Articles from prior issues of The Advocate

May/June, 1996

Sequential Interviewing: Good Business and Good Service Sense
by Glenn Sexton, North Carolina DDS Administrator

I APPRECIATE THE OPPORTUNITY TO share with you my reasons for supporting sequential interviewing (SI) as a permanent change in disability claims processing. SI establishes a direct link between the DDS decision maker and the client; it focuses development from the outset; it reduces processing time; and it takes advantage of the skills, experience, and efficiencies derived from the economies of scale available only in a DDS setting. DDSs have the trainers and supervisors that provide the infrastructure for reviewing claims and ensuring quality decisions. Overall, SI just makes good business and more importantly, good service sense.

In May , 1994, the North Carolina DDS and the Area Director for eastern NC (now SSA State Director) joined in a project to test what is now officially termed sequential interviewing. It is important to note that our success in this project is attributable to an excellent working partnership with the state Director and the Charlotte and Greenville DO staff and management.

In sharing the North Carolina experience with you, I will not describe only the beauty marks, but also the freckles and warts. It is important to know that implementation of SI is not simple and that major challenges occur. We have not solved all the problems. There may be others we have yet to identify. Still I am confident that the solutions can be devised without sacrificing quality or efficiency.

Our goal was (and remains) to provide faster and more efficient service to claimants in our state. We started the process on August 1, 1994, with the participation of the Greenville field office, which yields an average rate of new claims and one DDS unit. Today, SI involves two FOs, having added the state’s largest in Charlotte, and six DDS case processing units that share the SI claims. Because of redesign processes, the emergence of partnership council considerations, and the need to resolve DDS work flow issues, we have not and cannot undertake further expansion at this time. However, we are continuing our efforts to determine how to achieve statewide implementation so that we will be positioned to expand our use of the concept when that is possible. Centralized case receipt and assignment is necessary to achieve equitable and rapid distribution to examiners. At the same time, with a large case load, it is not practical to funnel all receipts through a single worker.

We are in the process of developing the best way for multiple workers in our Case Controls Unit to coordinate their assignment function. We know that at peak times several of the 40 FOs in North Carolina will be notifying us simultaneously about multiple pending interviews.

At the case processing unit level, we are running SI in a real-time working environment, not in a pilot setting that creates artificial circumstances such as reduced work loads for participating examiners, additional support staff, or reduced production expectations. Because we did not know what impact interview time would have, we did reduce case assignments for the first examiners involved in SI. When we expanded to two DDS units and two FOs, we placed all examiners on a full share of cases.

A major concern we had going into SI was the additional examiner time required to conduct the interview. Overall, there is a slight increase. I am not ready to assert what amount of time is added to the examiner’s job. Obviously, that measurement will vary among DDSs, depending on current practices with respect to calling claimants. We have established that the need for recontact is dramatically reduced. For us, the opportunity to cover most issues with one call has saved time and partially offset the investment of interview time.

To make the effort as realistic as possible, we excluded very few initial claims from the process. We agreed to accept both scheduled and walk-in claimants and teleclaims. Only a small group of claims involved in a separate Greenville project with a hospital were excluded from SI. Otherwise, no claim was exempt unless the claimant would not accept a telephone interview (we had one occasion of this and it was impairment-related.)

In Charlotte, we have even included claims that are taken in outreach projects. Just to illustrate public response to improved service, claimants heard that they could get faster decisions by filing at the hospital outreach location and the facility became swamped. Of course, the same level of service was available at the DO.

We expanded to six units in order to test methods of case assignment and to determine the most efficient means of passing the interview from the FO to the DDS. The expansion also allowed us to involve more people in interviewing and thus get a broader base for identifying problems in work flow. The volume of initial receipts from the largest FO is sufficient to provide a full complement of SI claims to one unit. This allows us to continue to monitor the overall effects of SI on our unit structure. The other five units receive a mix of SI and regular cases.

The unit that has full SI receipts, reduced its average processing time by five days within five months of initiating sequential interviewing. This unit was already below the agency average when they started SI. For comparison purposes, it is significant to know that the agency average is among the leaders nationally. I am confident, therefore, in attributing the unit’s improvement to SI rather than the correction of some other inefficiencies.

Interview times for all participants have averaged under twenty minutes, which is even more impressive in light of the reduced need for follow-up calls. Estimated FO interview times ran as much as twice the DDS time. The DDS advantage is easy to understand. The FO is required to obtain information that may not be necessary to the claim. Since they are not responsible for the development, they cannot know what information to pursue and what not to pursue and must follow a rote pattern of questioning. Obviously, this is not a criticism of the FOs. They have no alternative under the current system.

The examiner, on the other hand, has the opportunity to focus the interview on the alleged impairments and to secure information that is pertinent to alleged limitations and treatment. If the allegations will require ADLs, the examiner can secure them on the spot. If the allegations and interview indicate a possible medical-only allowance, the examiner can determine the best source, shorten the interview, call the source, and essentially complete the claim before moving to another claim. Also, there is no learning curve for DDS examiner interviewing. Examiners have always called claimants, physicians, employers, and other third parties for information. SI is just an expansion of a current task.

Overall, it is the opportunity to act immediately that is a major advantage and source of savings in SI. The examiner can proceed directly into development while the facts in the case are fresh. This same advantage of timely service , however, is a part of the major challenge in SI.

When the FO and DDS must wait for the claimant to sign and return the application and release forms, the DDS must delay development. A percentage of claims never materialize after the interview. The claimant, for whatever reason, may decide not to follow through. Because of this possibility, we do not create MER obligation until the claim is officially established by the FO. Too, many sources require a release form before they will release evidence.

Certainly, in the majority if cases, the claimant eventually returns the forms. However, the examiner will have lost the opportunity to act promptly. Time will be lost in reviewing the file and deciding a course of action. This is, for all practical purpose, double handling.

To overcome this delay, we are evaluating a procedural change that postpones the interview until the forms are returned. The claimant will be sent a cover letter explaining that an examiner will call immediately upon receipt of the application. The claimant must the return the material to the FO in order to continue the claims process. At the point the forms arrive in the FO, the process is virtually the same as the normal hand-off of an interview. This approach does not impose any delay from the claimant’s perspective. Both the DDS and FO are taking action at the earliest possible time.

We are planning an exception in the mail process for homeless claimants and others for whom telephone contact seems to be a problem. Identification of these claimants will be at the FOs discretion. The DDS will perform these interviews at the first contact (i.e., teleclaim through the FO), risk the claimant not following through and accept the lost efficiency of not being able to undertake immediate development. Again, we must be sensitive to what is best for the claimant.

I would endorse the following points among the major gains and advantages of sequential interviewing by the DDS:

1. Having direct and early contact between the claimant and the decision maker and providing a faster decision.

2. Taking advantage of DDS expertise in adjudication. Knowing what is needed for a decision so the DE can elicit detailed information about treatment and focus on relevant lines of inquiry regarding impact of the impairment and ADLs.

3. Using the automation and mass production capabilities of the DDS to immediately generate development requests on claims that do not require delayed handling.

4. Having training and supervisory oversight on a continuing basis to monitor and correct deficiencies.

Our hand-off between the FO and DDS is still being refined. We know that both DDSs and FOs will need to make changes in their work flow in order for sequential interviewing to work on a state wide basis. Staggered FO interview times and extended hours of DDS coverage for accepting interviews are examples of accommodations that appear necessary. Again, we are still searching for the most efficient service to the claimant. Overall, sequential interviewing makes good business and, most importantly, good service sense.