APPENDIX J
Testimony of the SSA Commissioner concerning the backlog
House Committee on Ways and Means Investigates
Social Security Disability Backlog. This is what the Social Security
Commissioner told the House about the problem.
Statement of The Honorable Michael J. Astrue,
Commissioner, Social Security Administration
Testimony Before the House Committee on Ways and
Means
April 23, 2008
Thank you for this opportunity to update you on
our efforts to improve our service to the American public.
I would like to start with Social Security’s
front door, the field office. The past few years have been tough for
field offices. As overall agency employment dropped from 63,569 in 2003 to
60,206 at the end of 2007, field offices felt the effect of staffing losses
more intensely because so many of our activities mandated by law are performed
in our field offices.
As staffing fell, workload burdens grew.
The general population continued to grow, and it got older, which meant more
retirement applications and more disability applications. New state laws
aimed at illegal immigrants increased the number of people seeking replacement
Social Security cards. New federal statutes required claims
representatives, teleservice representatives, and other field staff to take on
complex and time-consuming new responsibilities in Medicare Part D. This
year, our field offices are processing additional requests for 1099s to help
taxpayers file for payments under the stimulus bill.
Our field offices do their best, but simply
cannot provide the level of service the public expects from the Social Security
Administration at recent levels of funding. This Committee has recognized
this problem and I would like to thank you for providing SSA with the resources
to better fulfill our responsibilities to the American public. The 2008
appropriations was the first time that Congress has appropriated at or above
the President’s Budget request since 1993.
We are grateful to you for your support, and it
is helping our field offices and teleservice centers provide improved
service. We will use some of the extra funding to strengthen our direct
service operation with the hiring of 3,900 employees, 1,300 employees more than
the expected losses for this year. We are not going to be able to meet
our challenges by continuing to ask for more money to maintain the status quo.
Increases in personnel and infrastructure costs alone for the fiscal year that
starts this October will be at least $400 million.
To cope with rising workloads and likely fiscal
constraints, we have systematically reviewed the information that we routinely
request from or provide to the public. We believe that if we can
automate, reduce, or eliminate such information exchanges, we can improve
efficiency as well as the quality of our service and the morale of our field
employees. Our Ready Retirement Team has been leading this effort by
focusing on streamlining the retirement application process, a logical choice
because this past January the first of nearly 80 million baby boomers filed for
retirement.
This team already has driven change by
determining that retirees born in this country may not need to provide their
official birth certificate to prove their age. Instead, if a retiree
alleges a date of birth that satisfies our authentication standards, we will
accept the allegation. This simple change will allow baby boomers to file
more effortlessly over the Internet, telephone, or in our offices, employing a
more efficient process that will accelerate payment of the first check.
Furthermore, field employees will save time on a significant number of claims
each year.
The Ready Retirement Team also has greatly
improved the information available to people trying to decide the right date
for their retirement. As we will soon announce, we are planning to
provide people highly accurate on-line estimates of their monthly retirement
benefits, which we compute by using their actual earnings records. Our
current online estimators are difficult and time-consuming to use, and often
fall short on accuracy. The new version will be simple, easy-to-use, and
highly accurate. Our team worked hard with the technology and with
privacy experts to ensure that the negligible risks of inappropriate disclosure
of personal information justify the substantial benefits.
Although our electronic services are usually
ranked as the best of all federal agencies, my judgment is they are far from
good enough yet to deal with the imminent tsunami of baby boomers’
claims. After broad consultation with experts and advocacy groups, next
month we will be unveiling our new website, which will eliminate some of the
visual clutter and be significantly easier for the public to navigate,
especially if they are reaching out to us for the first or second time.
Our improved website will introduce the public
to the next critical Ready Retirement initiative: a total overhaul of our
online retirement application. Our current online form was put up quickly
about 8 years ago. It is nowhere near best demonstrated practices, and
for most of this decade only about 10% of the public has chosen to apply for
retirement online.
