Therapists relying solely on the medical community often found that referrals were an artifact of services provided by a treating physician, PT or case manager. Though the work-program practi-
tioner has always been an important
link in the case-resolution chain, the volume of referrals was diluted by the success of "up chain" services.
The next 18 to 36 months should be a time of unprecedented opportunity for the occupational therapist delivering services independently or through established work programs.
I see both temporary and permanent factors creating an opening for therapists to provide services to employers and long-term disability carriers.
Among the factors I see aligning to bring about this opportunity are:
• higher levels of field enforcement by OSHA,
• the effects of continued movement toward lean operation by medium and large enterprise (public and private),
• an expansion in the U.S. economy,
• the recognition and scrutiny of work evaluations at the federal level,
• an increase in ERISA-regulated long-term disability claims tied to the aging of the skilled work force, and
• a growing differentiation between allied health disciplines.
Taken together, the first three prongs of the changing paradigm breathe new life into the ergonomics-evaluation and risk-remediation skills of therapists. Although no new federal ergonomics initiatives appear to be on the legislative horizon, field enforcement and elevated citation goals by OSHA are creating de facto enforcement at the local level.
Compounding increased OSHA vigilance will be the legacy of lean operation as the U.S. economy expands. Lean principles and financial pressure on all enterprises and institutions is causing an across-the-board move to get more work done with fewer people. Factors three and four will have employers seeking skills that OTs have.
The expansion of the U.S. economy will eventually lead to hiring of new workers. These workers will be greeted by increased scrutiny of hiring practices at the federal level. Chief among the practices being monitored are post-offer tests. The demand on occupational therapists to write valid test protocols from accurate job analyses will increase as significant fines and judgments replace sloppy hiring practices.
In claims covered by the Employee Retirement Income Security Act (ERISA) there is a distinct pattern emerging across regions of the federal court system. Judges are challenging the use of physician-administered file review and verbal functional capacity evaluation. Where carriers were once relatively free to make disability determinations based on the findings of "hired gun" expert-witness physicians, the courts are finding this practice "arbitrary and capricious."
Rulings in favor of policy holders as a result of this behavior are not uncommon. One outcome of this trend will probably be the increased use of therapist-administered functional capacity evaluations by attorneys for policy holders and carriers.
The sixth factor creating an opening for OTs is one of those "full circle" things that happen in life. In 1993 other disciplines made a big push into services originated by OTs. Their well-developed marketing acumen, coupled with an advantageous position in the chain of referrals, gained them entry to fee payers where OTs could not.
The mistake occupational therapy made was to not use its proximity to the vocational world as a differentiator between disciplines. Now, coming full circle, the practice focus at the core of other disciplines - impairment - becomes a disadvantage.
Occupational therapy is the single discipline positioned to focus on work readiness and ability rather than on impairment. Stepping away from the old chain-of-referral medical model gives OTs the opportunity to build relationships with employers and fee payers as partners in maintaining safe and productive work places: keeping a worker safe keeps him out of the impairment-driven medical model of rehab.
Roy Matheson is founder and president of Roy Matheson and Associates, Inc. (www.roymatheson.com), a leading provider of training and certification for therapists performing FCEs, post-offer testing and ergonomic evaluation services. He serves on the Board of Directors of the MTM Association for Standards and Research.