Slow Progress In Obtaining And Analyzing Medical Records Via IT

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

Despite spending more than 10 years trying to increase the number of medical records received through health IT, SSA still receives most records in paper or ERE format. In the Fiscal Year (FY) that ended on September 30, 2020, SSA received only 11 percent of medical records through health IT. 

SSA experienced a decreasing trend in adding new health IT partners from 56 in FY 2018 to 12 in FY 2021 (as of August). During this time, SSA reduced the number of staff and contractors involved in health IT outreach and did not fully fund projects to increase electronic medical evidence. Also, expanding the number of health IT records by adding new partners is not a unilateral decision made by SSA, as prospective partners must be willing and able to meet SSA’s technical requirements, and COVID-19 was a factor. In October 2021, SSA informed us it was (a) working on Memorandums of Understanding with 3 entities to exchange health IT records with over 30 large health IT organizations and (b) adding more staff to develop and implement strategies to expand health IT.

Challenges in expanding the number of health IT records include some partners’ inability to send sensitive medical records, acceptance of SSA’s authorization form to release records to the Agency (Form SSA-827), and medical industry-wide differences in patient-identifying data fields. 

Additionally, SSA has had limited success analyzing medical records because MEGAHIT is limited to analyzing only structured data. MEGAHIT generated data extracts on only 7.3 percent of the 1.6 million health IT records SSA received in FY 2020. The extracts assist SSA disability examiners in making accurate disability determinations. Since 2018, SSA has been developing and testing the Intelligent Medical-Language Analysis GENeration application with new capabilities for reviewing medical records. As of August 2021, SSA was still testing and rolling out this application to its offices. ...

Supreme Court Opinion On Obscure Windfall Offset Issue

      From the syllabus of the Supreme Court's opinion in Babcock v. Kijakazi:

This case concerns retirement benefits due under the Social Security Act for a retired “military technician (dual status)" ... Like all dual-status technicians, Babcock was required to maintain membership in the National Guard. ... Upon retirement, Babcock applied to the Social Security Administration for benefits. The agency granted Babcock benefits but applied a statutory “windfall elimination provision” and reduced the amount of benefits to reflect Babcock’s receipt of civil-service pension payments for his work as a technician. ...

Held: Civil-service pension payments based on employment as a dual-status military technician are not payments based on “service as a member of a uniformed service” ...

     In other words, Babcock loses. Social Security will continue to apply the windfall offset to his Social Security benefits.

     While this seems like an obscure question to me, it probably affects at least hundreds of people, maybe thousands. That's the way it is with Social Security. It's so big that even tiny changes affect significant numbers of people.

It's A Bad Month To Be Trying To Do Business With Social Security

     January is usually a tough month for the Social Security Administration. There's a bit of hangover of work that didn't get done during the holidays but, more important, there's an increased workload because of the number of people who retire at the end of a calendar year and because SSA-1099s go out in January and their receipt occasions calls, not to mention those who call because they didn't receive an SSA-1099. All of this is still happening in January 2022 but Social Security faces more service delivery obstacles than usual. We still lack an appropriation for FY 2022 so the agency has little money to spend on overtime and the Omicron variant is causing a lot of employees absenteeism. All of this put together is a perfect storm that is causing horrific problems for anyone trying to do business with Social Security's field offices and teleservice centers. It's also likely to lead to little regular work getting done at the payment centers which get called upon to help the teleservice centers when they can't answer their phones.

Big Decline In Disability Claim Approvals Continues

      Social Security has posted final 2021 numbers on disability claims. Claims filed in 2021 went down slightly from 1,838,893 in 2020 to 1,820,282 in 2021 but there was a sharp 11.75% decline in the number of claims approved from 648,121 in 2020 to 571,952 in 2021. This is on top of a 10.46% decline in claims approved in 2020. Note that claims approved went down far faster than claims filed. The difference is vastly increased backlogs, mostly at the initial and reconsideration levels but also at the payment centers where favorable Title II decisions are implemented. The number of claimants in current payment went down 3.36% in 2021 from 8,151,016 in 2020 to 7,877,129 in 2021.