In order to keep field offices from being
totally overwhelmed, we are going to need to drive that online filing figure up
from about 13% to 50% over the next 5 years. The Ready Retirement Team
has a September 27, 2008 deadline for the first step of a two-step
implementation, and it has already shown a terrific prototype to advocacy
groups, and the Social Security Advisory Board. We found that we could
eliminate or simplify the vast majority of the application questions, and that
we could use cues, links, streaming video, and other techniques from the best
financial services websites to give the public a friendlier, faster, and
simpler experience. We expect the current 45 minutes for the average
online retirement filing to drop to an average of 15 minutes.
The second step of the Ready Retirement process
requires modification of 39 separate COBOL-based systems and will involve some
additional improvements to the form itself. The key improvement will be that
our computers will automatically send the claim to payment without the
involvement of a claims representative. In the coming years, this one change
could free up enormous amounts of staff time.
A similar work-saver that we recently
implemented is iAppeals. As you know, State agencies, called Disability
Determination Services, decide disability claims on our behalf at the first two
levels of the adjudication process. Currently, to appeal an adverse
Disability Determination Services decision, the claimant or the claimant’s
representative fills out a paper form and sends it to a field office, where the
staff manually enters the appeal into a system.
iAppeals, which is now used on a voluntary basis
in about 10-15% of all cases, eliminates this unnecessary manual work, reduces
the likelihood of human error, and ends one source of delay that contributes to
backlogs. For these reasons, in the coming year, we will propose a
regulation that will require claimants’ representatives to use iAppeals; the
status quo will be available for unrepresented claimants.
We also are having a separate intercomponent
team study the waiting areas in our field offices to improve both the
efficiency of the office and the experience of the public. We expect to
roll out many changes in the next year that will improve seating, layout,
privacy, signage, and other small, but important, things that make visiting a
field office a better experience.
Last month, I authorized the purchase of new
intake kiosks for field offices that will provide a modern, fast, and
user-friendly tool for the public to register the reason for their visit.
These kiosks incorporate touch screen technology and are similar to those many
Americans use for airline travel. We are also piloting the use of
personal computers in the field office reception area to provide the public
with connectivity to the SSA Internet website. These personal computers
provide an option for those people who may not have access to a personal
computer, or may not have understood our e-service options, to transact their
business with us electronically.
We are looking at using an unobtrusive slideshow
presentation to remind people of the documents they need in order to file a
claim or receive a new or replacement Social Security card. Those people
who do not have the necessary documentation with them can leave to get it and
come back, or call a family member to bring it to them, so that they will have
a fully successful visit. The slides will also provide information about
our online and 800 number services so visitors know there are alternatives to
visiting a field office the next time they need service.
Before I discuss our efforts to improve our
disability process, I want to mention that immigration initiatives and
demographic shifts have further strained some field offices with demands for
new and replacement Social Security cards. To ease this pressure,
we have moved to specialized card centers, mostly in densely populated and
rapidly growing urban areas. These centers allow us to provide faster,
more efficient, and more accurate service to the public. We are co-locating
these new centers with field offices because doing so is cost-efficient,
provides more career ladder opportunities to our employees, and most
importantly, better serves the public.
Now, I would like to turn to the disability
backlogs by starting with an update about our efforts to improve the quality
and speed of Disability Determination Services decision-making. In a time of
agency contraction, for most of this decade the Disability Determination Services
have suffered even deeper cuts than SSA. We have taken steps to reverse
this trend, and I am very pleased that the Disability Determination Services
will be able to replace all staff who have left or will leave their agencies
this year. This support is a key part of our effort to bring the number
of pending cases at the State level down below 500,000 for the first time since
1999.
Additional resources are vital, but must be
accompanied by our commitment to work smarter. A valid longstanding Disability
Determination Services criticism of SSA is that our medical listings do not
provide enough detail and do not keep pace with medical advances. In
making disability determinations, SSA uses the Listing of Impairments
(the Listings) which describes impairments that are considered severe
enough to prevent a person from doing any substantial gainful activity.
Although the Listings are a critical factor in SSA’s disability
determination and have been used in millions of cases since their initial
development in 1955, I discovered last year that some of the important listings
had not been updated for decades. Updating the Listings on a
regular basis will allow disability adjudicators to resolve disability cases
more accurately and efficiently. We have already published several final Listing
regulations, and we have developed a schedule to ensure that we update all of
our medical listings at least every 5 years.
