Ethical Considerations of an Outcome Based Vocational Rehabilitation Fee Schedule

The primary purpose of this mixed-methods study was to assess vocational rehabilitation (VR) providers’ opinions related to how a vocational rehabilitation outcome based payment schedule (VR-OBFS) may affect VR services for injured workers. One hundred rehabilitation counselors currently working in the state of Ohio completed a survey comprised of Likert-type and open-ended questions. The survey instrument for this study was created by the researchers in collaboration with a Delphi Panel consisting of fifteen established VR providers from Ohio who have worked in VR for an average of25 years (range of 7-34 years). Panel members collaborated during three rounds ofreview and feedback. Survey questions asked VR professionals to consider how a VR-OBFS may affect VR services for injured workers including factors such as duration and quality of services. Participants were also asked to describe the ethical challenges they may foresee as a result of the implementation of the VR-OBFS. The findings of the current study highlight concerns related to how rural areas will be affected, the financial consequences, complex case selection, and the ethical dimensions of the policy. IBtimately, VR professionals expressed fears that the best interests of the IW will no longer be the sole focus of treatment and, as a result, a VR-OBFS would sanction a direct contradiction to the CRCC Code of Ethics.