Dr. Jeremy Sharp (00:00)
Hey folks, welcome back to the Testing Psychologist podcast. Today is episode three in pillar two of the March sprint. We’re continuing our business pillar here with a discussion about psychometrists. So a lot of questions about psychometrists in the Facebook group and in my consulting, a lot of feelings about using a psychometrist. So we’re to talk about ⁓ how to hire
So we’re going to talk about psychometrists and frame it in the context of a ceiling essentially. So what do I mean by that? As a solo assessment clinician, though this would apply in group practices as well, any clinician, you know, your revenue is pretty strictly capped by two things. One is the number of hours that you’re awake and the number of hours that your brain can handle high stakes work. So in episode five, we talked about
your sustainable capacity. And for most of us, that number is surprisingly low, to be honest, when you really get honest. So.
Hey folks, welcome back to the testing psychologist podcast. Glad to be here. We are continuing with our ⁓ business pillar in the March sprint. And today we’re talking about the ceiling to your work. What do I mean by that? Talking about the idea that as a solo assessment clinician, though this applies really to any clinician in a practice, your revenue is strictly capped by two things. One is the number of hours that you’re awake and willing to work and
to is the number of hours that your brain can actually handle high stakes testing. So in a previous episode, we calculated your sustainable capacity. You remember that if you didn’t catch that episode, go back and check it out for sure. And for most of us, that number is actually surprisingly low. I But what if you could essentially double your caseload or at least your revenue without doubling your face to face time? This is where
the psychometrist or technician comes into play. So many psychologists hesitate to hire a psychometrist because they, you know, if you’re a drop in clinical quality or they aren’t sure if the math works for paying a psychometrist when you add in the supervision time required. So today we’re going to look at the actual numbers. We’re going to compare the revenue of a do it all psychologist with a ⁓ delegating psychologist. And we’re going to discuss how to account for that supervision tax.
on your time as well. So if you’ve ever considered a psychometrist and kind of hesitated because of the math involved or decline in quality, perceived decline in quality anyway, this is for you. So as per usual with this sprint, I’m going to mention the Crafted Practice Retreat, which is coming up this summer. It is the fourth year that this is happening. It’s an all inclusive, all inclusive testing retreat, business retreat for testing folks.
think it’s the only one of its kind. So if you want to connect with folks, build some potentially lifelong friendships and connections, which has happened for past years, attendees, it’s a great spot. It’s a great spot to do it. So we have small group coaching. We have implementation time. We have downtime where you can go get a massage or go on a hike or get in the water. And we do happy hours. We do…
All kinds of stuff and it is my favorite time of the year and many of the attendees’ favorite time of the year as well. We have several folks who have come every single year and continue to come back because of what it means and what it offers. So you can go to thetestingpsychologist.com slash crafted practice and get all the details and register. The early bird rate, is still in play.
until March 20th. So you might be able to catch the early bird rate. And if not, it’s okay. It’s still, I think, a very valuable experience. Again, thetestingpsychologist.com slash crafted practice. Okay, let’s talk about psychometrists.
Dr. Jeremy Sharp (04:20)
All right, everybody, we are back. We’re talking about the ROI of a psychometrist. So I’m going to begin this with a short discussion about the codes. Codes are important. So we talked about CPT codes a couple of episodes ago, maybe last episode. doing a lot of recording lately, y’all. But we’re going to talk about the psychometrist codes here because they are different. So when you hire a psychometrist, you are no longer billing for your own administration time, obviously. So…
⁓ CPT codes do separate test administration by a psychologist from test administration by a technician. So we’re going to move to the technician led CPT codes, which for the purposes of this discussion, they are 96138, which is the first 30 minutes of technician led testing and 96139, which accounts for each additional 30 minutes beyond the initial 30 minutes.