In addition, we have made a special effort to
provide guidance to decision-makers on the rare diseases and conditions where
we are most likely to delay decisions and make mistakes. This new emphasis on
rare diseases and conditions is an important element of our effort to use
computer technology to pull the straightforward cases out of the queue and resolve
them in an unprecedented brief period of time. Our retrospective analyses
indicate that a surprisingly high percentage of these cases are either decided
incorrectly or take an unusually long period of time to adjudicate.
The first piece of what will be a two-track
fast-track system is now up and running across the country. It is called
QDD – for Quick Disability Determination – and right now about 2.3 % of all new
claims are being identified for QDD processing, and over 96% of them are
allowances. QDD allowances are being decided in an average of 6 to 8
days. During the next several months, we expect the proportion of cases
being identified for fast tracking will increase as we continue to make
adjustments to, and test the limits of, the computer model. These adjustments
should not affect the processing time nor the allowance rate for QDD
cases.
We are also getting close to piloting the second
track, which we are calling compassionate allowances. These are cases
where the disease or condition is so consistently devastating that we can
presume that the claimant is disabled once we confirm a valid diagnosis.
By deciding more cases based on medical evidence alone, we can reduce the
number of claims that require further review.
Since this is new territory, we do not know what
the eventual mix of QDD and compassionate allowance cases will be, but a
reasonable guess is that by the end of 2009, about 4 % of our claims will be
fast-tracked. By the end of 2012, that number could be 6% to 9 % of our claims.
I stress, however, that right now these numbers are best guesses and that we
will not really know until we have pushed this effort for a longer period of
time.
We have also extended nationwide the Request for
Program Consultation, a Disability Determination Services quality initiative
that was incorporated into Disability Service Improvement. As we are
speeding up our processing of cases, it is essential that we maintain our focus
on accuracy. An institutionalized forum for communication between Disability
Determination Services and SSA on problematic cases is an important part of
that effort.
The Request for Program Consultation provides an
electronic forum to resolve disagreements between the Disability Determination
Services and our Office of Quality Performance. These disagreements may
involve, for instance, whether a Disability Determination Services agency
obtained appropriate documentation, applied policy correctly, or decided the
case accurately. The Request for Program Consultation is a web-based
application that is available to Disability Determination Services
nationwide. The Request for Program Consultation website allows
Disability Determination Services to submit requests electronically and those
requests appear instantaneously for review by the Request for Program
Consultation Team. The Request for Program Consultation Team analyzes and
resolves cases within seven days. Prior to this consultation process,
Disability Determination Services often waited several months for a definitive
resolution on complex cases. The Request for Program Consultation allows
us to gather data on each request and share it with all users so that they may
use that information to write better policy and make better decisions.
As we work to improve the timeliness and quality
of our disability determinations, we are also considering longer-term systems
improvement. We will be having important discussions with State
administrators in New Orleans next week to discuss a unified information
technology system to replace the current 54 separate COBOL-based systems that
are increasingly difficult to modify and expensive to maintain. A similar
consolidation effort collapsed in early 1999, but we have been working toward
this goal for nearly a year, and I am cautiously optimistic. If we can
obtain a sufficient degree of consensus with our partners in the States in the
next few months, we may move forward with this essential improvement provided
we have sufficient resources..
We are working on a new software tool called
eCAT (Electronic Case Analysis Tool) for use by disability examiners.
eCAT will prompt examiners about questions they should ask and documentation
that they need before making a disability determination. The initial model for
eCAT was developed by the Pennsylvania Disability Determination Services.
Unfortunately, eCAT was implemented prematurely as part of Disability Service
Improvement and failed miserably. The Virginia Disability Determination
Services is helping us refine eCAT so that we properly implement a good
concept. While eCAT will not be ready to pilot earlier than next year, it
offers the hope of using cutting-edge technology to make faster, more accurate,
and better-documented decisions.
I would like to now turn to the hearings
backlog. If you step back and look at the system as an economist would,
we have had, for many years, issues of allocation and distribution of
resources. The problem of allocation has been painfully clear – compared
to 10 years ago we have about 176 % more disability cases. We have taken
a big step toward resolving that problem by bringing onboard the 175 additional
administrative law judges and additional staff to support them. If we can
resolve space issues, we will also bring on another 14 National Hearing Center judges
this year.
