Consultative Examination (CE) Study and Consultative Exam Baseline Study

Consultative Examination Study

The consultative examination (CE) study featured medical consultants (MC) with administrative assistance from disability examiners reviewing both initial and hearings level CEs, focusing on:

  • CE Processes. Are CE requests complying with Federal regulations?

  • CE Content. Are medical sources conducting CEs and including content in compliance with Federal regulations?

  • CE Completeness and Quality. Do CEs include sufficient information to make a disability determination, and did the agency receive everything it paid for in the exam? Additionally, are there process and content factors that contribute to the quality of CEs?

Comprehensive Occupational Medical Services, subcontracting with Mathematica Policy Research, performed this study. They developed a questionnaire and studied 327 closed case folders containing CEs before the disability determination at the initial or hearing level.

They delivered a methodological report documenting the questionnaire reliability:  “Inter-Rater Reliability Analysis of Data to Document the Consultative Examination Process” (Volume 1 and Volume 2).   In another report they analyzed findings from the 327 case folders: “An Assessment of Consultative Examination Processes, Content, and Quality: Findings from the CE Review Data.”

A third deliverable is a reliable web-based questionnaire, with reliability established using agency MCs. The questionnaire is available for future agency research projects and programmatic improvements.

Consultative Exam Baseline Study

A CE is a physical or mental examination performed by a treating source or other medical source when additional information (e.g., clinical findings, laboratory tests, diagnosis, and prognosis) is needed to make a disability determination. The CE Baseline Study analyzed and documented the quality of CEs used in the initial level of disability determination; assessed if CEs were requested in compliance with SSA regulations; and established a baseline for CE quality.   

There were important limitations to this study. The study used the electronic folder for review.  At the time of the study, an electronic folder for the initial claim record was not available in sufficient numbers in all States.  Comparisons could only be made between States with electronic folders, and the cases were selected in a non-scientific manner, thus limiting the ability to generalize the study findings.  The study also did not include CEs obtained at the hearings level.  At the time of the study electronic folders were not available at that level.