MEGAHIT Working Well -- But How Much Does It Matter?

     From a report by Social Security's Office of Inspector General (OIG):

Despite challenges, SSA [Social Security Administration] continued expanding health IT [Information Technology] and partnered with 38 health care organizations, exchanged electronic records in 30 States and the District of Columbia, and identified ways of enhancing health IT case processing and data analytics. In addition, the DDSs [Disability Determination Services] reported they were generally satisfied with MEGAHIT (Medical Evidence Gathering and Analysis Through Health IT); however, some suggested enhancements to the system. Some DDSs also reported MEGAHIT issues that the Agency did not know about, despite SSA previously soliciting DDS user feedback. 

Finally, our review of 275 sample cases found (a) that MEGAHIT received electronic health records 19 days faster than traditional records and (b) SSA made disability decisions, on average, 21 days faster, in the 5 cases where only health IT records were requested. 

Recommendations 

1. Continue to solicit, on a regular basis, DDS user feedback in MEGAHIT enhancements. 
2. Enhance procedures to maintain and update MEGAHIT partner data, such as addresses. 
3. Enhance methods to improve the use of information received via Health IT. 
4. Increase health IT partners — taking advantage of nation-wide Federal efforts led by Health and Human Services’ Office of the National Coordinator for Health Information Technology. SSA agreed with the recommendations.

     Before anyone gets too excited about this, it's something that works best only when dealing with huge medical providers. In fact, that's the only way it works now since huge medical providers are the only ones using MEGAHIT. However, the vast majority of disability claimants receive at least part of their evaluation and treatment from smaller medical providers. Getting those records is mostly a matter of sending a written request through the mail and receiving a written response through the mail. That's not changing any time soon. MEGAHIT won't make those cases move any faster.

A Good Question

     Here's an e-mail I received from a colleague who practices Social Security law:

Under the new improved electronic filing system, we have gotten a couple of calls from SSA to the effect that we have not filed our 1695 with the request for hearing or recon; we have in the past been sending the 1695 to the local District Office and they would enter it and obscure my personal SSN. I am concerned that filing a 1695 electronically directly with the appeal will result in my personal SSN appearing for all time in the claimant's claim file. Is this a valid concern or is someone at SSA obscuring the attorney's SSN if the 1695 is filed electronically?

     I think he's asking a reasonable question. What is Social Security doing?

SSA OIG Has Good ROI

     From a Brookings Institution study on the Return on Investment (ROI) of Inspectors General at various agencies:

Annual Statistical Supplement

     The Social Security Administration has released its Annual Statistical Supplement for 2014. It's a compendium of almost all the statistical information about Social Security that you could ask for. By the way, as of 2013, there were 760 people drawing U.S. Social Security benefits who were living in war torn Yemen.

The Great Ideas Keep Coming

     A press release:

Today, Ways and Means Social Security Subcommittee Chairman Sam Johnson (R-TX) and Human Resources Subcommittee Chairman Charles Boustany (R-LA) introduced H.R. 2135, the Promoting Opportunity for Disability Benefit Applicants Act. The bill would authorize the Commissioner of Social Security to provide information on employment support services to individuals who are not awarded disability benefits.

Currently, applicants wait 100 days on average for an initial decision regarding a claim for benefits. Research shows this time out of the workforce makes it that much harder for denied applicants to get back to work.
To help people return to work, the bill authorizes the Commissioner of Social Security to provide denied applicants information on employment support services—both public and private non-profit—so that they may reenter the workforce instead of cycling through the application process. The bill provides information to denied applicants about services that may help them return to work and would not affect any appeal for disability benefits.   
Upon introduction, Chairman Johnson said, “We must do a better job of helping those individuals who can and want to work to do so. This bill makes sure Social Security tells these individuals about services that can help them connect to jobs.”
Upon introduction, Chairman Boustany said, “This bill provides access to important employment and work supports for individuals in need so that they can gain the necessary skills and job placement services to reenter the workforce quickly. Helping Americans find and keep good jobs to support themselves and their families is and should be our top priority.”
This bill is supported by the National Council of Disability Determination Directors and Easter Seals.  
Other House Ways and Means Committee Members co-sponsoring this legislation include Rep. Black (R-TN), Rep. Reed (R-NY), and Rep. Young (R-IN).  

