Social Security Disability:

SSA Quality Assurance Improvements Can Produce More Accurate Payments

HEHS-94-107: Published: Jun 3, 1994. Publicly Released: Jun 3, 1994.

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Pursuant to a congressional request, GAO reviewed the quality assurance (QA) mechanisms the Social Security Administration (SSA) uses to promote accuracy and consistency in disability determinations for the Disability Insurance (DI) and Supplemental Security Income (SSI) programs.

GAO found that: (1) although SSA has reported a 94-percent accuracy rate for state disability determination services' (DDS) determinations, many people question the reliability of the accuracy rate; (2) the SSA review program is not designed to assess errors, except when eligibility judgments are clearly wrong; (3) SSA is attempting to reengineer, rethink, and redesign its disability determination process to improve the quality of DDS determinations; (4) SSA needs to ensure that QA reviewers use performance accuracy standards effectively; (5) SSA has not reviewed the effectiveness of its accuracy standards since 1980; (6) the effective use of accuracy standards can improve the quality of DDS determinations; (7) although DDS internal QA programs are critical to correcting errors, SSA has not ensured the effective design and operation of internal DDS QA programs; and (8) SSA mass preeffectuation review is a cost-effective interim quality control mechanism, has helped DDS increase the accuracy of their DI determinations, and has saved more than $2 billion in unnecessary trust fund expenditures.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: SSA is redesigning its disability decisionmaking process, including quality assurance (QA). Because the future QA system will be substantially different than the system reviewed by GAO, the development of higher DDS thresholds within the context recommended by GAO no longer applies.

    Recommendation: The Commissioner of Social Security should evaluate the effectiveness of performance accuracy standards in promoting continued quality improvement, including raising the current threshold standard and considering new approaches to setting and using accuracy standards.

    Agency Affected: Social Security Administration

  2. Status: Closed - Not Implemented

    Comments: SSA does not intend to conduct a special study seeking to look at the application of the substitution-of-judgment and probability-of-reversal rules. The agency believes higher priority should be given to other workloads, such as the new welfare reform requirements and increased levels of continuing disability reviews (CDR). Because the study recommended by GAO applies to the current QA system, which will soon be replaced with a substantially different system, the need to spend funds for a special study no longer seems to be justified.

    Recommendation: The Commissioner of Social Security should determine whether QA reviewers are correctly applying the substitution-of-judgment and probability-of-reversal rules.

    Agency Affected: Social Security Administration

  3. Status: Closed - Implemented

    Comments: As part of SSA's plans to redesign the disability decisionmaking process, the agency plans to substantially redesign its system of QA. SSA plans to have an internal QA system that effectively identifies and corrects the root causes of errors up front in the development and adjudication of the case with less reliance on internal "end-of-line" case reviews.

    Recommendation: The Commissioner of Social Security should establish requirements to ensure that DDS have internal QA programs that effectively identify and correct the root causes of errors, including the extent to which any additional QA requirements would result in the need for increased QA staffing.

    Agency Affected: Social Security Administration

  4. Status: Closed - Not Implemented

    Comments: SSA recently revised the method of selection for preeffectuation review (PER) cases to a wholly targeted sample. Consequently, the difficulty of the workload increased, leading to the need to increase medical consultant staff by up to 40 percent. Although this action was taken for purposes unrelated to the GAO recommendation, it resulted in a substantial increase in medical consultant staff, as suggested by GAO. Since SSA plans to eliminate the preeffectuation review as part of its redesign of the disability decisionmaking process, an expectation of further increases in physician consultants would not be realistic.

    Recommendation: The Commissioner of Social Security should develop a plan to increase the savings gained through preeffectuation reviews by increasing the proportion of cases reviewed by physician consultants.

    Agency Affected: Social Security Administration

 

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