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.