FUNCTIONAL Know what you are getting CAPACITY When and how to use them EVALUATIONS Will they hold up in court? Making Everyone s Job Easier...
We are looking at the whole person abilities as well as disabilities. We have prepared this manual to help you understand: What is a quality Functional Capacity Evaluation (FCE)? When should an FCE be used? How can I be assured I m getting my money s worth? Will it hold up in court? 2
What Actually is a Functional Capacity Evaluation (FCE)? First An FCE is Not... An FCE is not a Lifting Assessment. This is a part of an FCE. However, an FCE goes much further. Also, lifting is not important to many job tasks. At The Freedman Group an FCE covers all tasks involved in the daily work; not just lifting. It is not Validity Testing. This is one of the most critical elements of any FCE; but validity testing unto itself will not tell the entire story. At The Freedman Group we believe that validity testing is not valid unless there are multiple validity tests and adequate cross validation. It is not an Impairment Rating (PPD). This is a separate objective evaluation of a patient s permanent physical impairment based on data collected during the FCE. Specific formulas and calculations are utilized to determine this rating. When requested, The Freedman Group can provide an impairment rating. It will always be based on The American Medical Association Guides to the Evaluation of Permanent Impairment (latest edition). What a Functional Capacity Evaluation (FCE) Actually Is... At The Freedman Group, we define an FCE as: A comprehensive evaluation of someone s abilities and inability s with regard to a specific work task or set of work tasks, including adequate validation to be credible in case closure and return-to-work issues. An FCE Must Have 3 Characteristics to Meet Our Standard... Strong Testing and Back-Up Data A valid FCE must have multiplicity of data to be credible. At The Freedman Group our FCE s contain a photographic record as well as extensive validity testing with cross validation to determine symptom magnification issues. Two systems with extensive bibliographies are utilized ARCON and BTE Work Simulation and Evaluation systems (The Freedman Group is the only evaluation center in Atlanta utilizing both systems on a daily basis for FCE s.) Other validity techniques are also utilized, to achieve high levels of confidence that the testing is valid. Licensed and Highly Trained Professionals only licensed occupational or physical therapists, specifically trained in FCE s and workplace injuries perform the testing at The Freedman Group. While some clinics utilize technicians to conduct FCE s, we do not consider an FCE to be valid, if done by non-therapists, especially if the FCE is to be used in court. Adequate Time A well-done Functional Capacity Evaluation usually takes at least four hours of clinical time to verify job functioning capabilities and limitations. Our FCE s generally take between four and five hours depending on the type of job, the severity of the injury, the cooperation of the patient, etc. Beware of the clinic that says they can do a credible job in a short timeframe. It simply can t be done, in our opinion. 3
How is the FCE Used? Generally, FCE s are requested within the context of a worker s compensation claim, in the management process of a disability case, or in the management process of a liability claim. We have seen a substantial growth trend in the use of FCE s as an evaluative tool to assist in return-to-work issues, toward claim settlement, and other case closure factors. Because FCE s are being used successfully in work case arenas, we are seeing a growth trend in their use in support of an auto or other liability claims as well. Often, the FCE is considered to be an essential part of a battery of final determinants which may also include an IME and Impairment Rating (PPD). When is an FCE Appropriate? Medical evaluation completed (with or without an IME). No additional treatment has been recommended. Maximum medical improvement (MMI) has been achieved. Refer for FCE to assist with case resolution. Medical evaluation completed. Treatment was successful, but there is no job or modified duty available with employer. Refer for FCE to determine work capabilities. Medical evaluation completed. Return to work light duty or regular duty was unsuccessful. Refer for FCE to determine work capabilities. (Note: a more extensive evaluation may be required at this time including a Job Site Analysis to determine possible work station modifications.) Medical evaluation completed. Patient continues to struggle and physician or someone involved with the case may want someone to take a fresh look at the person with the objective being to suggest additional treatment or alternatives. Patient may be on disability and the insurer is trying to determine whether disability benefits need to continue or is there a possibility this person is able to return to work. A patient may be referred for an FCE to help determine if the patient qualifies for social security benefits. A worker is being considered for new employment and is referred to determine if he/she can perform the essential functions of the job. The employee sustained a non-work related injury (e.g. an auto accident, a home or sports injury) and the employer wants to determine if the employee is capable of safely performing the essential functions of the same or a different job. 4