     It's amazing. Republicans believe that government is almost infinitely wasteful and ineffective (except for the Defense Department) yet here are Republicans who have great faith in the ability of state vocational rehabilitation (VR) departments to return disabled people to work. My experience with the North Carolina Department of Vocational Rehabilitation is that they're so obsessed with returning a high percentage of their clients to work that the only disabled people they want to help are those who will succeed in returning to work even if they get no help at all. This isn't because the people at VR are bad or lazy or incompetent. It's because they lack the resources to help many people. They don't even have sheltered workshops anymore! I don't know how VR is supposed to accomplish anything without sheltered workshops.
     I've recently had a young client with combined cognitive difficulties and mental illness who went to VR. The only thing VR could do for him was to get him a job at a fast food restaurant and provide him with a job coach for two weeks. Predictably, he failed at the job shortly after the job coach was removed. His family took him back to VR but they had no further interest in helping him. You call this vocational rehabilitation? He should have been in a sheltered workshop first. If he showed promise there, he should have been placed in a real job with a job coach. The job coach should have worked with him for far longer than two weeks. VR shouldn't have stopped helping him just because he failed at his first job.
     If this proposed legislation advances you're going to have state vocational rehabilitation agencies lobbying against it because they don't want to be inundated by denied Social Security disability applicants. If it passes, the vast number of people who are told by Social Security to go to VR will be turned away by VR. How does that look?
     These House Republicans don't get it. The vast majority of those denied Social Security disability benefits aren't going to return to work no matter what anyone does. They're too sick.

An Overpayment Story

     Woman thinks she's been overpaid by Social Security. She contacts the agency and is told to send them a check. She does so but later receives a notice saying she really was entitled to the money. It only took eight months and several phone calls to get Social Security to refund the money to her according to a story on a Michigan television station. The story doesn't say it but there's a real possibility that she'll eventually receive another notice from Social Security saying that she really was overpaid! You think I'm kidding but I've seen it happen.

Baltimore Sun On Vision 2025

     The Baltimore Sun has a piece on Social Security's Vision 2025. It demonstrates the controversies that Social Security faces in making long term plans.

Early Intervention

     Social Security is seeking information for an "early intervention mental health demonstration study." The agency is only giving 17 days to respond to its request for a good deal of information, suggesting that publication of the request is a formality, that Social Security has already identified a contractor.

     I hope this works but I'd be surprised if it does. Mental health problems aren't like appendicitis. They seldom crop up suddenly. If they do, it's usually something like a bad reaction to a prescription medication, a problem that wouldn't result in a person receiving Social Security disability benefits anyway. I have seen no sign that early intervention results in better long term results than late intervention. Less suffering but not less long term disability. You must have been disabled or be predicted to be disabled for at least a year to get Social Security disability. If mental health treatment is going to give you good relief for your psychiatric condition, you're not likely to get on benefits in the first place. In fact, even if you don't get good results from mental health treatment, you're not likely to get on benefits without a lengthy fight.

The "Vision Thing"

     The Social Security Administration has released Vision 2025, the long-awaited statement of how the agency expects to be operating ten years from now. I don't think I've ever read a more vacuous government document. Here's an excerpt from Acting Commissioner Colvin's message on the report to give readers a feel:

As the public moves confidently into the future, we must also change the way we operate. We are compelled to anticipate the social and technical advancements that offer new ways of navigating an ever-changing society. Our challenge is to embrace technological enhancements to achieve efficiency without sacrificing the personalized service for which we are known. Toward this end, we will build a stronger, ever-capable workforce, adopt engaging and contemporary training methods, expand our information and communication technologies, and modernize our operational capabilities. Of course, we must proceed toward this rapidly changing future, mindful of many present day realities. Our budgets will undoubtedly fluctuate, organized interests may express new agendas, social demographics will vary, and executive orders and congressional mandates will continue to affect the way we do business. Yet if we view such possibilities as opportunities, we can focus on creative solutions for meeting these challenges. Regardless of the complexities we might consider in the future, we must never disregard our customers’ expectations for excellence.

