Social Security Seeks Legislation To Allow Electronic Medical Release

From Social Security Update, an online newsletter from the Social Security Administration:

Each year Social Security makes more than 15 million medical record requests for disability applicants and beneficiaries. Social Security has been working diligently on ways to make the disability determination process go faster and smoother for applicants and all parties involved. Now, Social Security is working in collaboration with advocates and the Disability Determination Services (DDS) to get legislation passed that will streamline the medical release piece of the disability process.

Currently, when a person applies for Social Security or Supplemental Security Income, part of the application process is to have the applicant complete several medical release forms (SSA-827) which Social Security and DDS use to send to medical providers. Each time we need a piece of evidence from another source, we must send out another medical release form. Sometimes, it is required that we go back to the applicant to have additional releases signed which delays the process.

Expedited Records Request would make the process go much faster. Applicants will still be advised of the need to obtain medical records, but they will be asked to grant Social Security permission electronically instead of on a signed paper form. No additional evidence of authorization would be required for the provider to release the information to Social Security. The provision would also relieve providers of existing liability for disclosure of medical records to Social Security when they respond to a request.

AFL-CIO Calls For More Funding For Social Security

The Obama transition is posting documents and position papers it receives from organizations. The AFL-CIO has submitted a paper dealing with Social Security. They recommend a higher "replacement rate" for Social Security, that is higher Social Security benefits. That is unlikely to happen, but the AFL-CIO's justification is not without merit. Traditional pensions are disappearing. Most employer-based retirement plans now are defined contribution plans, such as 401Ks. Such plans do not guarantee retirement income in the way that traditional pensions do. Social Security benefits are more important than ever.

Of more immediate interest, AFL-CIO recommends higher funding for the Social Security Administration. It recommends achieving this by taking Social Security's administrative expenses "off-budget," so the agency's operating budget does not count against the unified federal budget. My guess, or perhaps hope, is that a number of other groups may recommend the same thing. AFL-CIO advises that Social Security's "focus on electronic filings and new requirements that claimants perform functions formerly provided by SSA staff should be reversed."

Somewhat embarrassingly, AFL-CIO told the transition team that "An immediate decision for the next President will be who should lead the Social Security Administration." Actually, no. While the new President can appoint a new Deputy Commissioner for Social Security, Michael Astrue can stay on as Commissioner of Social Security for another four years and, apparently, plans to do so.

SSAB Advice To Transition Team

The Social Security Advisory Board (SSAB) met recently with the Obama transition team for Social Security. The SSAB's written materials for this meeting are available on the SSAB website.

I hardly know how to describe the SSAB comments. They seem mostly to describe problems and issues at Social Security, but to provide few suggestions on what to do about them. Mostly, the comments suggest that Social Security needs to solve its problems by doing some sort of very smart reorganization. The SSAB has no idea what this very smart reorganization would look like, but Social Security has problems, so management at Social Security must come up with a very smart reorganization to solve the problems. There are vague hints at the possibility that SSAB thinks that the agency might just possibly need a few more warm bodies to get the work done, but these hints are submerged in a sea of this sort of thing:

SSA needs to develop a vision and focus on the integration of processes, investment in a modern technology platform, and development of a highly skilled and creative workforce. This is not merely tinkering around the edges—by addressing fundamental organizational change in these three areas—process, platform, and people, the agency has the potential to make the administration of the Social Security programs more effective in meeting the public’s demand for service.

This sort of drivel -- it sounds like something out of the comic strip Dilbert -- makes it hard to justify the continued existence of the SSAB.

Hearing Backlog Report

Social Security has posted its "Annual Report 2008 on The Plan to Eliminate the Backlog and Prevent Its Recurrence." Interestingly, the report is signed not by the Commissioner of Social Security, but by the outgoing Deputy Commissioner for the Office of Disability Adjudication and Review, Lisa de Soto. Should we ascribe any significance to this?

De Soto reports that "Fiscal Year 2008 was a tremendous year filled with impressive accomplishments" and, in a sense, it may have been since I am sure that everyone involved worked hard and some productivity gains were achieved, albeit usually at the expense of quality. However, the backlog still grew and that is the subject of this report, so it is hard to see how the last fiscal year could honestly be described as "tremendous."

The report predicts that the backlog will decline dramatically in coming years, but this prediction appears to be based upon an expectation of unprecedented increases in productivity.

Putting things in a positive light is one thing. Crowing about great successes when you have failed miserably is another. I do not know whether to call this spin or just fantasizing, but this report does not seem to be based upon reality -- a common complaint about the outgoing Bush Administration.

GAO Report On Medical Evidence Collection

From Collection of Medical Evidence Could Be Improved with Evaluations to Identify Promising Collection Practices, a report issued by the Government Accountability Office (GAO):

Obtaining timely and complete medical records is a challenge to DDSs [Disability Determination Services, state agencies who do disability determination for the Social Security Administration] in promptly deciding disability claims ... 14 of 51 DDSs reported the percentage of requests for which they did not receive records was 20 percent or more in fiscal year 2007. In response to this challenge, all DDSs conduct follow-up with providers and claimants to urge them to provide records. Over half of the DDSs (34 of 51) have also implemented more timely payments for records and six increased the amount they pay. ...

