The trouble with relying on the patient's doctors for a disability determination is that the doctors have a conflict of interest. If there is any doubt, most doctors are going to side with their patient about how limiting their conditions are. In thousands of disability cases I have taken over the past few decades, I have rarly been told by the claimaint that his or her doctor doesn't think he or she is disabled enough not to be able to work. I thought disability was supposed to be determined based on objective findings rather than the subjective opinions of one's doctor.
Doing away with the marriage penalty would make it easier to administer the program. No more "holding out" questions and determinations.
Rather than changing the income cap for SSI, I'd like to see T2 changed so going over SGA by small amounts didn't make one completely ineligible. Either make it something like a loss of one dollar for every two over or even one for one. It's a shame to terminate someone for SGA when they make $20 over SGA.
Another problem with patient doctors is that they often agree with the patient regarding disability while they are present in the office with the doctor, but the tune changes significantly when you see what actually gets entered into the records for the visit.
They already tested the $1 for $2 idea via the BOND demonstration project and decided that they weren't going to do it.
I gotta admit, I'm of mixed mind about the personal physician making disability decisions. You want their input to carry weight. But getting consistency in same? I've had claimants come in with dr notes simply saying "X is disabled to high blood pressure, low sugar, diabetes". (And let's not think about how the VA with % of disability issues would deal with this.) Implications on what is a disability and how would reasonable people agree that this person is disabled per law and documented accordingly. (Although how do you prevent a Dr "Rex Conn" situation, since, after all, some doctors are OK over prescribing opiates and running pill farms.) Pretty sure making this work would have a ton of new issues, esp on overwhelmed primary care and/or specialist doctors and staffs.
The first one is ridiculous. Voters have no idea that most treating physicians are willing to say anything. If voters looked at the evidence, they would see that most treating physicians exaggerate or are outright dishonest about their patient's condition.
If only people would actually communicate their desires to their Congressmen, and if only our Congressmen would give the same weight to their constituents’ interests that they do to their corporate lobbyists’ interests. And if only people actually exercised their right to vote and did so in a rational manner. If all that happened, America would probably actually be great again. Instead, it looks like we’ve yet again got a 50/50 chance of being the world’s laughing stock for another 4 years, and a 0% chance of seeing any meaningful improvement in our country for the next 2-4 years.
Look in the mirror, folks. America is a s**t-hole country because of YOU! Not Nancy Pelosi or whatever other boogeyman you’ve been brainwashed into blaming.
The RFC is the ALJ's subjective judgment as to what the objective medical evidence supports, just as a medical source's statement is their subjective judgment as to what the objective medical evidence supports. Determining disability has ALWAYS been a mix of objective and subjective. As to conflict of interest, they do as much as a CE has in supporting a denial. But I suspect neither of those conflicts weigh heavily, doctors generally are afraid to even get involved.
@1:09
It was always possible for ALJs to reject treating physician's statements, they just had to argue the point sufficient to withstand judicial review, which was possible. If the treater gave a conclusory statement it was particularly easy to reject it.
@7:36
Treating physicians are generally not willing to commit fraud even if they care about their patients. CEs on the other hand seem more than willing to.
Given the utter garbage I see daily from the DDS quacks, someone else should be making these decisions. The current system is arbitrary and just a mess. There is no consistency. Its a crap shoot for many claimants. You have doctors, some who aren't even allowed or are unable to practice medicine spending a few minutes on a file, at best, and then coming to an unsupported, sometimes ridiculous conclusion just to move the cases along. Too bad the claimant's can't go after them for malpractice. We have one DDS consultant whose license restricts her to only working for SSA. She lost her license twice over a substance abuse problem. She works for DDS in 2 different states. I think, given that the POMS says a medical consultant must be a licensed physician and defines a licensed physician as someone who practices medicine and the practice of medicine, while not defined in POMS, is defined everywhere else as treating patients, I think DDS is illegally employing this person. Wonder if a false claims suit would be appropriate as everytime DDS submits for reimbursement they are lying about her meeting the qualifications as a medical consultant? Back to the main point, the ridiculous things we see constantly on the DDE forms would make you laugh if you didn't know how bad some of these people need benefits. Any other system would probably be better. I've seen a lot less of what one might define as fraud from treating physicians than from the DDS quacks. Why not send every claimant with physical impairments for an FCE? Then send the FCE to the treating physician so that he or she can review and indicate whether they agree or disagree. If they agree, that is the RFC. If they disagree, it goes to an independent specialists to review and make a determination. An FCE would be difficult to challenge and, while the may cost a little more than the joke, drive by CE exams, they would result in far fewer appeals and would save the agency a lot of money. Although, anything that might threaten ALJ and hearing office jobs would be a nonstarter. After all, protecting the bureaucracy will always come first.
