still do a home visit, so you can ask about that option when you talk with Craig. We will try to accommodate folks, as we know the population we serve is older and less mobile.
Our evaluations are all supervised by a clinical neuropsychologist; i.e., a psychologist who specializes in brain/behavior relationships or geropsychologist who specializes in seniors.
Drs. Eggleston and Elovitz supervises the NP testing at Limbic Resources, Inc. While they both often do testing personally, the majority of our evaluations are performed by psychometrists. These are skilled folks who specialize in administering standardized testing. Typically they are doctoral level (or doctoral candidates) staff members, who bring a wide array of skills to the table. Note that all test analyses and diagnosing is done by the supervising psychologist on your case, but the face-to-face services are managed by our psychometry staff for most cases.
What is the Procedure?
Usually your primary care provider (PCP) or neurologist will refer you to us. They send us a fax with their referral questions along with a copy of your last medical visit note. Craig, our Hyannis office manager, will then call you or your family. He describes the procedures, confirms insurance and sets up an appointment. Currently, we ask that only one family member to accompany a patient. We see patients at either of our offices (in Hyannis or Buzzrd’s Bay) for interviewing and testing, takes about 2.5 to 3 hours. Appointments are available every day at about 9:00 AM and 1:30 PM.
We don’t send questionnaires in advance to you which avoids a hassle in paperwork. Instead, we prefer to take information in person and we already have medical notes about your from the referring doctor. It is helpful if you bring all your medication bottles and any over-the-counter things you take like vitamins, sleep aides, etc. with you. Just put it all in a bag or box and bring it along. The lists we get are usually incomplete and often incorrect, so we ask you to just bring everything you take with you. Sometimes we count pills to make sure they are taken accurately… You get the idea? Forget lists, just bring all your medications and supplements with you. We often find over-the-counter pills (especially those for sleep and allergies) to be contributing or causing memory loss!
The Report
We follow-up with a 6-7 page report of findings, diagnostic impressions and recommendations. We can mail (email is not HIPAA allowed) the report to you, family, different doctors, etc. if you bring their mail addresses. We strive to get reports out to you within two weeks of your appointment. IMPORTANT: Set up an appointment with the PCP who referred you to us about a month after the testing date to review the results with them as part of your overall workup and treatment plan. The report’s recommendations are linked to more information at AgeSure.com.
Why So Long for an Appointment?
We are usually backlogged a several months, as we accept Medicare and most other insurances which continue to cut the NP reimbursement. The reimbursement rate has been reduced by over 40% over the last several years, so there are very few clinicians left doing this type of testing for Medicare. In Boston in can take many months just to get an appointment, and you may see a student in a large hospital-based training program and the report may arrive three months after your appointment. So please be patient with us.
Why is the Medicare Reimbursement so Low?
Medicare is entirely paid for by the payroll tax (FICA) the federal deduction that came out of your paycheck all your working life. FICA is split with 7.65% of your gross pay is withheld from every paycheck. You might not realize it but your employer matched that, having to also pay 7.65% of your pay to the government. If you were self employed, maybe a plumber or a private accountant, you got a double hit having pay 15.3% of your gross income since you had no employer to match your contribution. OK, of that 15% everyone pays (put to about $170,000 income per yer), 12.4% goes into funding Social Security and 2.9% goes to fund Medicare. This isn’t a bad thing when you realize that over 14% of retirees rely on SS for almost of their retirement income, while over 40% depending on it for more than half their income.
So how does this result in NP testing reimbursement being reduced every year by Medicare? Well, first of all recognize it is all mental health spending (psychiatry, counseling, and psychological testing) that is getting reduced. There is no way FICA can get more funding without increasing both individual payroll taxes on working Americans and on their employers and at over 7% that is already high. It takes an act of Congress to increase taxes, and the last time that happened was in 2013 when Medicare portion was increased to 2.35% on folks making ≥ $200,000 per year. Tax increases are not likely, although it was just reported that in six years (2032) SS will only be able to fund 78% of scheduled benefits. Some new revenue source will be required to fund SS (seniors vote!) but any money will go to the SS portion, not Medicare.
So How Does Limbic Resources do it?
Anyway, consider that Medicare is now “gatekeeper” driven, as you need referrals for almost any procedure by your PCP before your insurance will pay for it. That means when your PCP (e.g., your family doctor) threatens to drop out of Medicare unless their reimbursement is increased, Medicare must find a way to satisfy them. Since Medicare is revenue neutral (they can’t raise more money) they must reduce rates for someone in the system to increase the rates for the gatekeepers, and the weakest providers are us mental health specialists. So we tend to get hit the hardest when “specialist” rates are reduced to increase the generalist gatekeepers. It’s just that simple, and I think we’ve convinced you it won’t get better in the future.
So, how do we manage to survive? We make a tiny percentage profit on each testing, but we have a high volume of folks thanks to using our psychometrists to do the direct testing. Our outfit on Cape Cod, to the best of our knowledge, is the largest provider of Medicare-paid NP testing in the US. Which makes sense when you realize Barnstable County (Cape Cod) is a retirement capital in the US, with a median age of 56 well above the national median of 39 – we’re even older, by about seven years, then Pinellas County (Tampa, Clearwater, etc.) in Florida!
Do You do Home Visits or Video (Zoom) Meetings?
We can only do NP testing in person. And, no, there is no AI involved with out process. After the COVID-19 crisis we became focused on in-office visits to maintain proper sanitation. We have offices in Hyannis near the hospital and in Buzzard’s Bay just over the Bourne bridge. On some occasions we can still do a home visit, so you can ask about that option when you talk with Craig. We will try to accommodate folks, as we know the population we serve is older and less mobile.