Recruiting and retaining qualified providers is a challenge to obtaining consultative exams needed to supplement insufficient medical records. For example, 41 of 51 DDSs reported routinely asking claimants' own providers to perform these exams; yet 34 reported providers never or almost never agree to do so. DDSs directors in our survey believe that current payment rates account for some of the difficulty recruiting and retaining consultative exam providers. In response to these challenges, 32 DDSs rely on medical providers who specialize in performing disability evaluations, and 20 pay providers for time spent preparing for appointments claimants fail to attend. SSA evaluates evidence from consultative exams, but these evaluations and the data they yield are too limited to identify and share promising DDS practices.

SSA has made progress moving to electronic collection of medical records, but faces challenges in fully implementing electronic retrieval and analysis of medical evidence. SSA now uses electronic images instead of paper copies of new claimants' records. Though SSA seeks to obtain all records electronically and provides options for online submission of records, only one large provider accounts for most of the records submitted online, and about half of all records received are on paper. To date, SSA has taken only limited action to identify and analyze the barriers providers face in using current electronic record submission options, and has not developed a strategy to address them. In the long run, SSA is participating in an advanced prototype to collect medical records in formats that can be searched and analyzed by electronically querying a hospital’s records database and directly retrieving the claimants’ records.

Social Security Bulletin Released

The latest issue of the Social Security Bulletin, a publication of the Social Security Administration, has been issued. It contains a nice article on the late Robert Ball.

A Message From The Commissioner Of Social Security

This came out today from the Commissioner of Social Security:

A Message To All SSA And DDS Employees

Subject: Continuing Resolution

Since October 1, we have been operating under a continuing resolution (CR) that holds us to last year’s funding level. The CR causes a significant strain not only because our workloads are increasing, but also because our fixed costs, such as rent and guard services, increase substantially each year. This CR has exacerbated our already fragile situation. We have done what we can to mitigate the deterioration in service, but the reality is that our inability to replace most staff during the CR will result in longer waiting and processing times.

I am sure by now you have noticed the adverse impact that the declining economy has had on our day-to-day work. The actuaries recently issued new projections of even higher workloads than we are already seeing in our front-line operations. Retirement applications are up, although not as much as we might expect because for every person who is taking retirement due to an unexpected termination, there is probably another person deferring retirement due to a loss in retirement savings. Calls and visits to field offices are up substantially, and both disability filings and appeals are surging.

We are hopeful that we will have a full-year appropriation for FY 2009 soon. Current indications are that Congress plans to pass an appropriation for us in January, shortly after the inauguration. Congress on both sides of the aisle understands our needs. The House Appropriations Subcommittee has recommended an additional $100 million for the agency above the President’s request, and the Senate Appropriations Committee has recommended an additional $50 million above the President’s request. These figures indicate that we could receive more than the President’s Budget for FY 2009, which would give us some much needed relief.

I want you to know that I am aware of the strain that you are under. I really appreciate your hard work and dedication in these difficult times. I will keep you posted on the future developments concerning our appropriations.

Michael J. Astrue

No Match Resolution Process Working Poorly

From a report by Social Security's Inspector General:

As part of the Annual Wage Reporting process, the Social Security Administration (SSA) attempts to match the names and Social Security numbers (SSN) on Wage and Tax Statements (Form W-2) that are submitted by employers against SSA’s Numident file — the repository for all issued SSNs. A Form W-2 that contains a name and SSN combination that matches the Numident file is posted to the Master Earnings File (MEF). However, in cases where the name and SSN combination cannot be matched to SSA’s records, the wage information on the Form W-2 is posted to the ESF—the repository of unmatched items.

To resolve name/SSN combinations that cannot be matched, also known as “no-matches,” SSA began sending EDCOR letters to employers in 1994. These letters are commonly called “no-match letters.” The EDCOR letter was designed to help educate employers about their name/SSN no-matches and remind employers about the importance of submitting accurate information on Forms W-2. The EDCOR letter explains to employers that some of the name/SSN combinations reported do not agree with SSA’s records and asks employers to submit a Statement of Corrected Income and Tax Amount (Form W-2C) within 60 days for each SSN listed on the letter. In addition, it explains that some of the name/SSN no-matches may be the result of common mistakes, such as transcriptions or typographical errors, incomplete or blank name/SSN, or the failure of an employee to report a name change to SSA. SSA mails EDCOR letters to employers on a flow basis beginning in February of each year. As shown in Table 1, over the years, SSA has used various criteria to determine whether employers should receive an EDCOR letter....

SSA’s EDCOR letters were not effective in communicating wage-reporting problems to employers and reducing the size of the ESF. While EDCOR letters were established to help employers resolve name/SSN no-matches, for TY 2005, we found about 74 percent of employers who reported wage items with mismatched names and SSNs did not receive an EDCOR letter primarily because of the Agency’s criteria for issuing the letters. In addition, employers who received EDCOR letters were not always informed about all of their no-matches because the EDCOR letters only listed up to 500 mismatched SSNs. For example, about 1,650 employers received EDCOR letters that did not include about 1.7 million of their 2.6 million no-matches. Moreover, our review found EDCOR letters provided employers with limited information needed to resolve name/SSN no-matches. The letters only included mismatched SSNs and not the reported names.

Furthermore, name/SSN no-matches were less likely to be resolved under the EDCOR process as compared to the DECOR process. In TYs 2001 through 2005, about 680,500 wage items were reinstated because of the DECOR process, whereas only 60,500 wage items were reinstated because of the EDCOR process. Finally, although SSA had developed a more effective process for employers to review and correct name/SSN no-matches electronically, we found employers seldom used the Business Service Online, which is a suite of Internet services for employers to exchange information with SSA.