Thursday, March 26, 2009

Soup to Nuts

Here are some interesting excepts from the Testimony Before the Subcommittee on Income Security and Family Support of the House Committee on Ways and Means and the Social Security Administration.

The hearing was held on March 24, 2009. For full transcript, visit this link.

All emphasis has been added. The “soup to nuts” (a perhaps unfortunate moniker), review confirms our post before the hearing, that the real problems begin at the state agency DDSs, where 54 different agencies make the first determinations. While the Field Offices or federal agencies that handle the technical aspects of claims, are overwhelmed by logistics, once adequately staffed the inference appears to be problems will be alleviated. Conversely, the DDS is not suffering from lack of staffing as much as lack of expertise. Training is only hinted at by Asture in a new and promising Star Chamber review, but is the other theme that could significantly affect the entire process. Of course, the wait that ensues from the DDS denial to the ALJ hearing reflects on the hearings process. However, since ALJ’s allow about 50 percent of the cases heard, one has to wonder if the DDS was making accurate decisions more often, fewer appeals would exist and the backlogs would be significantly diminished. This is an old battle, but reflects SSA’s decision inconsistency and its effects. Real folks are waiting up to 811 (and beyond) days to get a disability decision.


Patrick O’Carroll, Inspector General, Social Security Administration found that the average claim adjudicated in 2006, when decided initially by a DDS, was concluded in 131 days, but that if a claim was adjudicated upon a request for reconsideration, that time more than doubled, to 279 days. If a claim was appealed to an ALJ, the 279-day wait almost tripled, to 811 days, or 2.2 years. While issues surrounding the DDSs and the processing of both initial claims and requests for reconsideration are material to the overall backlog, …O’Carroll’s soup-to-nuts review establishes that the real delays begin when an appeal is filed. It was at this stage that the processing time jumped from 279 to 811 days. He recommended, “SSA publish this measure to show disability waiting time from the claimant’s perspective, to better inform Congress and the public.”

From the GAO:

SSA’s total backlog of disability claims doubled from 1997, reaching 576,000 in 2006, which has resulted in claimants waiting longer for final decisions.
The backlog was particularly acute at the hearings level. SSA also experienced declines in field office service delivery, with average customer wait times in field offices increasing by 40 percent from 2002 to 2006, and over 3 million customers waiting more than 1 hour to be served in 2008. Two key factors likely contributed to the backlog and service delivery challenges: (1) staffing reductions or turnover of field office staff and key personnel involved in the disability claims process, and (2) increased workloads. In particular, initial applications for disability benefits grew by more than 20 percent over the past 10 years.

Although DDS staff increased about 4 percent from 1997 to 2006, DDSs have experienced high rates of staff turnover and attrition. Attrition rates for DDS disability examiners, who are state employees, were almost double that of SSA federal staff. Many DDS senior managers we spoke with said that turnover of experienced disability examiners has affected productivity. For example, from September 1998 to January 2006, over 20 percent of disability examiners hired during that period left or were terminated within their first year. DDS officials said the loss of experienced staff affects DDS’ ability to process disability claims workloads because it generally takes newly hired examiners about 2 years to become proficient in their role.

In addition to disability claims backlogs and increased processing times, other aspects of SSA’s service delivery at field offices have declined in recent years. From fiscal year 2002 to 2006, the average time customers waited in a field office to speak with an SSA representative increased by 40 percent from 15 to 21 minutes. In fiscal year 2008, more than 3 million customers waited for over 1 hour to be served. Further, SSA’s 2007 Field Office Caller Survey found that 51 percent of customers calling selected field offices had at least one earlier call that had gone unanswered.

Declines in field office service delivery measures coincided with a period of staff turnover and losses agency wide. From fiscal year 2005 to 2008, SSA experienced a 2.9 percent reduction in total employees and a 4.4 percent reduction in field office employees. At the same time, employees and managers reported high levels of stress. When asked, 153 employees at 21 offices rate the stress they experienced in attempting to complete their work in a timely manner and 65 percent reported feeling stress to a great or very great extent on a daily basis, while 74 percent of office managers described high levels of stress.

