I just uploaded a 500+ page medical report on one of my clients. This isn't unusual these days. Electronic medical records have led to explosive growth in the quantity of medical records. The hearing offices are drowning in medical records. Why do I have a feeling that Social Security's next Ruling will urgently demand that I not submit lengthy medical reports, that I somehow cull out what's not really important?
19 comments:
Oddly enough I just received hospital records which total 10,000+ pages. I thought about sending just the admission and discharge notes but then remembered that I'm obligated to submit the entire batch. It will likely take at least an hour just to scan them to the ERE!
Thanks Obama!
Yes the new electronic records do contain a lot of filler but a lot of those records only exist because of the ACA and Medicaid expansion.
What Social Security NEEDS to do is hire people like state DDS does to summarize those records.
If the records were being summarized ALJ's could increase their workload and rather than hiring than curing backlog with more expensive ALJ's it could be attacked with a swarm of lower paid employees.
Yeah, it has become easier and less time consuming for me to submit medical records now. Before, I would carefully go through a lengthy hospital admission record to pull the pages that weren't relevant before submitting. Now when I receive a big stack of records from a hospital visit, I just check to make sure it's not a duplicate of another visit that's been submitted, then simply ask my assistant to submit the entire stack. I know most ALJs would probably prefer I continue to only submit the relevant pages (surgery notes, objective testings, intake/discharge summaries), but I can't run the risk of an ALJ calling me out on not submitting the entire contents. Puts the job on culling the records on the ALJ and their staff and not the attorney rep.
Please be professional here. Having the admission/discharge summary as the first pages is the best practice. Maybe sending 2 exhibits with what you thank is important and the 'rest' would be helpful. Just dumping thousands of pages, gleefully?, is no way 'to win friends and influence people' to quote Dale Carnegie.
Yes 9:44 AM,Mr obama was a good president compared to the white supremacist sympathizer we got now.
The Social Security administration needs to make the Myssa accounts MORE functional allowing claimants to submit their own records through the Myssa account portal. They also could use the account portal to communicate with claimants and beneficiaries about needed documents.
The Social Security administration should transfer ODAR appeal level to the state DDS while retaining the appeals council and judicial review.
It may be time for reform or restructuring the disability process.
12:17: the problem is that "best practice" is in direct conflict with the regulations that bind me as an attorney representative. And these regulations include sanctions. I'm not going to risk sanctions, especially when newer ALJs seem to pay extra attention to the new regulations.
I'd rather have all the records, 500+, 2500+, 10k+, or whatever. If you think it's difficult for me to fly through the orders, nursing notes, etc., it's not and really shouldn't be for any ALJ. If a file comes to me with thousands of pages but 90-95% of them are hospital records, it's not a big deal unless the claimant is using the ER as their PCP and going every five days for a stubbed toe, gastritis, bronchitis, etc.
Also, from my own experience, don't chop the record up in an effort to help us, save us time, put them in chronological order, etc. (unless you know certain judges prefer it). Most hospital records are continuous without a clear break in visit dates, so I have seen on several occasions half an MRI on p. 37 and the other half on p. 244. Same with HPI, diagnoses, etc. It makes it exceedingly difficult and frustrating to try and see the complete visit when you have to jump around hundreds of pages digging those things up. Then again, that could just be me.
12:45 Why would ANYONE want ODAR operations transferred to the state level? The ALJ position becomes political spoils. There is no APA constraining the state from squeezing judges who don't deny enough cases (or deny the "wrong" cases).
I'm open to creative ideas but that just seems like an invitation to increase the chaos and make things more political.
@3:40
Is there anything encouraging the state agencies to deny cases? I am actually uncertain what goes into the state agency's funding level. But I don't disagree with your point, transferring ODAR operations to the state level would be a bad idea.
It wouldn't be about funding so much as it'd be about the relative major loss of independence (and knowledge) of the decision makers. Unless you were going to stock DDS full of attorneys in that scenario, you would not like how any type of difficult or novel case is handled (I know, I know, many ALJs blow difficult cases currently--it'd be much worse) and the amount of process you receive. Also, without the judicial independence, SSA or the States would be able to apply pressures on the decision makers in a lot more ways to effect a lot more desired outcomes. And this is coming from a person who thinks the calls for process and ALJ judicial independence are abused, overblown, etc. in a way to give way too much deference to the judges.
