From The Tennessean:
The chairman of a Congressional Ways and Means subcommittee is requesting an investigation into doctors hired to review applications to the federal disability program.U.S. Rep. John Larson, D-Conn., cited recent reports by the USA TODAY NETWORK in a letter sent Wednesday to the U.S. Government Accountability Office, the federal government's chief fiscal watchdog agency. ...
In Tennessee, an investigation revealed some doctors were racing through applications submitted by people seeking to prove they are too sick or injured to work.
Paid by the case, doctors were reviewing up to five application files per hour. Experts said such speedy review of applications, which can contain thousands of pages of medical records, isn't plausible. ...
Larson, who chairs the Social Security Subcommittee, is asking the GAO to conduct its own state-by-state examination of doctors' performance.
There are some glaring abuses - occasionally you can see on a recon a note to the alleged independent recon reviewer words to the effect - 'no new medical submitted, please affirm' or a recon increasing the RFC since the claimant is approaching a grid milestone! I asked an AC member what happens if the 2 AC members disagreed - he said they send it to a 3rd; and how often does that happen, I inquired - once in 9 years was the reply! SSA has lot of problems; paying doctors to review 5 cases in an hour does create work for you though, is the only silver lining, for the cynical.
ReplyDeleteHell Yeah! Its about time.
ReplyDelete@3:32
ReplyDeleteOr on the rare occasion that the recon doctor does support an award, the case gets sent to "quality review" and they overturn the recon doctor.
Some cases take one minute to review as in "This child weighs 780 grams. Meets 100.04A" others take an hour or two to review.. The issue is whether the determination is correct. Not how long a doctor spent on it. Quality reviews is as or more likely to return a denial if reviewed as it is an allowance. 12% of something ... In this case average allowance rate at recon... is not "rare"
ReplyDeleteHow many DDS files have "thousands" of pages? Larson needs to take a look at HOHO files if he wants a good Haha. At that level there are many files that hit that benchmark yet TPTB want warp speed processing. Until Congress talks to those in the trenches at OHO, they will not really understand what is going on.
ReplyDeleteA thousand pages of "controlled with medication" doesn't take long to review.
ReplyDelete@9:52
ReplyDeleteI'm not sure the complaint is regarding listing determinations. You are correct, those are pretty quick. But most cases do not qualify for a listing, they may qualify for a low RFC which could direct a finding of disability. In terms of quality reviews being as or more likely to return a denial versus an allowance, no that's only in regard to random draws. Random draws apply both to allowances and denials, but quality review requests occur exclusively in allowances because there is no disagreement which could trigger such a request in a denial.
@10:43
Quite a few actually. Any VA case is probably going to have a few thousand pages, and with the growth of electronic record keeping, page length in general has exponentially increased.
@8:32
"Controlled with medication" is a medical conclusion. That might or might not be supported by the evidence being reviewed, but the time it takes review evidence does not differ as a result of the conclusion. Really, your point would be better if it were something like "a thousand pages of blood testing" or "a thousand pages of urology testing" does not take long to review, since at least those are simple.
If you do some research you will notice that some of those physician are returned after 50-60 years of practice medicine and not for a moment I believe that they are spending their retirement day looking at medical records for several hours per day. They are looking at the CE and maybe the summary from the DDS reviewer.
ReplyDeleteDDS mgmt have put the screws to DDS docs for the better part of 15 years to speed up & up. Ditto for adjudicative staff. Growing turnover has been the result. Perfect conformity to POMS + warp speed or there's thinly veiled threats of discipline. A significant number of experienced staff have been pushed out in multiple states. If/when there is an investigation, the management will simply complain about budget and point fingers down to the lowest level and push a trainer or QA staffer out. Nepotism is rampant. a lot of innocent folks have been harmed. Sad.
ReplyDeleteIn the case of the unfortunate man in the article, it is the examiner's job to obtain all relevant evidence possible not the doctor's. Since it took 6 months to make the initial determination it would seem they tried to do that
ReplyDelete@4:4O Management will do the same thing at hearing offices out of desperation to keep their jobs and to hide their own dereliction of duties.
ReplyDelete