The resource distribution problem is neither
obvious nor is its cause clear to me. Nonetheless, when you look at where
we were a year ago, it is clear that there was a longstanding imbalance in
Office of Disability Adjudication and Review resources. In particular,
the Chicago and Atlanta regions were dramatically under-resourced compared to
the rest of the country. The hearing offices in many of the most
backlogged cities – such as Atlanta, Cleveland and Detroit – were receiving 3-4
times as many filings per administrative law judge as offices in Southern
California and New England.
We have moved swiftly to correct this
problem. Where we can address it by changing jurisdictional lines in
adjacent locations, we have done so. As an example, our suburban
Pittsburgh office now serves Youngstown and other parts of eastern Ohio to take
some of the burden off overloaded offices in Cleveland and Columbus. For
the same reasons, we have reassigned responsibility for cases scheduled for video
hearings to less busy offices. At our site in Toledo, we have video
hearing capability, so that now administrative law judges in Boston assist the
Toledo office with their video hearings.
Our new National Hearing Center (NHC), which
holds video hearings from a central location, also gives us the capability to
move cases quickly and flexibly to conduct video hearings in the cities with
the worst backlogs. Right now, our NHC administrative law judges are
focusing their efforts on the backlogs in Atlanta, Cleveland and Detroit.
We are planning to expand this NHC initiative as soon as we can and intend to
address the backlogs in Miami, Columbus, Indianapolis, and other cities where
claimants have been waiting the longest.
With the allocation of the 175 newly-hired
administrative law judges, we have made equalizing resources a priority even
though we have received some criticism for doing so. We are sending 10 to
Ohio and just 1 to New England. That is not a regional bias – I am from
Boston myself – but a data-driven decision that recognizes that there is a
strong correlation between filings per administrative law judge and cases
pending.
We have also received some criticism that we are
not providing adequate support staff for our administrative law judge corps. In
my opinion, that is a fiction designed to sidetrack some of our productivity
initiatives. Since I began as Commissioner, I have increased the number
of support staff per ALJ from 4.1 to 4.4. The number of staff needed to
support a disposition will change as we fully implement the backlog plan, but
at the moment that number is difficult to project with any certainty. We
know that automating many of our clerical functions will reduce the amount of
time spent by staff on more routine tasks, and allow them to absorb additional
workloads. We are also working to standardize our business process, which
should result in additional staff efficiencies. We will continue to
monitor the appropriate staff to ALJ ratio as the new processes are implemented.
While we will still have a handful of offices
that will be under-resourced due to various barriers, such as the cumbersome
process for adding additional space, we are just months away from no longer
being able to offer resource issues as a defense to poor productivity.
It is time for everyone from senior management to the most junior support staff
to commit themselves to finding the best ways to work together to make sure
that nobody waits an inexcusable period of time for a final decision on an appeal.
Performance varies greatly from office to
office, and we are working toward having the least productive offices model
themselves, to the extent possible, after the more productive offices.
While waiting for the new administrative law judges and support staff to be
fully trained and productive, we have done our best to attack the backlogs with
a series of administrative and regulatory changes that have slowed the increase
in pending cases and slightly reduced average processing times. We could
have made even greater progress, but chose instead to make the important
commitment to clear out the most aged cases where the claimant has waited 1,000
days or more for a hearing. I would like to take a little time to explain
why that decision is so critical.
For most of this decade, SSA created rules and
incentives focused solely on the most prominent metric for measuring the
backlog – total cases pending. As logical as this decision may seem at
first, if you think about it harder you will see that it creates a perverse
incentive to focus on the easiest cases and to set aside the difficult
ones. That is what happened until the start of the 2007 fiscal year, when
we had about 65,000 cases over 1,000 days old, some of which had been pending
for as long as 1,400 days.
Even though these 1,000-day-old cases generally
take 5-6 times longer than new cases to resolve, we set the goal of clearing
them out by the end of the year. We came within 108 cases of that goal by
the end of FY 2007, and I am happy to report that all of those cases are now
gone. From a moral perspective, we had to dedicate our resources to clear out
these cases because it is just wrong to let claimants wait an unconscionable
length of time in order to meet a hearing-pending goal.
