U.S. House of Representatives
- February 28, 2008
Committee
on Appropriations
Subcommittee on Labor, Health and Human
Services, Education, and Related Agencies
Statement for
the Record
Reducing
the Disability Backlog at the Social Security
Administration
The Honorable Patrick P. O'Carroll, Jr.
Inspector General
Social Security Administration
February 28, 2008
Good morning, Chairman Obey, Congressman Walsh, and members
of the Subcommittee. It's a pleasure to be here today, and I thank the
Subcommittee for the invitation to testify, and for your commitment
to the efficient and accurate operation of the Social Security Administration
(SSA). Efficiency and accuracy in SSA's operation is of course more
than an issue of preventing the waste of appropriated funds; it is a
critical public issue affecting millions of Americans every day. Like
this Subcommittee, and like SSA itself, my office is committed to doing
all it can to confront the many challenges that SSA faces in bringing
critical benefits to the people who rely on them for their well-being.
Of the challenges inherent in administering the world's largest social
insurance program, SSA currently faces none greater than the backlog
of disability claims. SSA's data as of the end of January 2008 indicate
that the number of cases waiting for a hearing decision was 751,767,
leading to average waiting times for FY 2008 of 499 days. This waiting
time for appeals is unacceptable, and despite SSA's efforts over the
past several years, the delays have actually increased, rather than
decreased. Since taking office, Commissioner Astrue has renewed and
reinvigorated SSA's efforts to reduce these backlogs. My office is working
closely with him in this regard, and I am confident that through our
efforts, and with Congress' assistance, we will be able to make significant
headway.
I am particularly pleased that in attempting to reduce the backlog,
Commissioner Astrue is cognizant of the need to maintain the integrity
of the process. From the OIG's inception in 1995, we have sought to
help SSA strike the balance between service and stewardship. Since that
time, we have succeeded in helping SSA maintain its reputation for quality
and responsive public service, while significantly improving the accuracy
and integrity of SSA's programs. Unfortunately, the exception to SSA's
service reputation is the disability backlog. Action can and must be
taken to reduce, and then eliminate, the lengthy delays faced by disability
applicants, without compromising the integrity of the program.
To address this challenge, SSA must address problematic issues in a
number of areas:
First, the structure of the SSA components that oversee the disability
process has already been studied, streamlined, and improved through
a joint effort between SSA and the OIG, and I'll describe that effort
in detail in a moment.
Second, issues of staffing, productivity, and the use of technology,
particularly in SSA's 140 hearing offices must be addressed. Are the
hearing offices adequately and appropriately staffed, with an efficient
ratio of support personnel to judges, to ensure that they are performing
at maximum efficiency? Are hearing offices, and Administrative Law Judges
(ALJ) in particular, operating at acceptable and consistent levels of
productivity? And is SSA making full use of available technology, from
case management systems to electronic disability folders, to improve
the disability process and hearing office performance? The OIG has completed
audit work in these areas, and is both performing and planning additional
work, and I will describe those efforts as well.
Third, SSA, with the help of the OIG and Congress, must continue to
seek new and innovative ways to improve the disability process and reduce
waiting times. Over the years, various plans have been introduced and
piloted or implemented with varying degrees of success. Under a new
Commissioner, new ideas must be brought forward to improve critical
service delivery to disability applicants.
Finally, I spoke a moment ago of stewardship, and in this vein, any
plan for improvement in the disability adjudication process must include
mechanisms to ensure that the evidence being used to adjudicate claims
is genuine and that claims are being adjudicated fairly, accurately,
and consistently. Again, my office has performed work in this area that
should assist the Commissioner in his plans to reduce the backlog, and
more work is in process.
With all of these issues in mind, we are working closely with SSA on
new and innovative approaches to old problems, and I applaud the Commissioner
for his dedication and ingenuity. I'd like to address each of these
issues to give the Subcommittee a comprehensive understanding of the
OIG's work in these areas and our role in reducing the disability backlog.
Management Structure
As I mentioned earlier, one of Commissioner Astrue's first actions
upon taking office was to examine the management structure of SSA.
Prior to Mr. Astrue's arrival at SSA, the Agency had for some years
been planning and implementing its Disability Service Initiative (DSI),
a comprehensive redesign of the disability determination process. The
development of DSI had altered several aspects of the Agency's structure,
particularly within the Office of Disability and Income Security Programs
(ODISP). Since Commissioner Astrue would proceed with some, but not
all, aspects of DSI, it was not clear that the current management structure
remained appropriate to his plans.
To that end, he requested that the OIG conduct an evaluation of ODISP,
the component responsible for directing and managing the planning, development,
and issuance of operational regulations, standards and instructions
for the OASDI and SSI programs. He requested that this review be conducted
in a 6-week timeframe, that it be as comprehensive as possible, and
that it include recommendations for any restructuring that the OIG thought
would better enable SSA to confront the disability backlog.