     No, it doesn't get specific at some later point in the document. It just stays at this level of advanced meaningless abstraction.
     Let me hasten to say that despite what I've quoted above, neither the Acting Commissioner nor upper management at Social Security is brain dead. They only produce such drivel because they're forced to. Here are the problems they're trying to address:

• The Government Accountability Office (GAO), egged on by some Republicans in Congress, keeps demanding that Social Security produce a "vision" for the future but it's not just any vision they want. For years, they have made relentless demands for a "vision" that does away with person to person service at Social Security because person to person service is just so passe in this age of the internet and so much money could be saved if we just got rid of the old fashioned idea that you should be able to actually talk with someone about your case. 
• The people at GAO have no clue about the complexity of Social Security. As far as they're concerned, it's just retirement benefits. Survivor and disability benefits are nothing more than a footnote. SSI isn't even a footnote as far as they're concerned. Mentally ill people? Let them use their computers! Cognitively impaired people? Surely, someone other than Social Security can help them with their Social Security problems. You can't expect government to do everything!
• Despite egging GAO on with its insane demands that Social Security plan for the elimination of face to face service, individual Republicans in Congress definitely don't want field offices closed in their districts. They believe, in the abstract, that technology can replace personal service but not when it comes to their districts. It goes without saying Democrats don't want field offices closed.
• Social Security management is well aware that doing away with face to face service is unthinkable. The programs they operate are far too complex to function without a field office structure. Not only can that not be done by 2025; it won't be possible by 2125.
• It's impossible to make any meaningful plans for service delivery in 2025 because of budget uncertainty. In fact, it's almost impossible to make meaningful plans for service delivery in 2016 because of budget uncertainty. 
• Even without budgetary uncertainty, who knows what technology will bring us by 2025. Does anyone think that Steve Jobs ever had a ten year plan for what would happen with the iPhone? Anyone who thinks they have a clear view of what will happen with technology in the future shouldn't be working for Social Security because they're delusional.
• Few people in upper management at Social Security now expect to be in upper management at the agency in 2025. They're responsible people but they're bureaucrats. They're mostly concerned with getting by from year to year. GAO's demands for a "vision" for 2025 are laughable, so Social Security produces a laughable "vision."

Sad

     From Social Security:

For 4/28/15, The Social Security Administration Offices at Headquarters are dismissing early as a precautionary measure. Please remain calm and follow all traffic commands. There are no credible threats at this time. Please adhere to the following schedule for an orderly dismissal. 10:30 am WOC Building/Childcare, 11:00 am Wabash/NCC/ Security West, 11:30 am West Building/East Building, 12:00 pm Annex/ RMB, 12:30 pm Altmeyer.

     Pray for everyone's safety and for the future of the city of Baltimore.

     Update: Social Security plans to open its central offices as usual on Wednesday.

Updated Disability Insurance Trust Fund Numbers

     Social Security's Office of Chief Actuary has released the first quarter numbers on the operation of the Disability Insurance Trust Fund. These numbers are crucial because the Chief Actuary's prediction is that the Disability Insurance Trust Fund will run out of money at the end of 2016.

    The Disability Insurance Trust Fund finished the first quarter of 2015 with $54.3 billion in U.S. government bonds. This was down $5.9 billion from the end of 2014. The Disability Insurance Trust Fund had lost $6.4 billion in the first quarter of 2014.