What is Included in the FCE? Part 1: Patient Self-Profile... Includes the patient s perception of their current work and physical demands of the job, their vocational history, problems and attitudes toward work and perception of discomfort/pain levels. This patient profile is often skipped in many clinics resulting in vital information being overlooked. However, it is always included at The Freedman Group since we have found, in many cases, that some of this information helps explain actions occurring during the testing. Part 2: Therapist Fact Finding... Patient history is expanded and the information in Part 1 is verified or questioned. We also go into detail regarding how the injury occurred, the specific nature of the job, and how the injury has influenced the patient s ability to perform activities of daily living, home activities, leisure activities, etc. During this part, a general picture of the work environment, including the job responsibilities, is developed. Specific physical demands are discussed in great detail. We go to great lengths to obtain and review an employer s job analysis or description, if it is available. Many times, the therapist has discovered a conflict with what the description says and the patient s perception of their work. This is often a vital piece of information that affects the results of the testing. Part 3: Testing... Depending on the type of injury, the job the patient is returning to, or the new job being considered, a battery of tests will be conducted to determine strength, range of motion, dexterity, work endurance abilities, etc. If it s part of the job task, we try to test for it. Specifically, the FCE testing may include: lifting, grasping, pinching, pulling, reaching, pushing, twisting, crouching, crawling, stooping, kneeling, fine dexterity, eye-hand coordination, etc. Sitting, standing, walking, balancing, and stair or ladder climbing abilities and tolerances are also observed and tested. Edema may be measured, and re-measured for comparison and analysis, if necessary. Additionally, some actual work simulation usually occurs as part of the testing. This may include material handling, working with construction tools, word processing and data entry, material sorting, small part inspection and assembly, simulated driving, etc. Often the patient may bring in their own work tools, which we encourage, so we can simulate their job as closely as possible. In other cases, employers may supply products or tools for use. The Do your best! That s what we tell every patient coming in for an FCE. If they do their best, we ll know it and everyone comes out a winner. 5
clinic, has an adequate supply of tools, equipment and work simulation devices to create most work situations. As part of the FCE, the therapist will perform a clinical evaluation of the musculoskeletal systems including posture, strength, joint mobility and soft tissue deficits. Since The Freedman Group therapist spends so much time with the patient during the Functional Capacity Evaluation, it is very possible that a potential problem may be identified. Our therapists have identified neurological, cardiovascular and vision problems, for example. In this case, the therapist will note this possibility and provide the information to the appropriate member of the patient s rehab team. If deemed warranted, the therapist may stop the evaluation, or temporarily suspend it, to consult with someone immediately so as not to put the patient at risk. The patient is encouraged to do their best. This is very important because The Freedman Group places a high degree of attention on consistency of effort by utilizing a variety of testing and standardized protocols with extensive bibliographies. A heavy emphasis is placed on validity testing in order to determine whether the patient is attempting to manipulate the results of the test or is giving their best effort. Other validation and good observation techniques are utilized throughout the entire evaluation. Part 4 Analysis and Recommendations... Each therapist spends an extensive amount of time reviewing the patient work and medical files that have been provided. Available job descriptions are analyzed. Testing scores are calculated and analyzed. Evaluation notes are reviewed and a final report is written summarizing all available information. Reports include an executive summary, a work capability checklist, recommendations and a 16-20 page full write-up complete with photographs and data support. At The Freedman Group, conclusions and recommendations are focused on achieving certain pre-evaluation objectives such as return-to-work parameters, recommendations for job or home modifications, the need for additional therapy, the need for a reconditioning program prior to return-to-work, or to help settle a claim. Functional Capacity Evaluations that don t provide specific recommendations are incomplete, and you have not gotten your money s worth. Who Orders the FCE? We receive referrals for FCE s from a variety of sources including: physicians, insurance adjusters, case managers, rehabilitation consultants, personnel from self-insured companies (risk managers, human resource personnel, company nurse or doctor), defense attorneys and plaintiff attorneys. Our therapists are attuned to the entire rehabilitation team that may be involved in a case. Evaluation Length The Freedman Group FCE is usually completed in four hours, on average. Most of the FCE s are done in one day. When requested, an FCE can be conducted over a two or three day period to make comparisons. Before and after the FCE, the evaluating therapist will spend up to an additional two to three hours, without the patient present, performing chart reviews, analysis, and write-up. All together, we have found that a quality FCE requires about seven hours of allocated therapist s time, on average. 6