That review determined that ODISP was not focused solely on planning
and program policy issues, but was responsible for several operational
functions that detracted from its primary policy function. In addition,
we found communication lacking, both within ODISP and between ODISP
and other SSA components. We also believed that some functions within
ODISP might be better aligned to improve coordination and productivity,
and that some operational functions appeared to be inconsistent with
ODISP's mission and might be better managed elsewhere in SSA.
In light of our findings, we provided the Commissioner with a detailed
list of recommendations for the restructuring of ODISP, the redistribution
of certain ODISP functions, and the centralization of SSA's policy function,
which was in many ways shared between ODISP and SSA's Office of Policy,
creating unnecessary redundancy and confusion.
SSA generally agreed with our recommendations and made sweeping changes
to the management structure of ODISP in particular, and of other components.
These changes have laid the framework for improvements to multiple SSA
processes, including the disability adjudication process.
Staffing, Productivity, and Technology
Staffing levels, the productivity of staff, and efficient use of technology
are key elements in improving the disability appeal process. If staffing
is insufficient, and if productivity is substandard or inconsistent,
timeliness and accuracy (service and stewardship) both suffer. Moreover,
providing additional funding and resources to SSA creates an obligation
to use that funding wisely. All staff should have access to appropriate
technology to maximize performance and accuracy. With this in mind,
the OIG has conducted several audits to assist SSA.
Total case processing time is not only a reflection of the efficiency
of SSA's hearing offices, but of the time it takes for initial claim
determinations to be made in the State Disability Determination Services
(DDS) that make these initial decisions. In 2004, we conducted an audit
entitled Disability Determination Services' Claims Processing Performance,
intended to identify factors that may have resulted in differing levels
of performance at selected DDSs.
We selected 10 DDSs according to a formula designed to provide a relevant
sample that would include both high- and low-performing offices. In
reviewing each of the 10, we discovered that poor-performing offices
were consistently those that experienced the most attrition, the fewest
disability examiners in relation to total staff, and those that purchased
consultative examinations with the most frequency, rather than waiting
for medical documentation from the treating physician that is often
delayed.
We made several recommendations, including that SSA continue to work
with the States to resolve these delaying factors, initiate a staff
model mix with an optimal ratio of examiners to total staff, and initiate
outreach efforts to speed the receipt of treating physician evidence.
Of course, the disability backlog lies primarily in the hearing and
appeals process rather than in the initial determination process. Looking
at those staffing and productivity issues we released another audit
report in 2004 entitled Best Practices in the Highest Producing Hearing
Offices. We found that an earlier practice of soliciting and identifying
best practices in hearing offices had resulted in 24 best practices
that hearing offices had found helpful in improving performance. That
practice, however, had been eliminated, and instead, in 2002 and 2003,
the former Office of Hearing and Appeals (OHA) issued two "best
practices" memoranda, the first listing 191 best practices, the
second listing 271. The sheer numbers of these best practices made it
difficult for hearing offices to determine which to implement, and some
of the best practices were contradictory.
We recommended that OHA (now the Office of Disability Adjudication
and Review, or ODAR) return to its prior practice of soliciting and
distributing a shorter, clear list of best practices. We also outlined
in our own report the most commonly-used and apparently successful practices,
and recommended that OHA share that information with its hearing offices.
SSA agreed with our recommendations.
Turning from best practices to support staff issues, in 2005 we issued
an audit report entitled The Effects of Staffing on Hearing Office Performance.
In that audit, we found that during the 5 previous years, the number
of dispositions per day per ALJ had improved (from 2.03 to 2.40 cases),
yet timeliness had declined (from 316 to 391 days). While some factors
contributing to this apparent contradiction were beyond SSA's control
(such as an ALJ hiring freeze and an increase in claims) the decline
in timeliness could result to some extent from SSA's allocation of staff.
We found that while the national average staffing ratio was 4.7 support
staff for each ALJ, offices ranged from a national low of 3 support
staff per ALJ to a high of 18.5 support staff per ALJ. Of the 76 hearing
offices with a ratio below the national average of 4.7 to 1, 63% had
disposition rates below the national average.
This suggested that disposition rates and timeliness were related to
staffing levels. While increasing staff in every hearing office was
not an option, making sure that staffing levels were consistent surely
was. We recommended that SSA establish and implement an ideal staffing
level ratio for hearing offices nationwide, and provide contract-based
file assembly assistance to those offices whose disposition rate remained
below average even with appropriate staffing ratios. SSA agreed with
our recommendations, and it is our hope that they will make these recommendations
part of their initiative to hire new ALJs.