What 
The trouble with relying on the patient's doctors for a disability determination is that the doctors have a conflict of interest. If there is any doubt, most doctors are going to side with their patient about how limiting their conditions are. In thousands of disability cases I have taken over the past few decades, I have rarly been told by the claimaint that his or her doctor doesn't think he or she is disabled enough not to be able to work. I thought disability was supposed to be determined based on objective findings rather than the subjective opinions of one's doctor.
ReplyDeleteDoing away with the marriage penalty would make it easier to administer the program. No more "holding out" questions and determinations.
Rather than changing the income cap for SSI, I'd like to see T2 changed so going over SGA by small amounts didn't make one completely ineligible. Either make it something like a loss of one dollar for every two over or even one for one. It's a shame to terminate someone for SGA when they make $20 over SGA.
Another problem with patient doctors is that they often agree with the patient regarding disability while they are present in the office with the doctor, but the tune changes significantly when you see what actually gets entered into the records for the visit.
DeleteThey already tested the $1 for $2 idea via the BOND demonstration project and decided that they weren't going to do it.
I gotta admit, I'm of mixed mind about the personal physician making disability decisions. You want their input to carry weight. But getting consistency in same? I've had claimants come in with dr notes simply saying "X is disabled to high blood pressure, low sugar, diabetes". (And let's not think about how the VA with % of disability issues would deal with this.) Implications on what is a disability and how would reasonable people agree that this person is disabled per law and documented accordingly. (Although how do you prevent a Dr "Rex Conn" situation, since, after all, some doctors are OK over prescribing opiates and running pill farms.) Pretty sure making this work would have a ton of new issues, esp on overwhelmed primary care and/or specialist doctors and staffs.
ReplyDeleteIf that's what the voters want, then they need to vote for the people who will make those changes. Which they won't.
ReplyDeleteThe first one is ridiculous. Voters have no idea that most treating physicians are willing to say anything. If voters looked at the evidence, they would see that most treating physicians exaggerate or are outright dishonest about their patient's condition.
ReplyDeleteIf only people would actually communicate their desires to their Congressmen, and if only our Congressmen would give the same weight to their constituents’ interests that they do to their corporate lobbyists’ interests. And if only people actually exercised their right to vote and did so in a rational manner. If all that happened, America would probably actually be great again. Instead, it looks like we’ve yet again got a 50/50 chance of being the world’s laughing stock for another 4 years, and a 0% chance of seeing any meaningful improvement in our country for the next 2-4 years.
ReplyDeleteLook in the mirror, folks. America is a s**t-hole country because of YOU! Not Nancy Pelosi or whatever other boogeyman you’ve been brainwashed into blaming.
@12:54
ReplyDeleteThe RFC is the ALJ's subjective judgment as to what the objective medical evidence supports, just as a medical source's statement is their subjective judgment as to what the objective medical evidence supports. Determining disability has ALWAYS been a mix of objective and subjective. As to conflict of interest, they do as much as a CE has in supporting a denial. But I suspect neither of those conflicts weigh heavily, doctors generally are afraid to even get involved.
@1:09
It was always possible for ALJs to reject treating physician's statements, they just had to argue the point sufficient to withstand judicial review, which was possible. If the treater gave a conclusory statement it was particularly easy to reject it.
@7:36
Treating physicians are generally not willing to commit fraud even if they care about their patients. CEs on the other hand seem more than willing to.
Given the utter garbage I see daily from the DDS quacks, someone else should be making these decisions. The current system is arbitrary and just a mess. There is no consistency. Its a crap shoot for many claimants. You have doctors, some who aren't even allowed or are unable to practice medicine spending a few minutes on a file, at best, and then coming to an unsupported, sometimes ridiculous conclusion just to move the cases along. Too bad the claimant's can't go after them for malpractice. We have one DDS consultant whose license restricts her to only working for SSA. She lost her license twice over a substance abuse problem. She works for DDS in 2 different states. I think, given that the POMS says a medical consultant must be a licensed physician and defines a licensed physician as someone who practices medicine and the practice of medicine, while not defined in POMS, is defined everywhere else as treating patients, I think DDS is illegally employing this person. Wonder if a false claims suit would be appropriate as everytime DDS submits for reimbursement they are lying about her meeting the qualifications as a medical consultant? Back to the main point, the ridiculous things we see constantly on the DDE forms would make you laugh if you didn't know how bad some of these people need benefits. Any other system would probably be better. I've seen a lot less of what one might define as fraud from treating physicians than from the DDS quacks. Why not send every claimant with physical impairments for an FCE? Then send the FCE to the treating physician so that he or she can review and indicate whether they agree or disagree. If they agree, that is the RFC. If they disagree, it goes to an independent specialists to review and make a determination. An FCE would be difficult to challenge and, while the may cost a little more than the joke, drive by CE exams, they would result in far fewer appeals and would save the agency a lot of money. Although, anything that might threaten ALJ and hearing office jobs would be a nonstarter. After all, protecting the bureaucracy will always come first.
ReplyDelete