So the vital distinction here is that these codes typically reimburse at a lower rate than the psychologist led testing codes, which are 96136 and 96137. We discussed these in the last episode. On average, insurance is going to pay about 10 to 20 % less for the technician codes than they do for a psychologist. Your mileage may vary, of course, depending on your panels, but this is important to keep in mind when we’re talking about.
reimbursement and a question that comes up for folks when they ⁓ think about the return on investment for a psychometrist. So at first glance, this might look like a loss, right? Like why would you want to be paid less per hour for essentially the same service? And answer is because though the technician or psychometrist is in the room earning that lower rate, you as a psychologist are in your office earning a significantly higher rate by doing either more intakes or
professional work, which is accounted for by 96132 and 96133 for a second client. There’s also the possibility, of course, that you just take that extra time to live your life and make peace with making less money. That’s fine too. Time is important and valuable for many folks. But for the sake of this discussion, we’re going to go ahead and move forward with doing the math if you were to fill the psychometrist’s time with
clients. So let’s transition to that. I want to look at the solo versus scaled models for a typical, let’s just say 15-hour assessment case. So in the solo model, you would spend an hour on intake, six hours on the testing, and eight hours on feedback, report, and thinking time, right? So some of you might be saying, my gosh, like I’ve never gotten reimbursed for that many hours. That’s fine. I mean, we can ⁓ scale this up or down depending on…
your typical ⁓ reimbursement for your assessments. But for the sake of this example, we’re going to say an hour for intake, six hours on test administration and eight hours on feedback report and thinking time. This is not uncommon for many of the major commercial panels. So if we assume kind of a blended reimbursement rate across CPT codes of one hundred and fifty dollars an hour, that case is going to generate twenty to fifty total. It took you 15 hours of your own
personal life and time to earn that. Okay, so your effective rate is $150 per hour times 15 hours.
Okay, so let’s transition to the scaled model where you use a technician. So in this example, you would spend one hour on the intake and eight hours on the report. Okay, so you’re still doing the intake, the feedback, and the report writing. So that’s a total of nine hours. The psychometrist, on the other hand, is gonna take up those six hours of testing that you would have otherwise done. So even with the lower technician reimbursement, let’s say the testing, those six hours of testing,
generates $500. Okay, so it’s about $90 per hour, give or take. So we combine that. So we’ll take the $500 that the psychometrist is earning and then your professional hours for this evaluation, those nine hours that we talked about, is going to generate $1,200. Okay, so the total case revenue is going to be slightly lower. It’s $1,700, right? $500 plus $1,200. But the important thing is that it only costs you about nine hours of your time
Dr. Jeremy Sharp (08:46)
compared to 15 hours. And so your effective rate just jumped to nearly $200 an hour. $1,700 divided by 9. A little less than $200 an hour. So by delegating this administration, you freed up six hours to start an entirely new case. And in the time that it used to take you to do one evaluation, you can now be well on your way to a second evaluation. OK.
Now let’s talk about what I would call the supervision tax because I’m sure some of you are saying like, I still have to supervise and that costs money and time and I have to pay the psychometrist. So what does that look like? Well, we have to account for this. You can’t just hand a test kit to a psychometrist and walk away. The clinical consensus and ethical guidelines, I think, from our different organizations are pretty clear that you are 100 % responsible for the data that a psychometrist ⁓
generates or gathers, right? So this just means you have to spend the time to make sure it’s accurate. So for every case that a psychometrist handles, you should budget, I would say, at least 30 to 45 minutes of direct supervision and data review after they are thoroughly and fully trained. So I’m going to separate the training. That’s kind of a different discussion. But once they’re up and running, you could ballpark 30 to 45 minutes of supervision per case. And this is where you’re talking about.
You know, did they note any behavior observations that you might have missed or that you need? ⁓ This is battery planning and adjusting throughout the day if you need to, depending on the patient’s ⁓ progress. Were there any errors in the scoring that you might need to catch? And just talking about the client presentation throughout the day and notable factors, things like that. So the question here is, ⁓ is it actually worth it? Well, as usual, I want to do some math and
figured that out. again, we said, you you might spend a half hour on supervising each case. Now at our reimbursement rate of $150 an hour, you are quote unquote spending $75 worth of time supervising that technician. Plus we’re going to pay them, let’s call it $30 an hour for the six hours of testing. So the cost of a technician total cost on one given case is about $260. Okay. So
Again, that’s $75 worth of supervision time from you plus six hours of $30 an hour. So 180 plus 75, it’s about 255, 260. So remember earlier, you we said that we have saved you about six hours of time, however. So you’re presumably filling that six hours with that higher reimbursement rate of about $150 an hour.