Our most recent review in this area examines ALJs' caseload performance,
an issue that goes hand-in-hand with the staffing of hearing offices
and consistency among hearing offices. In this audit, we sought to evaluate
the effect of varying ALJ caseload performance on the disability claim
process and the backlog. We found wide variations in ALJ performance
among hearing offices. In fact, during fiscal year 2006, ALJs processed
cases ranging from a low of 40 per ALJ to a high of 1,805. Further,
about 30 percent of ALJs processed fewer than 400 cases per year. This
is a cause for concern, as the agency has indicated an expectation of
at least 500 cases per year for each ALJ. We concluded that if the performance
of ALJs at the low end of the spectrum is permitted to continue, this
will continue to have a negative effect on the disability backlog.
We further surmised that the lack of any formal performance accountability
process for ALJs is a key reason for this inconsistency in performance
and in the resulting negative effect on the backlog. Conflicting opinions
between the Agency and the union representing the ALJs as to the propriety
of establishing ALJ performance standards has thus far frustrated attempts
to impose such standards. We recommended that SSA establish standards,
examine offices where ALJs have high productivity and issue best practices
based on the operation of those offices, and identify offices where
ALJs have low productivity to ascertain the causes and take corrective
actions. SSA agreed with our recommendations.
We also have a related audit in progress, undertaken at the request
of Congressmen Michael McNulty and Sam Johnson. We have begun a review
entitled Administrative Law Judge and Hearing Office Performance. In
that study, we are examining factors that affect ALJ and hearing office
performance, ODAR management tools, and SSA initiatives aimed at increasing
ALJ productivity. We believe that this audit may provide the Commissioner
with important recommendations to improve hearing office performance
and productivity, and will provide Congress with critical information
with respect to funding and staffing levels.
To make the most of better distributed and more productive staff, it
is critical that full advantage be taken of available technology. Case
management software is critical to efficient operation, and the use
of electronic folders can eliminate lengthy delays in adjudications
caused by searching for and transporting millions of claims and hearing
folders.
SSA's Electronic Disability, or e-Dib, initiative uses technology to
improve performance in the disability programs. Specifically, the goals
of eDib are to expand use of the Internet for completing disability-related
forms, to automate the disability claims intake process, to provide
electronic access to disability-related information and ultimately to
produce a paperless disability process. Another important aspect of
this process is the use of technology to track disability appeals and
provide helpful and accurate management information. In a 2001 audit,
we found that the Hearing Office Tracking System (HOTS), the predecessor
to the current Case Processing Management System (CPMS), had inaccurate
data and lacked consistent management controls over data inputs. CPMS
was established, in part, to improve data reliability and management
controls.
In 2006, our Office of Audit examined CPMS to assess its ability to
improve workload management at hearing offices. We found that unlike
HOTS, CPMS management reports were accurate, but also found that ODAR
management did not always use CPMS reports in their caseload management,
particularly with respect to stagnant cases, identified in CPMS' "No
Status Change" indicator. We made recommendations to improve the
use of CPMS as well as to more effectively use CPMS to identify potentially
violent claimants, and SSA agreed with our recommendations.
A year later, we conducted an audit entitled Management's Use of Workload
Status Reports at Hearing Offices, which was designed to assess the
"No Status Change" indicator. That indicator can be attached
to a case by CPMS at 12 different stages of case processing, from "Master
Docket," where the case is first entered into CPMS, to "Mail,"
where the final decision is sent to the claimant. The number of days
that must elapse before the "No Status Change" indicator is
attached (and the case appears in the "No Status Change" management
report), varies for each of the 12 stages.
We examined the workload status reports to determine where bottlenecks
occurred that would significantly delay case adjudications and identified
the three most significant obstacles to timeliness. We also found that
more than 50% of cases were not being tracked at all, including hundreds
of thousands of unworked cases. We made several recommendations to SSA
to improve its processes to take full advantage of CPMS, and SSA agreed
with our recommendations.
Most recently we have initiated a review entitled Timeliness of Medical
Evidence at Hearings Offices. On October 29, 2007, SSA issued a notice
of proposed rulemaking, which proposed revisions of policies and standards
affecting the timeliness of medical evidence. This notice stated that
untimely medical evidence causes ALJs to "…reschedule the hearing,
which not only delays the decision on that case, but also delays the
hearings of other individuals."
The Commissioner requested that the OIG determine what information
is available to demonstrate that medical evidence at the hearing office
level has been untimely. Our current evaluation is an expedited review
of how untimely medical evidence can delay the hearings process, whether
potential bottlenecks are being monitored by management, and the overall
integrity of that management data.
Finally, I want to elaborate on my earlier reference to SSA's e-Dib
initiative. Many aspects of e-Dib should have brought about significant
improvements in the processing time of disability appeals. One such
tool was the creation of electronic hearing folders that eliminates
the often-lengthy delays incurred in locating and shipping folders around
the country. Surprisingly, this and other e-Dib measures appear to have
only marginally improved processing times or reduced the backlog. We
are looking at ways to examine this phenomenon in order to supply SSA
with recommendations on how e-Dib might be better used to improve performance.
