Articles from prior issues of The Advocate

July/August, 1998

ESADE Hosts Bi-Regional
by Debi Chowdhury & Eric Knieling

THE NORTHEAST/MID-ATLANTIC BI-REGIONAL CONFERENCE was held at the Desmond Americana June 9-12, in Albany, NY. ESADE hosted this event, the theme of which was “Promoting a Culture of Quality in Decision Making.” Over one hundred people attended, including many members of the medical community and SSA officials, in addition to current and prospective NADE members. ESADE worked long and hard with the medical members of the conference planning committee, Arlene-Reed Delaney, M.D. and Richard Blaber, M.D., Medical Consultants, NY Division of Disability Determinations, Albany, with the guidance and support of the NY DDD Medical Director, and CME Director, I. Arnold Slowe, M.D. to attain Continuing Medical Education accreditation for each of the six medical lectures presented at the conference. Any physician who attended a medical lecture received CME credits, which was the first time this has been accomplished for a NADE conference, either regionally or nationally. A certificate was also awarded to others attending the medical training to document their participation in these events.

As a prelude to the conference, ESADE hosted an opening night buffet dinner reception, highlighted by a presentation of “A Historical Perspective of NADE,” given by Mary Blum, Susan LaMorte, Frank Giordano, and Debi Gardiner.

The meeting officially began on Wednesday, June 10th, with a traditional Thanksgiving blessing offered by Mr. Kellar George, and Mr. Brian Patterson of the Oneida Nation’s Men’s Council. The welcoming address was given by Brian J. Wing, Commissioner of the Office of Temporary and Disability Assistance, the parent agency of the NY DDD, who strongly encouraged the advancement of the professionalism of disability adjudicators through membership in NADE. Dr. Slowe then addressed the conference, stressing NY DDD’s leadership and innovation in continuing medical training for medical consultants and examiners via CME accredited medical lectures. Debi Gardiner, current President of NADE, provided an informative overview of testimony given to Congress on several issues, a general update on legislative items, and current concerns of NADE. Debi also encouraged the celebration of National Disability Professionals Week, as well as membership recruitment.

Other highlights of the first day included a presentation by Joe Markovic, Director of Policy and Procedure, SSA OD, presenting SSA Associate Commissioner Ken Nibali’s message, explaining the growth of the SSDI and SSI disability program, and the requirement by Congress of management of the disability rolls via CDRs. The number of CDRs done by the DDS is expected to rise from 443,000 in FY 97 to 759,000 by FY 1999. Mr. Markovic noted that SSA exceeded it’s target of 655,000 total CDR’s by DDS & SSA components, completing 713,000 during FY 97. The emphasis on this aspect of the program is in keeping with Commissioner Apfel’s first priority re the solvency of Social Security in general. A number of other items were addressed during this session, including PUT, FPM, rationales, lost folders for CDRs. He also listened to the concerns of conference attendees regarding the DC Redetermination process and the implementation of the complete rationale process. Pamela Gardiner, Assistant Inspector General, Audit discussed the anti-fraud initiatives being piloted in 10 states, including New York, in a cooperative effort by the DDS, the SSA office of Inspector General and state law enforcement departments, stressing the rate of recovery from successful prosecution for fraud. Other featured SSA speakers were Beatrice Disman, SSA Regional Commissioner, and Susan Roecker, Deputy Director, DPRT. Ms. Disman stated that while solvency of Social Security was the first priority of the Commissioner, the management of the SSI program was priority #2. Ms. Disman is the leader of the SSA Regional Commissioner’s workgroup on this project. GAO has identified SSI as a “High Risk” program, with special concerns regarding accuracy of payments, which stood at 94.5 percent nationally. She discussed proposals of administrative sanctions against claimants who knowingly conceal information to continue to receive benefits. Ms. Disman praised all components in their handling of the DC redetermination process, under very trying circumstances, as an example of what can be accomplished when we all work together as a team. In response to a question, she reassured us that SSA remains committed to the Federal/State partnership, with the decision as to which component will do which parts of the program yet to be resolved. Ms. Roecker spoke on the Disability Redesign project. She stated that the FPM (Full Process Model) pilot was a fantastic test of over 30,000 cases nationally, that the controls were handled very well, and that the test has yielded valid results; especially noted was a lower appeal rate, and an increase in initial allowances. A complete assessment of the first phase of FPM is scheduled to be completed by Sept. 1998. The Single Decision Maker (SDM) process was also noted to be a success, with accuracy of adjudication higher than for other claims, slightly shorter MPT, and somewhat higher initial allowance rate. SSA has found that the testing of the SDM has been sufficient, the Regulations to implement SDM are in the works to go to the Commissioner for signature, and the roll out process is being considered. Planning for 1999 includes the beginning of implementation of the Personalized Decision Interview (PDI), and elimination of the Recon step by June or July of 1999. Ms. Roecker addressed the Adjudication Officer project as requiring further evaluation, as it had not yet shown saving in terms of cost effectiveness or productivity. Examiners expressed their concern regarding the elimination of AO as a replacement. Ms. Roecker emphasized that we need to do a better job on initial claims, but that SSA needs to provide the DDSs with procedures, funding, and authority to do this.