You may like DDS because they are quick, but they are only quick because they find obvious pays and then do shoddy analysis and come up with weak, non-disabling RFCs for the other cases they happily send down the line.
i'm not sure what the issue is. As one person noted above, any decent ALJ or attorney at SSA is used to reviewing hundreds or thousands of pages of records per day and will be able to quickly scan through to determine what they think is important.
Having a complete record is much more important than you think and definitely outweighs any perceived inconvenience of having to review "large" documents.
I think the highlighting and bookmarking done by the DDS should carry over to subsequent levels. As it is now the highlighting and bookmarking done at the initial level does not even carry over to the recon level. Any found in error could still be removed. This would allow subsequent reviewers to have a better idea of the actual dates and findings already in file. It will help focus in on what is new and what has changed
I'm just going to highlight here that the Eric Conn situation started with an ALJ that didn't want to spend his time reviewing medical records and demanded only RFCs... Even beyond DBD, there were many ALJs who insisted that rep staff cull out lab work results and other"superfluous" records that they could not read or interpret.
5:10 if DDS does such a bad job then why does ODAR agree with them so often?
I see that Obama Tourette's syndrome has struck the comments section. Electronic medical records are actually a funded mandate from that noting progressive activist, George W. Bush.
And SSA will *never* delegate the notion of culling out the "unimportant" stuff to the rep. Charles' former brother representative, Eric Conn, can tell you why this is so.
Over to you on Line One, Eric.
Eric. Eric?
Sorry, we can't find Eric for some reason.
Anyway, the ALJ union will complain about file size, but there's no practical solution. The Agency IS working on software to eliminate and remove duplicate, which would be a help, but would someone then need to actually read the "duplicate" pages to do a reality check?
SSA could solve this problem by simply issuing a regulation that would allow a claimant/rep not to admit certain types of records (i.e. nurses notes) if he/she does not feel that they are relevant. That was the "filler" would be removed, but the important records (doctor notes, tests, discharge summaries, etc....) would still be submitted.
The problem with the rule as it currently stands is that ODAR just doesn't trust reps to be honest. They assume the reps will withhold evidence to deceive the court. This is the only court/agency that treats attorneys in with this much distain.
I think ODAR generally trusts reps to be honest. ALJs have long memories and it would be incredibly stupid to poison your credibility with the ALJ.
The agency higher ups certainly don't trust reps.
Experienced Senior Attorneys could and should be utilized to write analyses of cases they review for potential O-T-R’s and cannot pay. I did this for MANY years, and received numerous compliments from ALJ’s. I tried to keep my Analyses, or short Briefs, down to a page, and I organized each in a similar fashion. If Procedural History of the case was noteworthy, or if there were issues pertaining to AOD, DLI, Res Judicata, prior applications, or ALJ decisions with RFC’s, I highlighted them. Then, I would list the “Severe” impairments, and make any remarks I thought significant concerning “Non-Severe” impairments.
Next, I tried to summarize the Facts in a paragraph. I also pointed to evidence of work activity, whether it was SGA, etc., if this were an issue. Sometimes, I would bring attention to certain daily activities I believed were noteworthy.
Finally, I detailed the RFC I believed the evidence supported, often in the frame of a VE Hypo. I also noted the MSS’s I relied, the ones I rejected, and explain why.
Despite all the KUDOS dating back to the start of the SA Program in 1995, I NEVER received any credit for the Analyses, or Briefs, I wrote on the cases I screened and could not pay. I attribute this to the obsession with production numbers/quotas, even though SA’s technically were not supposed to have them. The bottom line is my Analyses/Briefs played an integral role in the flow of cases through the office. Yet, I was never given credit for them.
Back in 1997, a Management from the AC visited my Hearings Office, and made it a point to inform me how much he liked the Case Analyses I was writing. For this to be implemented, Mgmt. would have to reinstate the Senior Attorney Program to the point where SA’s spend much, if not all, their time screening cases for potential O-T-R’s. Mgmt. would also have to look beyond production numbers/quotas, and realize the most efficient and best way to handle the flow of cases in Hearings Offices is with more of a TEAM approach. The Analyses/Briefs I wrote played a very important role, but . . . Regular readers know the rest of my story. Hiring more Attorneys, having more SA’s, etc., performing such work would cost much less than continuing to hire ALJ’s who have no support staff, or TEAM, once they start. Just my two cents.
Just dump whatever you get into the record and let SSA sort it out. That's what SSA rules now demand, so that's what they get. Sure it's a stupid rule likely to bloat the already record backlogs, but that's Berryhill's call to make.
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