New Approaches
Earlier, I mentioned DSI, the disability redesign plan created by the
previous Commissioner of Social Security, which had just begun implementation
when Commissioner Astrue took office. He took a hard look at DSI, and
requested the OIG's input.
The OIG undertook the organizational review of ODISP that I described
earlier, but we also conducted a review of one promising aspect of DSI,
Quick Disability Determinations (QDD), which was already operational
in SSA's Region I and had shown some success. QDD claims are initial
disability claims that are electronically identified by a predictive
model as involving a high potential that the claimant is disabled, for
which evidence can be easily and quickly obtained, and where the case
can be processed within 20 calendar days of receipt. In our audit, we
set out to determine whether cases selected for QDD were processed within
the guidelines established by SSA, and to identify any possible improvements
to the QDD process before it was expanded to SSA's other regions.
We found that QDD cases were generally processed within guidelines,
but that SSA should consider improvements to the case selection process
before expanding the program to other regions. Specifically, we found
that while medical disability determinations were made quickly, non-medical
case development was delaying payment to a significant degree. We also
found that prioritization of QDD claims was problematic in that it did
not take into account the 5-month waiting period for title II disability
claims. Many such claimants were approved through QDD despite the fact
that they would be unable to receive benefits for several months due
to the waiting period. Meanwhile, title XVI claimants, who are eligible
to be paid immediately, received no priority in the QDD queue, nor did
title II beneficiaries nearing the end of their waiting period.
We recommended that SSA seek ways to accelerate the non-medical processing
of claims to avoid reducing the benefit of the QDD process, and seek
ways to prioritize QDD claims to avoid allowing claims that cannot yet
be paid while delaying claims eligible for immediate payment.
We have a number of additional audits planned or in progress that we
feel will assist SSA in reducing the disability backlog. These include
studies of whether video hearings have had an impact on the backlog
and how effectively hearing offices process cases remanded by the Courts.
We will also continue our work on ALJ and hearing office performance
and conduct an audit in which we study aged claims at the hearing level
to identify actions SSA can take to reduce the backlog of these cases.
Accuracy and Integrity
As I mentioned earlier, it is critical that in improving processing
time and productivity, we not lose sight of accuracy and integrity.
One stewardship initiative that has been a resounding success is the
Cooperative Disability Investigative (CDI) program. Designed in the
1990s as a joint effort among the OIG, SSA, State DDSs, and local law
enforcement agencies, the CDI program's mission is to detect fraud early
in the disability adjudication process-at the time of initial application.
Nineteen CDI units in 17 states receive fraud referrals from the State
DDS. DDS staff, the experts in reviewing initial disability claims,
are in the best position to identify possibly fraudulent benefit claims.
They refer the case to the CDI unit, where it is further reviewed by
a DDS examiner assigned to the unit. If it appears that fraud may have
occurred, the examiner then hands the case off to the investigation
team (an OIG Special Agent, who acts as team leader, and two State or
local law enforcement officers).
The CDI program, in addition to preserving SSA funds by detecting fraud
before benefits are ever paid, removes from the determination and appeal
processes cases that will clearly never be allowed. In turn, this preserves
resources in the DDS and in ODAR that can be used to adjudicate legitimate
cases. During fiscal year 2008 to date, CDI has resulted in more than
$110 million in savings to SSA and other agencies. This successful program,
which has grown from five to 19 units since its inception, is limited
only by funding, and has been heralded as a success by GAO, which recommended
placing CDI units in all 50 states.
Finally, there is no more important aspect to stewardship than Continuing
Disability Reviews (CDR). The primary focus of today's hearing is the
process by which disability claims are processed, adjudicated, and either
allowed or denied. CDRs, however, are the only means (other than claimants
who volunteer information that will stop their benefits) by which SSA
learns that beneficiaries' disabling conditions may no longer preclude
them from working. Ensuring that Social Security funds do not go to
initial applicants who are not entitled is no more important than ensuring
that beneficiaries already on the rolls remain entitled to benefits.
I applaud the Subcommittee's support of CDRs and redeterminations and
encourage your continued support in this area.
I have a very productive working relationship with Commissioner Astrue,
and I know that SSA, like the OIG, is dedicated to improving service
and reducing the disability backlog, ever mindful of the need to preserve
stewardship and integrity in the process. I welcome the Subcommittee's
interest, dedication, and support of our efforts, and look forward to
continuing to work with you to deliver the right benefits to the right
people with as little delay as possible. Thank you, and I'd be happy
to answer any questions.
www.socialsecurity.gov