     There's no question that the Disability Insurance Trust Fund is doing somewhat better as time goes along. That's inevitable since the number of people drawing Social Security disability benefits is declining and the economy is growing. However, there's little doubt that the Disability Insurance Trust Fund will run out of money in the not too distant future. Because of the modest improvements in Trust Fund operations, I'd say that, absent some unexpected change, the exhaustion date is likely to be in the first half of 2017, perhaps around the end of the first quarter.

     Benefits do not stop if the Disability Insurance Trust Fund runs of money. There would still be enough income to pay at least 80% of benefits. However, it would be a chaotic situation with benefits reduced by varying amounts each month since trust fund income varies significantly from month to month. Some older beneficiaries would be shifted into retirement benefits since they're entitled to whichever is higher. That would reduce the draw down on the Disability Insurance Trust Fund but be an accounting nightmare.

Student Loan Debts Having Serious Effects On Social Security Recipients

     From The Hill:

A pair of Democratic senators is demanding to know more about the growing number of seniors who are seeing their Social Security benefits slashed to cover student loan debt.

Sens. Claire McCaskill (D-Mo.) and Elizabeth Warren (D-Mass.) sent a letter to the head of the Government Accountability Office (GAO) Thursday, calling for a study on this growing segment of senior Americans. The percentage of households headed by people aged 65 to 74 with student loan debt quadrupled from 2004 to 2010. ...

“Garnishing Social Security benefits defeats the entire point of the program — that’s why we don’t allow banks or credit card companies to do it,” said McCaskill, the top Democrat on the Senate Special Committee on Aging, in a statement. ...

In 2014, the government withheld $161 million in Social Security payments to cover student loan debt that had fallen into default....

Federal Bar Association Newsletter

     The Social Security Law Section of the Federal Bar Association has released its Spring 2015 newsletter. This is the only attorney group with members in private practice as well as members employed by the Social Security Administration.

NADE Newsletter

     The National Association of Disability Examiners (NADE), an organization of personnel involved in making initial and reconsideration determinations on Social Security disability claims, has released its Spring 2015 Newsletter.

More Seemingly Plausible Ideas From House Social Security Subcommittee

     A press release from the House Social Security Subcommittee:

Today, Social Security Subcommittee Chairman Sam Johnson (R-TX) introduced the Improving the Integrity of Disability Evidence Act of 2015. The bill will ensure that the Social Security Administration (SSA) uses medical evidence only from reputable sources when making a disability determination.

“Hardworking American taxpayers expect that honest information is used when making disability determinations,” Chairman Johnson said. “It’s just common sense to say if you can’t participate in Medicare, Social Security can’t consider your medical evidence. Americans want, need, and deserve a fraud-free disability program.”

According to a 2013 report released by the Senate Committee on Homeland Security and Governmental Affairs, some claimant representatives seek out doctors who will provide medical opinions leading to a disability-benefit award without question. The report gives an example of a lawyer who sought out doctors with licensure problems to provide medical opinions to support benefit claims.

The SSA’s regulations already prohibit the agency from purchasing consultative exams from medical providers whose license has been suspended or revoked because of concerns with professional competence or conduct. However, the SSA does not have any similar restrictions on medical opinions provided by a claimant. In addition, to protect beneficiaries and federal health care programs, the Center for Medicare and Medicaid Services is authorized to bar a provider from receiving payment from federal health care programs due to certain actions. By law, doctors who have been convicted of program-related crimes, abused patients, committed health care fraud, or have a felony related to a controlled substance cannot participate in Medicare.

This legislation would prohibit the SSA from considering medical evidence from doctors who are barred from participating in Medicare or who were assessed a civil monetary penalty for submitting false evidence by the SSA.

A similar provision was included in Chairman Johnson’s Stop Disability Fraud Act of 2014 (H.R. 5260) from the 113^th Congress, and in Social Security Subcommittee Ranking Member Xavier Becerra’s recently reintroduced Social Security Fraud and Error Prevention Act of 2015 (H.R. 1419).

