Q&A: Future of Functional Capacity Evaluation (FCE)
What do you believe is the future for cases involving Short-Term or Long-Term disability, compared to what we're used to in Workers' Comp?
This is an excellent, forward looking question.
Here's my thinking on the future of Functional Capacity Evaluation:
Keep in mind that we are talking about the FCE market in the United States. My comments would be different if we were talking about British Columbia. (The markets in Ontario, Canada and the United Kingdom have problems similar to the U.S. market, but are at a different phase of market development.)
Recent inclusion of functional capacity evaluation reports as evidence in short- and long-term disability cases foreshadows positive change to the practice of FCE in the United States.
Here's the background:
For the most part FCE's performed for workers compensation are not reviewed in an informed environment.
In the U.S., with very few exceptions, there is no legal review process that acts as a crucible of quality. Since the workers compensation system is a no-fault, non-tort system, very rarely do two informed attorneys sit across a table or stand before a labor board and examine expert FCE witnesses. In most cases the arbitrator of quality is the fee payer. This lack of informed review allows a very low standard of practice for functional capacity evaluations.
The important change is the use of short- and long-term disability cases in courts that have the power, under the Federal Rules of Evidence and the Federal Rules of Civil Procedure, to examine the details of an FCE. Under these rules a written report must be submitted for cross examination. And, when submitted for cross examination the evaluator must be able to present and defend his/her findings. The evaluator cannot rely on "the computer told me the result" or "the formula for determination is secret". And, given the findings in Indergard v. Georgia-Pacific, a job-calibrated functional capacity evaluation protocol will replace the standardized test battery approach to FCE. My belief is that the necessity for public testimony by functional capacity evaluators will dramatically change the FCE landscape.
The downside in the current FCE arena is the growth of FCE referral brokers and the emergence of superficial FCE training programs.
My observation of referral brokers is that they tend to reinforce the status of FCE as a commodity. A broker's expertise is the ability to market and sell. This takes advantage of the new evaluator who has not established a practice based on answering referral questions. Coupled with the broker's lack of quality differentiation, the result is a fast moving "mill" of evaluations churned out with little focus on validity, practicality and utility (see the Practice Hierarchy for definitions).
Safety is the foundation of the Practice Hierarchy espoused by
the APTA, APA and NIOSH and is the central focus of Matheson FCEs.
The second part of the downside formula is the annual emergence of superficial FCE training and "certification" programs. Every year we have people come through the five-day Matheson Functional Capacity Evaluation Certification Program with the intention of rolling out a copy of our training. Every year we have people stand outside our classrooms counting the number of people attending the program. I can feel them calculating what they perceive to be a great revenue stream. I can also see them figuring out how to set up the training in low cost venues with little or no transportation costs for equipment and computers. And, just like spring coming each year, these folks offer two or three days FCE "certification" courses within a few months of having attended our courses.
The result of these superficial training courses is that it has diluted the long-term quality of service.
One can participate in this type of training and easily set up a practice taking referrals from brokers. But, just like unqualified people buying too much house from home loan brokerage mills, eventually the market collapses.
I think the FCE market is in that state now.
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