SSA projects an increase in disability claims and other workloads over the coming years while at the same time anticipates the retirement of many experienced workers. Specifically, SSA projects: overall 13 percent increase in retirement and disability claims from fiscal years 2007 to 2017. A growth of 22 percent in the number of retirement and disability beneficiaries from 2007 to 2015. That nearly 40 percent of its current workforce will be eligible to retire in 5 years and 44 percent will retire by 2016.

From Commissioner Astrue’s Statements

Improve consistency and accuracy on complex policy issues; we have instituted a process for resolving disagreements between DDS disability examiners and Federal quality reviewers. In cases where the two components disagree on substantive issues, staff experts review the case and reach consensus. We anticipate we will resolve our most complex cases through this Request for Program Consultation (RPC) process. In addition, the RPC enables us to quickly pinpoint training needs and clarify or modify policies where necessary.

We plan to develop and implement a common case processing system for the DDSs.Currently, each of the 54 DDSs has its own unique processing system. A common system will help us take advantage of rapidly changing health care industry technology and provide the foundation for a seamless electronic disability case processing system.Our DDS partners agree that we need a common system, and we are working closely with them to develop requirements. This essential improvement will modernize and streamline our disability process, and we can only make important improvements on a timely basis, such as eCat, if we have a common system.

Monday, March 23, 2009

Another Focus on SSA's Challenges

Tomorrow, Tuesday, March 24, 2009, the Committee on Ways and Means, Subcommittee on Income Security and Family Support will hold a joint hearing on Eliminating the Social Security Disability Backlog. The hearing will focus on the Social Security Administration’s (SSA’s) large backlog in disability claims and other service delivery declines, including backlogs in program integrity activities. The entire announcement, which we have excerpted from below; can be found at this link.

In the past, “program integrity” in SSA parlance, has been a vague concept, including quality control, fraud and review of recipients' benefits. This hearing should at least be interesting, as the statistics will be flying. Discussion will include decision delays with, “[m]ore than 1.3 million Americans currently awaiting a decision on their case…...the problem is particularly severe at the hearings level, where the backlog has more than doubled since 2000 – from about 310,000 to more than 765,000 – and the average waiting time is now almost 500 days.”

In the course of waiting 500 days, disabled claimants often exhaust their limited resources. Many lose homes, housing, hope, friends, family and their health worsens. It would be particularly interesting if this hearing additionally focused on the other levels in the disability process such as the local SSA Field offices, which are understaffed, and the initial and early appeal process in the state agencies, which are inconsistent in program application and fraught with error. The state agencies proffer the first determinations of disability. An initial and reconsidered denial is the starting point for the long wait to appear before an administrative law judge.

The agency resources and solutions are both dwindling. The Government Accountability Office (GAO) recently reported that the backlog is now so severe as to warrant a slot in its biennial “high risk” list of federal programs. Clearly, demographics are at play as the population ages and more disability and retirement claims are filed while more skilled agency employees exit. The hearing will discuss provisions involving increased access to professional representation for disability claimants and changing how claimants give consent to release medical records.

Co Chairman Jim McDermott noted that, congress, “[h]as responded to this crisis by providing the Social Security Administration with increased funds in order to begin to actively address this problem, but it is time for the agency to take more action to significantly reduce the waiting period ….also ensuring the integrity of the process.” McDermott allowed that he looked forward to, “[h]earing about the initiatives that the agency is taking to address this problem and what additional steps Congress can take to help.”

The challenge is not so much gaining a focus on the problems. Congress has done this for years and increasingly since 2000. What is needed is a clear view of the agency's and advocates’ proposed solutions. Meanwhile, the wait continues for 1.3 million claimants who simply want their disability cases heard.