Electronic Medical Records And Social Security

The Specialized Advisory and Assistance Service (SAAS) of the Social Security Administration has prepared a report on Social Security's trial use of an automated electronic records retrieval system to obtain medical records on Social Security disability claimants in Virginia. I had not previously heard of SAAS. Can anyone enlighten me on them?

The report was not released by Social Security but by MedVirginia, the Health Information Exchange, or HIE, that Social Security is working with. MedVirginia's press release has the title "Social Security Administration Study: $2 Million Return from HIE." The $2 million return that MedVirginia is talking about is not for Social Security but for Virginia hospitals which tells you where MedVirginia is coming from.

The executive summary for the report is the worst that I have ever read. It is far too long and far too wordy. My eyes glazed over as I read sentences such as, "The overarching technical success was the transmission of semantically interoperable live health information via the NHIN." Why do academics write so poorly? Is that a requirement to get a Ph.D.?

Hidden away in the report is the fact that the "mean case processing time" for the cases transmitted across the HIE was 59 days while the comparable state average was approximately 84 days. I am not sure what this number represents since the report also states that only "anecdotal evidence suggests that some disability determination decisions may have been made faster with this electronic process." Fifty-nine days as opposed to 84 days sounds like more than anecdotal evidence. Maybe the 59 days number does not mean as much as it seems to mean.

One intriguing tidbit from the report is that some of the development for the project was outsourced to Dubai creating time zone problems for all involved.

I have to wonder after reading this report what SAAS is and why was a private contractor releasing this report instead of Social Security? Also, why would the contractor be so crass as to tout the profit potential of HIE for health care providers in this sort of press release? That is serious tone deafness.

Bad News

The President has decided to seek a three year freeze on domestic discretionary spending. The freeze would allow increases in spending only to match increases in the cost of living. This freeze includes the Social Security Administration's operating budget. This is potentially devastating for Social Security. The agency was dramatically underfunded during the Bush Administration and now faces rapidly increasing workloads due to the aging of the baby boom population.

Update: I am getting messages from people telling me in effect "What's the problem? The President is exempting Social Security." Sure, he is exempting Social Security benefit payments. Unfortunately, there is no sign that the President is exempting Social Security's operating budget from this planned budget freeze. The operating budget is a separate matter from the benefit payments.

And We Thought Backlogs Were Bad At Social Security

At the Department of Veteran's Affairs Regional Office in Roanoke, VA, the stacks of backlogged case files are so big that they threaten the structural integrity of the building!

Understaffing Social Security Makes Sense If You Start With This Premise

From CNS News:

The Social Security Administration (SSA) spent $30 million in stimulus money in 2009 to hire 585 new bureaucrats who will be responsible for certifying whether people are eligible for disability so they can be paid by the taxpayers not to work.' ...

Sandra Fabry, director for the Center for Fiscal Accountability at Americans for Tax Reform, called SSA’s use of stimulus funds for ODAR a “bad deal for taxpayers on both ends.”

“You’re paying money on the front end to make these hires and are obligating taxpayers at the same time to pay millions and millions more on the recipients’ side,” she said.

Bottom line, Fabry said, the move by SSA grows the scope of government in both spending and “dependency.” ...

Fabry acknowledged the claims back-log, but questioned whether or not this is a good use of taxpayer dollars ...

Glad It Worked Out For Him

From the Independent Mail of Anderson, SC (emphasis added):

When Freddie Jordan could no longer feel his hands or his feet, which prevented him from working as a pipe fitter, he was nervous.

For 15 years, he worked with Stover Mechanical as a pipe fitter, and he’d only missed three days of work. Surely, he said, that would count for something when he discovered he could no longer work because of the neuropathy in his hands and his feet. At 57 — just five years short of retirement — he knew he was going to need to apply for disability benefits.

“I was scared,” said Jordan, a Honea Path resident. “The insurance company told me that I was going to need an attorney. And I had heard that some folks had to wait two or three years for their benefits. I didn’t want to lose my land and my truck.”

His fears were eased, he said, when he called the Social Security Administration office in Anderson.

First, they told him he didn’t need a lawyer. Save that money, they said.

“They told me to just tell the truth, and I’d be OK,” Jordan said.

His wait was three months, not three years. Now, for two months, Jordan has been receiving his benefits.

Social Security Releases Much Data

A press release from Social Security:

Michael J. Astrue, Commissioner of Social Security, today announced that the agency is making new data about beneficiaries and the agency’s disability and hearing processes available to the public. The new data supports the President’s Transparency and Open Government initiative and is available at www.data.gov.

“I applaud President Obama’s commitment to creating an unprecedented level of openness in government and the new datasets we are posting far exceed what was asked of us,” Commissioner Astrue said. “Social Security has always valued transparency and sought to give the public user-friendly information about our programs. Each year we send millions of Americans personal information about their Social Security contributions and potential benefits. Our website www.socialsecurity.gov has a wealth of information about our programs and the Social Security trust funds. I hope the new data we are making available will lead to a better understanding of our operations and the important role we play in people’s lives. I look forward to engaging Americans in the business of their government.”

Here are a few examples of the value of the Social Security datasets available today:

• Researchers can find out about the work-related experiences of our beneficiaries receiving Social Security disability benefits and give us policy guidance for our disability programs.
• The public can see information about hearings workloads and a breakdown of the types of decisions made by Administrative Law Judges.
• Researchers can study the effects of current and proposed legislative and program provisions.
• People who have requested a hearing on their disability claim can estimate the amount of time they may have to wait for the hearing to be held and for a decision.
• The public can see general information requested under the Freedom of Information Act.

“These new datasets are just the beginning of our efforts. In February we will launch our Open Government webpage that will include improved access to our data in a variety of formats. In April we will publish our Open Government plan,” said Commissioner Astrue. “Let me also reassure all Americans that while our goal is to become more open and transparent, we will continue to vigilantly protect the personal information the public entrusts to us. We will ensure that transparency does not put that information at risk.”

Here is the list of Social Security provided datasets. Here are what I find to be the more interesting of the newly released data, some of which I was unable to open due to technical problems, which I have noted below:

• Hearing Office Dispositions Per ALJ Per Day Rate Ranking Report
• Hearings Held In-Person or Via Video Conferencing Per Hearing Office
• Hearing Office Average Processing Time Ranking Report (technical problems)
• Hearing Office Workload Data (technical problems)
• State Agency Workload Data (technical problems)

Please let me know if you can open the datasets that I had trouble with.

OIG Report On Hearing Office Productivity

In response to a request from Senator Voinovich, Social Security's Office of Inspector General (OIG) has produced a report on Hearing Office Disposition Rates. Nothing surprising about the findings:

Our review identified various factors that impacted hearing office productivity. Specifically, we found ALJs had control over certain factors that affected hearing office productivity—motivation and work ethic, case review time, and hearings management. Further, we identified factors related to support staff that can also affect hearing office productivity—staff quantity, quality, and composition.

Fast Scheduling

My firm is seeing some Social Security hearings scheduled within a month after asking for one. This might be welcome news except for the fact that we have many other cases where claimants have been waiting for over a year for a hearing. These cases being scheduled rapidly are not ones which are supposed to be expedited, such as those for terminally ill claimants or "wounded warriors." We are seeing this from at least two different hearing offices. This just started this month.

Is this a local phenomenon or is something happening regionally or nationally that could explain this?

My opinion is that the only fair thing is to schedule hearings in the order in which claimants asked for them insofar as practical. What I am seeing seems inappropriate to me.