A functional capacity evaluation (FCE) evaluates an individual's capacity to perform work activities related to his or her participation in employment. The FCE process compares the individual's health status, and body functions and structures to the demands of the job and the work environment. In essence, a FCE's primary purpose is to evaluate a person's ability to participate in work, although other instrumental activities of daily living that support work performance may also be evaluated.
Last month's article discussed who can benefit from an FCE, and a physical therapist's role in the FCE process.
What Are the Components of the FCE?
The components of the FCE will vary based on the purpose of the assessment. The FCE typically begins with a client interview, medical record review, and musculoskeletal screening. Functional testing may include graded material-handling activities such as lifting, carrying, pushing, and pulling; and positional tolerance activities such as sitting, standing, walking, balancing, reaching, stooping, kneeling, crouching, crawling, object handling/manipulation, fingering, hand grasping, and hand manipulation. Pain monitoring is frequently performed during the FCE to document client-reported levels of pain during various activities as well as to manage pain. The FCE may also include evaluation of an individual's hand dexterity, hand coordination, endurance, and other job-specific functions.
The FCE report includes an overall physical demand level, a summary of job-specific physical abilities, a summary of performance consistency and overall voluntary effort, job match information, adaptations to enhance performance, and treatment recommendations, if requested. Some FCEs are designed to also report on the worker's ability to meet the cognitive demands of the job in question.
FCEs are done on a one-on-one basis and may range in length from 4-6 hours. The FCE may take place over two consecutive days.
Referral and Payment for FCEs
People are generally referred for a FCE by physicians, physician assistants, and nurse practitioners; insurance representatives; case managers; employers, human resources personnel, and risk managers; attorneys (for either the plaintiff or defense); other therapists; or chiropractors. Individuals can also self-refer in states that allow direct access to occupational therapy services, but a referral may be required for reimbursement.
FCEs are paid by workers' compensation insurance plans; self-insured plans; individual insurance plans; Federal, State, and/or local agencies; Managed Care Plans; individuals themselves, employers, or legal firms.
Rates can and do change based on geography and overall evaluation time. Precertification of the service and verification of the state fee schedule or reimbursement policy is advised.
Because Physical Therapists are experts at evaluating an individual's ability to perform activities, highly skilled at analyzing work tasks, and able to measure the wide range of environmental factors that can affect work performance, they are well qualified to perform FCEs.