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Vaccine Mandate Compliance Rate Increases At Social Security While Suspensions Loom For Those Who Fail To Comply

     From The Hill:

Federal government agencies are preparing to take increasingly harsh steps against unvaccinated employees in order to implement President Biden’s COVID-19 vaccine mandate for federal workers.  

Some agencies plan to send letters warning of possible suspensions to employees who have not complied with the mandate. Many are also prepared to fire employees who don’t follow the rule, though such moves would be further down the road. ...

The departments of Treasury, Transportation and Agriculture as well as the General Services Administration, Social Security Administration and Nuclear Regulatory Commission are all expected to begin suspending employees who are not complying with the mandate in the coming weeks. ...

Some agencies also saw success in convincing unvaccinated workers to get the shot toward the end of the year. The Social Security Administration, for instance, as of Friday had achieved a 98.9 percent compliance rate and a 91.5 vaccination rate, compared with a 95 percent compliance rate and 87.7 percent vaccination rate as of November.  ...

Is This A Good Idea Or Just Too Intrusive?

     From a posting by Social Security on SAM.com:

This is a Request for Information (RFI). This RFI is for informational and planning purposes only and shall not be construed as a solicitation or as an obligation or commitment by the Government.  ...

The Social Security Administration (SSA) is conducting market research to identify potential vendors capable of providing record locator services to help identify interactions between a disability claimant and the healthcare system (e.g., physician visits, hospitalizations). ...

During the application process [for Social Security disability benefits], claimants may spend a great deal of time gathering information and trying to remember dates of medical treatment and provider details.  The process relies solely on claimant recall for the names and addresses of medical providers and dates of treatment.  As such, the body of medical evidence assembled for evaluation may be incomplete and omit information that could be critical in making an accurate determination of disability. ...

Technical Requirements:

• The service shall support the ability to accurately identify a patient based on key demographic information supplied by SSA, such as patient name, date of birth, gender, address, and Social Security number.
• The service shall support the ability to provide an encounter/treatment history within a specified timeframe for an identified patient, which consists of a list of treating facilities/providers, including address information, Medical Record Number (MRN), date of encounter, and conditions that were treated or evaluated.
• The service shall support the ability to provide a list of active medications within a specified timeframe for an identified patient, including the prescription date along with the prescribing doctor, facility, and address.
• The service shall support the ability to identify the electronic address of a specific patient’s electronic medical record based on key demographic information supplied by SSA.  ...
• The service shall support the ability to notify SSA when specific patients, identified by key demographic information supplied by SSA, have had medical encounters, and provide information about the treating provider or facility, the date of the encounter, and the electronic location of where the associated electronic medical record could be found.

      I really want for Social Security to have a complete medical record on my clients. I try hard to figure out who they've seen and to help complete the record set that Social Security has. Contrary to what some would think, the problem isn't claimants trying to conceal medical sources they've seen. I don't think that's what this RFI is even about. The problem is that medical histories get complicated and claimants forget. Still, this RFI seems a bit creepy to me. Do we really want the government to have the power to troll across all medical records to find every last bit of records on an individual? To be able to construct a list of prescribed medications at any given moment? Would you want the government having this kind of power to gather your medical records?

If Full Retirement Age Is Based Upon Life Expectancy, Shouldn’t It Go Down Now?

 

     

     To be clear, I think full retirement age should be considered a proxy for the physical infirmities that go along with increasing age rather than life expectancy. We should not be forcing older people to be filing disability claims when their health problems are just to be expected at their age. However, there are others, particularly on the right, who think that full retirement age and life expectancy should be linked, although I think that this stance has had more to do with hostility to the general concept of social security than anything else. Increasing life expectancy gave them an argument to do something they wanted to do anyway -- cut Social Security benefits.

What Do You Think?

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