Controls Over Medical Examinations Necessary for the Social Security Administration To Better Determine Disability

HRD-79-119: Published: Oct 9, 1979. Publicly Released: Oct 9, 1979.

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In 1978 the federal disability insurance program and the Supplemental Security Insurance program paid about $72 million for independent medical examinations of persons claiming disability. The need for and the quality of the medical information purchased is not well documented. Program officials do not know how often state agencies have paid for independent medical examinations which were too comprehensive or were inadequate for determining disability without further information. The way disability decisions are reached differs considerably among the 54 state agencies under contract with the Department of Health, Education, and Welfare (HEW). Social Security Administration (SSA) budget officials have attempted to control the increase in the number of examinations by limiting budget increases until program officials could justify them. Two of the most important factors in determining what the consultative examination purchase rate should be and the number of examinations being purchased unnecessarily are program documentation standards and state agency case development practices.

Differences within SSA over the consultative examination budget demonstrates the need for an improved measurement system. Since SSA does not accurately measure state agency performance and evaluate key issues affecting consultative examination purchases, the appropriate spending level for examinations has not been determined. There is little reliable information on the quality of the medical information purchased. The objective of the disability determination process is to provide quality, uniform decisions to claimants in the least possible time and at the lowest cost to the government. These standards of quality, timeliness, and cost can help to identify problems. However, SSA emphasizes these standards separately and uses them individually to measure performance. This practice encourages state agencies to adopt expedients to meet the short-term goal at the expense of the other goals and the overall program objective.

Recommendation for Executive Action

  1. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Secretary of HEW should direct the Commissioner of SSA to: (1) develop and implement with state agencies clear, concise, and attainable documentation guidelines under the standards of timeliness, accuracy, and cost; (2) conduct a national elapsed time study to determine how long it takes to make a sound disability determination and to identify the best developmental practices used by state agencies; (3) redefine required development practices based on the desired level of time, accuracy, and cost to be achieved by the state agencies; (4) improve the system used to measure state agency performance by setting goals with the help and participation of state agencies, making the necessary changes to the systems used to measure accuracy and processing time, developing a capability to evaluate state agency efforts to obtain the medical evidence of records and the appropriateness and quality of consultative examinations on an ongoing basis, and providing feedback to state agencies based on overall performance rather than considering the performance standards individually; and (4) assist state agencies with correcting problems that limit the achievement of the program objective.

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