     Let me explain why this seemingly reasonable idea is really bad. First, anyone representing Social Security claimants who seeks out doctors with disciplinary problems to examine their clients and give medical opinions is a fool. The reports will carry little weight. If you've got any sense, it's not worth even thinking about doing. Only one example is cited. Is this enough to justify legislation? Second, and more important, what do you do about the claimant who has the misfortune of having as their treating physician someone who runs into disciplinary problems? The patient isn't the one who has done wrong. They have no way of knowing that their doctor is going to run into disciplinary problems or, for that matter, that they have already run into disciplinary problems. Honestly, do you check on this yourself before seeing a new physician? Going ahead with this proposal would cause some very sick people to be denied even though they're done nothing wrong. A physician who has fraudulently overbilled Medicaid has done something wrong and should be punished but don't punish their innocent patients.

Rising Tide Against Redistributive Government Policies?

     Is there a rising tide of opposition to redistributive government policies, such as Social Security, and is the rising inequality in income and wealth in the United States actually fueling that opposition?

Let Them Eat Cake!

    I see posts from one or more people on this blog saying that it's obvious that Social Security should be approving fewer disability claims since there's so many more sedentary office jobs now than there used to be. I think those who make these posts need to answer an important question. Why do people work at low wage, physically demanding jobs instead of higher paying, sedentary office jobs? To me, the answer to the question is obvious. They can't do the higher paying, sedentary office jobs! If you work in an office this may sounds nuts. Of course, anyone can work in an office. It's not that hard. Really? You may not be giving yourself enough credit. It takes at least a modest degree of intelligence as well as at least a moderate degree of social ability and mental stamina to work in an office. Not everyone has those characteristics. A high percentage of disability claims are filed by people who have the misfortune of having a borderline or low average IQ or who have chronic psychiatric problems. Those folks end up working in low paying, physically demanding jobs because they have no choice. Really, why else would anyone work in such employment if they could find an easier job that pays more? In high school, you didn't hang out with the people with low IQs or chronic psychiatric problems. They were almost invisible to you then and they still are but they exist in large numbers. It doesn't take much to disable them because they never had much to offer an employer other than a strong back and a willingness to work. The whole idea that you can take a person off the factory floor and put them in an office job is, for the most part, a "Let them eat cake" solution to disability.  And, no technological changes in manufacturing and in offices haven't helped. The technological changes have increased the cognitive demands of factory work leaving those with low IQs at a greater disadvantage.And, please, don't tell me that because infants can make iPhones do amazing things that anyone can work. That's just ridiculous.

     

Why Age Matters

     I keep seeing comments posted here saying, basically, that it's an outrage that Social Security pays disability benefits to people it knows can work just because they're over 50. This is based upon the fact that if a person is 50 or older, can no longer do work they've done in the past due to their medical condition and are limited to sedentary work, it may be possible to get Social Security disability benefits based upon the "grid regulations."
     The person or persons posting this miss some important points. To qualify for this treatment, you have to be unable to do any job you've done in the last 15 years and you must lack transferrable skills to sedentary work. But, it's still an outrage that Social Security pays disability benefits to people it knows can work? No, they really can't work. The Social Security Act requires the consideration of age, education and work experience in determining disability. Age has been given a prominent place in the consideration of disability because as people age they become less adaptable. When you're 25, making a transition to some entirely different type of work isn't so difficult. At age 50, it may be impossible. So, no, those people really can't work because they can't realistically make the transition to completely different lines of work. If this makes no sense to you, it's probably because you're younger. Wait a few years. If you're lucky, you'll get older and you'll have no difficulty understanding. There aren't any advances in medicine or rehabilitation or anything else that's likely to change this because it's hard-wired into the human aging process.

Why Would They Trust The Obama Administration On This?

     A press release:

Today, Ways and Means Social Security Subcommittee Chairman Sam Johnson (R-TX) introduced H.R. 1800, the Guiding Responsible and Improved Disability Decisions Act of 2015 (the GRIDD Act). The legislation would require the Social Security Administration (SSA) to update the medical and vocational regulatory guidelines for determining disability, which have not been updated since they went into effect in 1979.