Scheduling... Location... Patient Appointment Management All Functional Capacity Evaluations are performed at The Freedman Group clinic conveniently located just four minutes from the intersection of I-75 and I-285. There are ample restaurants, hotels and shopping malls in the area, should the FCE be scheduled as an overnight or multi-day examination. The clinic can assist in making these arrangements. The clinic performs four to five hundred FCE s annually on patients generally coming from a five state area. The Freedman Group is fully equipped to manage multiple FCE s, work conditioning and outpatient rehab simultaneously - but only by licensed therapists. Unless requested otherwise, we routinely schedule the FCE appointment approximately two weeks from the referral date. This gives the clinic enough time to obtain necessary approvals, receive medical and job records, and clear any potential problems such as transportation, lodging, translator arrangements, etc. From time-to-time you may have someone you want seen quickly. Just ask for a priority scheduling and we ll do our best to accommodate your need. Our FCE reports are issued on a timely basis. Frequently, a verbal summary, along with a fax summary of work capabilities, is provided quickly, while the full report is being completed. Receiving Your Referral... Call the clinic at any time to schedule an FCE. The clinic is in full operation, nine hours a day, five days a week, with FCE s scheduled daily. Should you call during a busy period, or during non-clinic hours, you may leave as much information as you desire on our voice mail system and we will get back to you quickly. Call several times, if necessary, to complete your message. You may always start the referral process via a fax. For your convenience, we have provided a comprehensive fax referral sheet on page 11 for you to copy and use. You may always use your own referral sheet or letter. Our referral form is quite comprehensive and provides us with an efficient beginning of the process so that we can get proper approvals, and important names, addresses and phone numbers. We can provide you with these convenient referral forms on pads. Please call the clinic for a supply. Be assured that strict confidentiality is practiced, at the Freedman Group, all the time, with regards to retrieving information from our voice mail and fax systems. Actual tools and materials are used, whenever possible, in the clinic. 7
After We Receive Your Referral... After we have confirmed the FCE appointment date with you and received the patient information, we handle the rest. Your office will not be bothered with keeping the patient on-track and on-schedule, as long as we don t perceive a problem. Typically, our next steps are: Obtain approval from guarantor. Send out patient packet (a copy is available on request). Send the patient reminder letter asking for a confirmation call. Call the patient to confirm, if we have not been called 72 hours before the appointment. Contact the people involved with the case, if the patient does not confirm 72 hours in advance. For your information, your patient is told that that we are obligated to report their tardiness or cancellation. We also advise them that a scheduled appointment is approximately 4 hours and that a no-show, may result in a cancellation fee being charged to their employer or insurer. This often assists with patient compliance. Please advise us, as soon as possible, should your case settle or you are aware that a patient will not be showing up for a Functional Capacity Evaluation. It is difficult to schedule four-hour evaluations on short notice to fill a cancellation. Approvals / Pre-Certification... The Freedman Group will obtain all insurance or other guarantor approvals. We require a signed letter, which we provide to the guarantor, so that there is clarity on the fee and what service(s) are being provided. Transportation... The clinic recognizes that non-compliance with the scheduled FCE appointment, a no show, often occurs, at the last minute, with transportation problems stated as the reason. In the event that your patient or client has a transportation problem, The Freedman Group can make immediate transportation arrangements providing we have authorization. Understanding the job at the worksite helps the therapist become a better evaluator in the clinic. 8
Non-English Speaking FCE s The Freedman Group routinely performs FCE s for the Hispanic community, as well as other non-english speaking patients. Please discuss with us whether your patient speaks and/or understands enough English to complete the testing. We have an excellent staff of on-call Hispanic interpreters. Our on-call interpreters are trained by The Freedman Group to report accurately what the patient is saying without attempting to provide additional and/or subjective information. We can also arrange for interpreter services for any language, provided we know, far enough in advance, that there is a need. We require our interpreters to keep in touch with the patient at various times prior to the appointment to assure that the patient understands when their appointment is, how to get to the clinic, etc. Sorry. In order to maintain objectivity, we do not allow relatives, friends, or anyone involved in the case to interpret for the patient. Will Our FCE Hold Up in Court? Know who you are working with! A bio of the clinic director is included for your review. We are always willing to provide references and sample reports for you to review. Only licensed occupational or physical therapists, specifically trained in FCE s and workplace injuries, perform the testing at The Freedman Group. Over 4000 FCE s have been conducted by our therapists. Total objectivity is the standard placed on every FCE performed at The Freedman Group. That s why we use two systems with extensive bibliographies for evaluation, validity testing and cross validation. We will stand behind our data and evaluation methodology for any legal proceeding. It s amazing the difference in test scores of a worker really seriously injured but motivated to return to work and the worker with an injury who does not want to work. That s why validity testing drives our FCE s. 9