We were not satisfied with our initial success,
and for FY 2008, we redefined our goal as cases 900 or more days old. We
had 135,000 of the newly-defined aged cases at the start of FY 2008. I am
pleased to report that we are ahead of schedule for completing all 135,000 of
these cases this year; we have already completed 63% of them. Our
intention is to reduce the tolerance level again in FY 2009, but I plan to wait
until September before doing so.
I know you recognize that our ability to make
continued progress with this workload in the next fiscal year will depend
greatly on our fiscal position. If we do not receive a timely
appropriation or must deal with the uncertainties and budget reductions created
by a continuing resolution of unknown duration, our task will be much more
difficult to accomplish.
Reduction of the aged cases should also produce,
later this calendar year, a real benefit for everyone who is waiting. The
aged cases represent a large percentage of the paper cases in the system, and
it is extraordinarily inefficient to run two complex hearing office systems
instead of one. What should give everybody on this Committee hope for
next year is that the paper cases should be substantially gone by the end of
the year – around the same time that most of the new administrative law judges
are reaching full productivity. The convergence of these two events means
that we expect to hit the “tipping point” –where both total cases pending and
average processing time are declining– sometime in January or February of next
year, with the caveat that progress may be slow if we are still under a
continuing resolution.
We have other possible improvements in the
pipeline. In June, we expect to start a 6-month pilot program with the National
Organization of Social Security Claims Representatives, an association
primarily comprised of lawyers. In this pilot, we are testing a program that
will allow representatives to conduct video hearings from their offices. This
initiative should offer convenience and comfort for many claimants, save time
for attorneys, and cut down on our investment in bricks and mortar, a cost
which increases above the rate of inflation year after year.
We are planning on a test in Michigan which will
use the same type of case profiling mechanisms that we used in our successful
attorney-advisor and informal remand initiatives to look at cases heading from
the Disability Determination Services to Office of Disability Adjudication and
Review.
Michigan is a "prototype" State that
does not have reconsideration, and we are looking at ways of providing a quick
screening tool to enhance the quality of the initial determinations. What we
learn from this screening activity may help us identify cases that can be
triaged at an earlier point in the appeals process.
We have started a pilot on centralized
processing of notices, which may sound dull, but in theory should save an
enormous amount of time for hearing office support staff that then can be used
for moving cases. Regardless of the success of this pilot, at a minimum
it will be an opportunity to make Office of Disability Adjudication and Review
notices more up-to-date, clear, and user- friendly.
We will continue to improve Office of Disability
Adjudication and Review’s basic electronic system. A new system to help
support staff ready files for hearing should be rolling out state-by-state by
the end of the year. We are working on systems that will improve
docketing and allow authenticated attorney representatives to access the
records to check files for such things as case status and evidentiary
development. As I have said before, there is no magic bullet answer, just
a multitude of small nitty-gritty improvements necessary to run a more
efficient and compassionate process for the American public.
Before I close, I feel obligated to bring one
aspect of last month’s Trustees’ Report to your attention. Although the
combined OASDI trust funds do not reach exhaustion until 2041, the disability
trust fund will be exhausted in 2025 under current assumptions. Although
that date is later than the 2019 trust fund exhaustion date for Medicare
Hospital Insurance, it is one more reason why Congress needs to work together
on a bipartisan basis with the administration to give younger Americans reason
to have confidence in the future of Social Security.
To conclude, we have made slow and frustrating
progress in fixing our service delivery problems, but we are making progress,
and I am grateful to each Member of this Committee for your support. As I
have laid out in this testimony, changes that will take place between Labor Day
and the end of the year – streamlined online filing, at least 175 new
administrative law judges picking up steam, and the full shift from paper to
electronic systems in Office of Disability Adjudication and Review – should
produce considerably more improvement next year. Operating under a continuing
resolution for a prolonged period of time would worsen a situation already made
difficult by years of increasing workloads and limited resources. It is
also essential that we receive the full President’s Budget for FY 2009 in order
to keep up with increasing workloads and meet our commitment to eliminate the
hearings backlog by the end of FY 2013. So I ask for your timely support
of the President’s budget.
Thank you for this opportunity to lay out in
detail our plans and progress, and I will be happy to answer any questions you
have.
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