Articles from prior issues of The Advocate

September/October, 1998

Redesign Meeting with DPRT and SSA Components
by Debi Gardiner, NADE President

NADE MET WITH MEMBERS OF the Disability Process Redesign Team on Thursday, July 16. The meeting was one in a series of meetings held with stakeholder groups to review and discuss redesign test data.

Sue Davis, DPRT Director, opened the meeting.

Sandi Sweeney, Communications Team Leader for DPRT, talked about the themes for the previous meetings. Management discussed preliminary data, cost benefit analysis, resource impacts, staff and support, changes on the employees and workloads and customer service impact. The panel was generally positive. The unions had a concern regarding Single Decision Maker (SDM) and the elimination of Medical Consultants from any of the cases. They discussed the enablers not being in place and the loss of job security. Elimination of reconsideration was also an issue. The DPRT team felt this was also a positive panel. It is believed that this will result in better customer service. Also, one of the Medical Consultants in attendance stated that he believed that he could trust the SDM to consult when it was necessary. The NTEU discussed the AO and Senior Attorney process. Job security appeared to be a concern and there was some feelings that the AO could eliminate the staff attorney. They felt the attorney skills better qualified them. There were also concerns that under the OQA process, regarding the ALJ review of the senior attorney.

The SDMs were highly motivated. They liked the independence and took more ownership.

Harry Pippin, Team Leader for the Full Process Model (FPM) Test and Mark O’Donnell, Program Analyst for the SDM Pilot discussed on-site visits. Key findings were the management was supportive, there was concern with 100 percent review and the backlogs which came about. It was noted that the SDM, under FPM, could handle 85 to 100 cases, but it was unmanageable at 120. The AO was comfortable at 50 to 60 cases. They believed the Pre-Decision Interview (PDI) provided better public service; however, very few determinations changed. Decisions were better in the stand alone. PDIs took about 15 to 30 minutes on the phone and 45 minutes to an hour if done in person. The SDMs were highly motivated. They liked the independence and took more ownership. They were frustrated with the backlogs. They believed they were making better decisions and providing better public service. It was more demanding. The Medical Consultants, for the most part, were supportive of FPM. They now realize that it makes more efficient use of their time and talents. The AOs were enthusiastic. They felt they needed more support staff and the lack of feedback was frustrating. When there was FPM, it is believed the cases were better documented. They believed the claimants that had a PDI were better informed. OHA felt that the AOs in FPM were better documented. At first, the examiners were excited about SDM and the doctors were lukewarm (at best). SDM is a misnomer. It was noted that examiners operate on one track and MCs on another. Face-to-face referral to the MCs coadjudication worked. It is actually an enhancement in the MC role. Using examiners to complete assessment forms allows the MCs to help the examiner in their adjudicative skills. From an operational standpoint, face-to-face MC/examiner consultations, rather than written, are better. This (MC/examiner) procedure reduces backlogs, increases the level of accuracy, decreases the incidence of technical returns, and the examiners still tend to use the MC more with combinations of impairments. The SDM tends to magnify any weaknesses an examiner has in case management. Every SDM said that he/she could not work more than 12 cases a week. There is a need for a great deal of training. Unit by unit, rather than examiner by examiner, is probably better. When doing this as an individual, there is nobody there for backup. They are currently looking into the ordering of CEs and reviews of the report (because the MC’s name is on the request they feel their license could be on the line).

Kelly Croft, Director of Workforce Analysis, stated that the study is still very much ongoing. The numbers are changing, especially in the hearing process. They do not know yet where it will end up. (Kelly provided us with a handout.)

Tom Evans, Deputy Associate Commissioner of the Office of Quality Assurance provided us with a handout and an overhead presentation that was very informative. He stated that to be a winner, we must:

1) Pay eligible people sooner,

2) Cut cost of administrative process, and

3) Watch the program.

Does FPM accomplish this? The projectability of the pilot is critical. We have to know what will happen in the DDSs and OHAs to know about the cost of FPM. Every time we have a 1 percent increase in allowances, it is another 2 billion dollars. Of the people offered PDI, 38.6 percent appealed and of those not offered the PDI, 46.0 percent appealed - so 7.4 percent were stopped by PDI. Only 55.7 percent accepted the PDI. How do we make this number go up? In FPM, there has been a substantial increase in the improvement of quality/accuracy. It takes approximately 700 days to get paid by the ALJs (this is an average). The bad news is, you have 60,000 more appeals to OHA under the FPM. FPM without PDI puts almost 200,000 cases extra in OHA. They do not do FPM without the PDI. The AO is paying about 16 percent in stand alone. FPM AO is paying about 12 percent. The quality, for AO stand alone, has substantially improved over time. DDS quality on steps 4 and 5 is not as good as the AO. FPM AO exceeds all prior performance levels. The allowance rate is 52 percent. When AO/ALJ stand alone, it went up 8 percent to 60 percent. There are fewer dismissals. The denial rate does not change. With FPM the denial rate is 57 percent. The ultimate allowance rate is 1 percent under the FPM. The bottom line analysis is:

1) How will we use the test data to make projections for a national rollout?

2) Allowance rate is marginally higher, they are allowed earlier and the PDI gives better claimant service.

3) The PDI adds days, allows 3.2 percent, improves overall quality, reduces the rate of appeal 7 percent and would add more cases to OHA.

4) Accuracy decreases program costs and increases costs for fewer incorrect denials. 5) Customer service - more served early, people like the PDI and it takes 130 days out of the process to reach OHA.

Mary Glen Croft, Project Officer for the AO Pilot, provided us with a handout on the AO Pilot and talked about many of the issues which had previously been discussed in regard to the AO position.

Sue Davis, Sue Roecker, (Deputy Director of DPRT), and John R.Dyer, (Principal Deputy Commissioner of Social Security) ended the meeting with discussion, questions and answers and wrap-ups. We talked about the impact of SDM on the individual (workload, processing, etc.) We wondered how the claimants felt about FPM. Tom Evans told us that they were in the process of obtaining information on this issue and they will share it with us when the receive it. We discussed productivity and cost. A great deal of discussion ensued about training. We talked about how training would be critical if this were to succeed. Training needs to be consistent between the MC and the SDM. Training will be needed for interviewing, completion of forms, new roles and skills and just to help in the transition from being a paper process to becoming more claimant oriented. Time frame for implementation was talked about a length. How long is needed for training? Do we do this all at one time? How do we make the transformation? We discussed the need for clear policy and procedures.

The meeting was extremely informative and we really are appreciative to all of those who attended and for having the opportunity to provide input.