Peggy Freedman Occupational Therapist & Clinic Director Peggy Freedman has been an Occupational Therapist for over 25 years. She is President and Clinic Director of The Freedman Group a practice specializing in the evaluation and treatment of injured workers with a specific focus on Validity Testing, Return-to-Work and Case Closure issues. She can often be seen driving bulldozers, manufacturing steel or plywood, walking on construction girders, paving roads, picking warehouse orders, doing computer data processing, call center phone answering or even working in large commercial kitchens. Peggy uses her extensive fieldwork to understand critical demands of work, which, in turn, has helped hundreds of employers and insurance companies design ergonomically correct workstations, as well as prevent cumulative trauma and back injuries. A sought-after speaker, she is a frequent guest lecturer at Brenau University School of Occupational Therapy and has spoken at Georgia Tech on cumulative trauma and ergonomics. She has been the featured speaker for The Georgia Occupational Therapy Association, The Workers Compensation Law Institute, The State Workers Compensation Seminar, The Association of Georgia Occupational Health Nurses, the Veterans Administration, The Private Rehab Suppliers of Georgia, and CNN News. Her topics include The Role of the Occupational Therapist in the Workers Compensation System, Proper Treatment Sequence for the Industrially Injured Worker, What is a Functional Capacity Evaluation, Cumulative Trauma, How to Manage the Injured Worker, Reflex Sympathetic Dystrophy and Osteoporosis and Exercise. Peggy has performed over 4,000 Functional Capacity Evaluations and more than 30,000 treatments in a wide array of settings including industrial sites, private practice, hospitals, home health, and nursing homes. She evaluates and treats orthopedic injuries, hand injuries, mastectomy related problems, cerebral vascular accidents, geriatric issues, complex multiple disabilities, rheumatoid arthritis, traumatic head injuries, cumulative trauma and others. Her extensive reliance on validity testing, assessing the whole person, and her tell it as she sees it policy has been singled out by the legal community. She is called upon frequently, as an expert witness, in disability, workers compensation and personal injury cases, by both defendant as well as claimant law firms. Her strong advocacy for providing an essential forum for the entire rehab team working on a case has been called...the most thorough and best approach with a higher probability of returning someone to work quicker and permanently. Prior to opening The Freedman Group, Peggy was practicing with Progressive Sports Medicine & Physical Therapy (a Beverly/Matrix Rehabilitation Company), Rehab Diagnostics, and The South Cobb Center for Orthopedic Rehabilitation. She was involved in the initial set-up of the first CARF (Commission on Accreditation of Rehabilitation Facilities) in Southwest Florida and a pioneer in work conditioning/work hardening programs. Her client list has included: Georgia Pacific, Georgia Power, National Services Industries, The Coca-Cola Company, Sprint, Southwire, CIBA Vision, Scientific Atlanta, C.W. Matthews, The Atlanta Journal- Constitution, Atlantic Steel, Lockheed, General Motors, Boise Cascade, Marriott Corporation, Unisys, Ford, and MARTA, as well as a myriad of rehabilitation and insurance companies and many law firms. Peggy has a Bachelor of Science degree in Occupational Therapy from The Medical College of Georgia and has been on the staffs of several Georgia Hospitals.
Please copy this form for your referral. Fax or mail to the Clinic. Workers Compensation Auto Private Other PATIENT REFERRAL Patient is referred for: Functional Capacity Evaluation (FCE) Work Conditioning/Hardening Back School Occupational Therapy PATIENT INFORMATION 1311 Powers Ferry Rd. Suite 600 Marietta, GA 30067 (770) 541-7401 Fax: (770) 541-7403 www.thefreedmangroup.com Physical Therapy Jobsite/Ergonomic Analysis Work Station Modification Other: Appointment: Day: Date: Time: Name of Patient: Address: Social Security #: Telephone #: Alternate #: Claim #: Date of Birth: Diagnosis: ICD9 Code: DOI: Next Physician s Appointment: Job Title: Referral Source: Phoned in by: Date Referred: EMPLOYER: Address: Telephone #: Direct Supervisor: Human Resources: Workers Compensation Mgr.: PHYSICIAN: Address: Telephone #: Fax: INSURANCE COMPANY: Address: Telephone #: Fax: CASE MANAGER: Address: Telephone #: Fax: ATTORNEY (Patient): Address: Telephone #: Fax: ATTORNEY (Employer): Address: Telephone #: Fax: Please call The Freedman Group for a complimentary supply of these forms.
Services Functional Capacity Evaluations Job Site Analysis Ergonomic Assessments Home Assessments Occupational Therapy Hand Therapy Physical Therapy Health & Safety Programs 2000, The Freedman Group 1311 Powers Ferry Road Suite 600 Marietta, Georgia 30067 Phone: (770) 541-7401 Fax: (770) 541-7403 www.thefreedmangroup.com Making Everyone s Job Easier. ARCON is a registered trademark of Vernova, Incorporated BTE is a registered trademark of Baltimore Therapeutic Equipment Company