In an ideal world, would it be optimal to send every claimant who lists angina or tachycardia to a cardiologist? Or every claimant who lists fibromyalgia to a pain specialist? Perhaps. But you probably wouldn't get a much better return in terms of the type of information that these exams record. A CE, or consultative exam, is basically a physical and the information that is obtained is fairly general.
Any competent doctor should be able to do one, regardless of their area of specialty, right? Also, the examining physician is not tasked with trying to sleuth anything out. He or she is simply providing a recent snapshot of a claimant's condition. Which goes to the heart of why consultative exams are scheduled in the first place. Usually, it is simply because the claimant's medical records do not contain recent documentation (meaning within the last 90 days). Recent documentation is required for social security to determine that the claimant is currently disabled and, thus, award, benefits.
Even if the social security administration came to the conclusion that it would be better to send all claimants to doctors practicing in specialized areas for consultative exams, how would this be afforded? There's no doubt that you'd have to pay more to get specialists to perform such exams. As it is now, DDS agencies are constantly recruiting new physicians to perform consultative exams because other physicians are continually dropping out of the program. Why? Low rates of reimbursement for performing exams AND the fact that social security claimants often fail to go to their scheduled appointments. If you think about it, you're only going to get doctors who aren't too busy, or who need the revenue. That's not going to include specialists.
On the subject of funding, the DDS agencies across the country seem to rely on federal funding, even down to the salaries of examiners, who are state employees. It doesn't seem conceivable that the federal SSA budget, which depends on Congressional approval, would expand to facilitate this--after all, right now the forced position of SSA is that they will only replace one out of every three social security field office workers that are lost to attrition or retirement.
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