Psychological Testing in the Service of Disability Determination (2015) / Chapter Skim
Currently Skimming:
6 Economic Considerations
6 Economic Considerations
Pages 177-196
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 177... ...
In this context, the chapter provides an initial framework for evaluating the economic costs of implementation and highlights the types of data that will be needed to accurately determine the financial impact of mandatory psychological testing as recommended by the committee for disability determinations. A more thorough assessment of the financial implications is beyond the committee's ability or charge.
|
From page 178... ...
offices would need to collect in order to accurately assess the net financial impact of implementation. COSTS OF PSYCHOLOGICAL TESTING Costs of Psychological Testing Services As the recommendations state, the administration of psychological testing would be part of the normal disability determination process.
|
From page 179... ...
Health and $86 $87 $4.8 $81 $122 behavioral assessment (96150) a a Centers for Medicare & Medicaid Services provides pricing data for this code in 15-min ute rather than hourly increments.
|
From page 180... ...
For purposes of comparison, the costs are shown for 1 hour of service. In practice, the time for evaluation varies with the type of testing required and the complexity of the case.5 The average cost of testing services varies by the type of testing, psychological versus neuropsychological, and by the type of provider, as in a psychologist or physician versus a technician.6 For an equivalent unit of service, a psychiatric diagnostic interview is the most expensive and was reimbursed by Medicare at an average rate of $134 in 2014.
|
From page 181... ...
This variation suggests that the demand for psychological testing for disability determinations will also vary, resulting in larger outlays in some states than in others. Whether this variation in demand for testing services interacts with variation in testing prices to reduce or increase costs is something that would have to be investigated once testing is implemented.
|
From page 182... ...
By definition, these are individuals for whom a determination regarding benefits requires further case development, including assessment of their ability to perform substantial gainful activity at some job in the national economy.8 In addition to calculations for all applicants reaching this stage, the table shows cost estimates should psychological testing be required for the subset of applicants with mental impairments other than intellectual disabilities or arthritis and back disorders. The results from this exercise demonstrate the variation in projected costs associated with factors related to implementation including which tests will be required, the qualifications mandated for testing providers, and the number of individuals who will need to be tested.
|
From page 183... ...
Mental Disorders (Excluding Intellectual Disability) Neuro Psychological psychological Neuro Psychiatric Testing by Psychological Neuro- Testing by psychological Health and Diagnostic Psychologist/ Testing by behavioral Psychologist/ Testing by Behavioral Number of Interview Physician Technician Status Exam Physician Technician Assessment Persons (90791)
|
From page 184... ...
TABLE 6-2 Continued 184 Arthritis and Back Disorders Neuro Psychological psychological Neuro Psychiatric Testing by Psychological Neuro- Testing by psychological Health and Diagnostic Psychologist/ Testing by behavioral Psychologist/ Testing by Behavioral Number of Interview Physician Technician Status Exam Physician Technician Assessment Persons (90791)
|
From page 185... ...
All Diagnostic Groups Neuro Psychological psychological Neuro Psychiatric Testing by Psychological Neuro- Testing by psychological Health and Diagnostic Psychologist/ Testing by behavioral Psychologist/ Testing by Behavioral Number of Interview Physician Technician Status Exam Physician Technician Assessment Persons (90791)
|
From page 186... ...
Accurately assessing the costs of mandatory psychological testing by SSA will require more detailed information on the parameters of implementation as well as experience in the field once testing has begun. ASSESSING THE BENEFITS OF PSYCHOLOGICAL TESTING Recent calls for greater use of psychological testing in SSA's disability determination process assume that the current process is making significant mistakes and allowing unqualified applicants onto the disability programs (Chafetz and Underhill, 2013; IOPC, 2013)
|
From page 187... ...
Most important is the assumption that the current disability determination process, as implemented by DDS offices, is unable to detect any applicants who exaggerate or fabricate their impairments and related functional limitations. Although not stated directly in the analysis, this assumption is implicit in the authors' use of base rates of malingering from populations of applicants and claimants ex ante of any disability screening.
|
From page 188... ...
minus the children as of December 2011. Costs were estimated by multiplying the average disability figure for each mental condition by the December 2011 number of individuals with that condition, summing over all conditions, and then multiplying by 12 for the yearly estimated amount.
|
From page 189... ...
The alternative estimates also show the sensitivity of the estimated cost savings to the assumption about the potential for mandatory SVT and PVT use to improve the accuracy of SSA disability determinations. The 40 percent test failure rate preferred by Chafetz and Underhill (2013)
|
From page 190... ...
All Awardees Process All Awardees Process Mental Disorders SSDI 49,700 28,398 $236,060 $134,882 $59,015 $33,721 (excluding Concurrent 42,041 21,430 $157,117 $80,089 $39,279 $20,022 intellectual disability) SSI Adults 54,639 24,225 $152,923 $67,801 $38,231 $16,950 SSI Children 72,203 41,636 $202,081 $116,531 $50,520 $29,133 Arthritis and SSDI 117,512 109,295 $671,336 $624,393 $167,834 $156,098 Back Disorders Concurrent 46,459 42,098 $173,628 $157,330 $43,407 $39,332 SSI Adults 32,649 29,677 $81,172 $73,783 $20,293 $18,466 SSI Children 622 244 $1,546 $607 $387 $152 All Diagnostic SSDI 399,722 233,522 $2,069,914 $1,209,267 $517,479 $302,317 Groups Concurrent 210,812 111,331 $787,853 $416,070 $196,963 $104,017 SSI Adults 183,930 90,792 $498,182 $245,914 $124,546 $61,479 SSI Children 171,574 90,479 $464,716 $$245,066 $116,179 $61,267
|
From page 191... ...
For SSDI and SSI, the average benefit amount for mental disabilities (excluding intellectual disability) was calculated as a weighted average of the average monthly benefits awarded for mental disability diagnoses (excluding intellectual disability)
|
From page 192... ...
Although these estimates are far from exact, they suggest that caution is warranted when projecting potential cost savings from mandatory psychological testing. As noted earlier, the static calculations in Table 6-5, although useful for comparing to Chafetz and Underhill, are not appropriate for computing the expected savings associated with implementing SVTs and PVTs in SSA's disability determination process.
|
From page 193... ...
The average benefit amount for mental disabilities (excluding intellectual disability) was calculated as a weighted average of the average monthly benefits awarded for mental disability diagnoses (excluding intellectual disabilities)
|
From page 194... ...
• Some published estimates of the potential cost savings to SSA assoiated with the use of symptom validity testing and perfor c mance validity testing are based on assumptions that if violated would substantially lower the estimated cost savings. Potential cost savings associated with testing vary considerably based on the assumptions about who it is applied to and how many individuals it detects and thus rejects for disability benefits.
|
From page 195... ...
Submitted to the IOM Committee on Psychological Testing, Including Validity Testing, for Social Security Administration Disability Determinations by Joanna Firmin, Social Security Administration, on October 23, 2014. SSAB (Social Security Advisory Board)
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.