So by having a technician, you’re kind of freeing yourself up to bill an extra $900, which is way more than the $260 that the psychometrist costs.
Dr. Jeremy Sharp (11:53)
So I think it’s worth it just from a pure ROI standpoint. The remaining question, though, is quality. This is a big question for folks. Unfortunately, to the best of my knowledge, we don’t have great data on that beyond just anecdotal data. So it’s uncertain exactly how much quality slippage happens as a psychologist moves from that one-to-one model to more of a technician-led model. The longitudinal data, I don’t think, is there. ⁓
at least as far as I could find. So I think one thing that combat here is just, you know, is in the training. So if you do pretty thorough training and you document really well, you know, what expectations you have and what you like to pay attention to, you can even record, you know, sessions, testing sessions to kind of do quality control. All these things can go a long way.
One last point though is to address like, do you talk to clients about ⁓ using a psychometrist and navigate whatever their perception may be? And of course I can’t predict or speak to like every single data point or practice around the country and how this is going over, but I can say that we have personally gotten very little pushback with the clinicians who use a psychometrist. And ⁓ one thing that helps with that is that, you know, we say that we take a team approach and we like to get
multiple eyes on a person. So it’s not just one person. It’s, you know, we get multiple inputs. People seem to like that. I also use the comparison to the medical model quite a bit. I use the example of radiology. It just seems, it seems easy. There are plenty of other subspecialties you could use, but you know, I think of it and describe it to people like I am the radiologist and our psychometrist is the ⁓ X-ray technician or the person who operates the MRI machine. And
You know, I’m sure there are some of you who are thinking that like clients will have a big reaction to that and they may not come to you if you’re not doing all of the testing. But just to play devil’s advocate a little bit, you if you look at it through this radiology lens, would you expect or even feel confident in the results if the radiologist themselves was operating the MRI machine? I personally don’t think I would. I would
I would wonder why a radiologist is operating the MRI machine and kind of wonder if they actually know how to do it because presumably they have like training that’s a more, you know, more elevated than that and, and, ⁓ you know, different, different specialty. So that’s one way to think of it. I think it’s going to vary, you know, people are going to have different perspectives here and that’s totally fine. But this is just one way to think of it. ⁓ if you are considering,
moving to a psychometrist model and weighing them.
Dr. Jeremy Sharp (14:49)
All right. So starting to wrap up, when do you actually pull the trigger, so to speak, and make this happen? So if you’re okay with everything that we’ve talked about here, then it comes down to volume as well. So you can think of it like a, almost like a two case rule. So if you have a consistent wait list and you find yourself turning down more than two evaluations a month, simply because you don’t have the time to like sit in the room and ⁓
move the blocks around and administer the test to people, then you’re probably losing more in opportunity costs than the psychometrist is going to cost you in ⁓ compensation. So that’s a quick shortcut to think about it. If you’re turning away or booking further and further out, you know, up to about three or more cases a month, then that’s a good, good rule of thumb. Hiring a tech though is a mindset shift for sure. You’re going to be moving from ⁓
identity as a tester to more of a diagnostician and you’re moving from the administration business to the interpretation business. So lots of things to think about here. People have lots of thoughts and feelings around this. I’m just presenting this perspective for you to consider. Now in our next episode we’re going to continue the business pillar and we’re going to wrap this up with a discussion of the private pay pivot. I’m going to be talking about how to you know how to shift your model from
insurance-based model to one where you have more private pay clients. There’s a question that comes up a lot and I’m gonna just discuss this process for finding more clients who are willing to pay for more of a premium service. So I hope to catch you next time. Thanks for listening.
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