Dr. Grover Evans, Director, Arkansas DDS, the Awards Luncheon keynote speaker, took us all on a three day journey to Arkansas, emphasizing the concepts of integrity, motivation, and trust, on which to build a solid foundation. Dr. Evans’ motivational speech was received with great enthusiasm. ESADE was presented the NE NADE Chapter award; Conference Chairperson Debi Chowdhury was awarded Professional of the Year for the region, and the Director of the Puerto Rico DDS was cited for the Administrator’s Award. A special presentation was made by Debi Gardiner to Jim Coseo, the former Associate Commissioner for the NY DDS, for his support of NADE. We wished him well on his new career in the private sector.

Featured at the conference were three panel discussion; a panel discussion on quality, and how to avoid DQB returns, which was preceded by a role playing skit, using signs which spelled out the words “explain it” - re the need to clearly state the reasons for decisions. Taking part on the panel were ROQA (DQB) Directors, Ira Callis, NY; Gail Davis, Philadelphia, and Eugene Jerry of OQA (OPIR), moderated by Thomas Malvey, Chief, Quality Control, NY DDS. The second panel of DDS Administrators addressed the NY & PA DDS experience with the Full Process Model, and the roll out to complete rationales in Arkansas. Dr. Evans, Arkansas DDS Director, highlighted his presentation with information regarding the use of voice recognition software to dictate rationales. Jim Coseo moderated the panel, and spoke on the success of FPM in NY, while Howard Thorklson, PA DDS Director, voiced some concerns and reservations in relation to the FPM pilot in his state. Al Cannistraro, DHU Supervisor, Albany, NY DDS led a panel discussion of DHO’s regarding issues involved in the DHU process.

The subject of the Disability Adjudication training System (DATS) was presented by Anne Graham, Policy Analyst, OD, and member of the DATS workgroup. Ms. Graham stressed the need for NADE to support this project, being advocated by Susan Daniels, SSA Deputy Commissioner, as a vehicle to promote the professionalism and uniform training of disability adjudicators within SSA, the DDSs and OHA in particular. Dr. Chris Ann Schiro-Geist, the Coordinator of the DATS workgroup, supplied numerous handouts, and made herself available to attendees to talk about this critical program. Susan LaMorte provided insights into the DCM pilot in NJ, for which she had the responsibility of training 25 Federal DCM’s & Project Supervisors on the medical aspect of the disability program. We thank both Anne and Susan for graciously agreeing to speak on very short notice; we appreciate the excellent presentations they made.

At the Northeast regional board meeting, Debi Thomas was reelected President; Debi Chowdhury, Vice-President, and Jane Osgatharp was again elected Secretary/Treasurer. The issue of NADE’s stand re giving CE’s equal weight to treating source evidence was discussed; Debi Gardiner agreed to revisit this issue.

The medical lectures were well attended and appreciated, especially the CME lecture on Evaluating Speech and Language Disorders in Children, presented by Dr. Kathleen Whitmire, Chair, Communication Disorders Dept., College of St. Rose, Albany. Another highlight was a presentation made by George Bousvaros, MD, NY DQB, on typical problem areas found by DQB in evaluation of cardiovascular disorders; other topics covered were Gulf War Syndrome; the effects of depression on ability to work; childhood mental impairments, and assessing remaining work capacity from a treating source’s point of view.

Many ESADE members contributed to the success of this conference, and we thank them all. All the speakers and panel members made the program special. We thank Brenda Kaselis, and the NADE Northeast Regional Board, as well as Eugene Jerry, NADE Mid-Atlantic Director, Debi Gardiner and the National Board of NADE for all their help and advice. We especially thank our fellow NY NADE members of the new Southern Tier (STADE) chapter, for their help with goody bags, and to the WNYADE (Buffalo) chapter for their assistance. This training meeting is a wonderful example of the investment NADE has in advancing the cause of professionalism for disability adjudicators connected to the SSA & SSI disability programs, building on the respect already given to NADE as an organization by SSA and the public. The planning and staging of this conference was a great experience, and will hopefully set the stage for our chapter to go onto a bigger and better future. Next year’s Bi-Regional conference will be held in Columbia, MD. We hope that everyone who came to this year’s conference in Albany benefitted by being here, and had a great time.