Recently, the Social Security Administration’s Office of the Inspector General (OIG) issued a report highlighting one of the problems with these outdated rules for cases in Puerto Rico. The OIG found that these rules favor claimants who are unable to speak English, even though Spanish is one of the island’s official languages.
 Upon introduction, Chairman Johnson said:

"Hardworking American taxpayers expect Social Security to fairly, consistently and accurately decide who should receive disability benefits. That's why it makes no sense that Social Security uses rules from 1979 to decide if someone should receive benefits today! I've been calling on Social Security to update its rules, and the recent Inspector General report just further makes that case. This legislation sends a clear message to Social Security: It's time to update your rules—and now. This is what Americans want, need, and deserve."

House Ways and Means Committee Members co-sponsoring the legislation include Tom Reed (R-NY), Kenny Marchant (R-TX) and Diane Black (R-TN). Other original co-sponsors include Representative Mimi Walters (R-CA).

For more information, click here.

     Here is the entire relevant text of the bill:

As soon as possible after the date of the enactment of this Act, the Commissioner of Social Security shall prescribe rules and regulations that update the medical-vocational guidelines, as set forth in appendix 2 to subpart P of part 404 of title 20, Code of Federal Regulations, used in disability determinations, including full consideration of new employment opportunities made possible by advances in treatment, rehabilitation, and technology and full consideration of the effect of prevalent languages on education.

     If you're sure that passage of this bill would result in fewer people drawing Social Security disability benefits, you don't understand the situation. The number of unskilled jobs has declined dramatically over the last thirty years. Any honest updating of the grid regulations is almost certainly going to result in more disability claims being approved, not fewer. Don't believe me? Read back in this blog about the Occupational Information Development Advisory Panel (OIDAP). There was plenty of tension as Social Security tried to stage manage OIDAP so it could avoid paying more claimants. That didn't work so well. That controversy has gone underground as the responsibility for developing a new Occupational Information System (OIS) has shifted to the Department of Labor but it's going to burst into the open eventually. Pass this bill and you're opening Pandora's box a little sooner.
     This bill is evidence to me that the Subcommittee lacks a Republican Social Security disability policy wonk on its staff.

Nice Idea But It's Not Going To Work

     There's a bill pending before the House Social Security Subcommittee that would require that the Social Security Administration "develop online tools to help beneficiaries assess the impact of earnings on eligibility for and benefit amounts of state and Federal programs." 

     It's a nice idea but I have my doubts that anything developed will be helpful. The problem is that Social Security's work incentives are so incredibly complex that they won't fit easily into an online format. You don't just plug in your earnings for a month to determine the effect upon your benefits. There's far more involved than just how much you earn. Earn $2,000 in the first month you work and there's no effect upon your benefits. Keep working and earn $2,000 a month for twelve months and your benefits probably stop -- and note that I said probably, since there's the separate blind standard, there's the issue of whether it's self-employment which has different standards, there's Impairment Related Work Expenses (IRWE) and there's the question of whether you're performing a made-work or subsidized employment job. Keep working at that some pay rate for a time before stopping and what happens depends upon how long you were working before you stopped. There's no simple way of explaining it because it's quite complex. See the image above from the Subcommittee summary of the bill to get an idea of the complexity. 

     This isn't a partisan issue. I think that virtually everybody familiar with this subject would agree that we need a much simpler system of work incentives. I think that almost all would agree that even with a much simpler system few Social Security disability benefits recipients will return to work. They're too sick.
     The work incentives have gotten so complex because members of Congress over several decades have believed that there must be some way of returning lots of Social Security disability recipients to work. They haven't bothered to study the incentives that already existed. They just kept adding more. Additional incentives or tweaked incentives or better explanation of incentives -- none of it is going to work. The idea that large numbers of disability benefits recipients can ever be forced or enticed to return to work is a fallacy.