SSA on track for automated claims processing

Many citizens who become unable to work and who apply for disability benefits wait an average of 97 days for Social Security Administration officials to process their claims. This is especially true of citizens who live in eight southeastern states in the agency's Region IV.

But that region is hardly an exception. Processing disability claims takes months to complete in almost every region because SSA employees work with antiquated case folders stuffed with paper records. Jo Anne Barnhart, SSA's commissioner, has voiced concerns about the number of people with terminal illnesses who die before agency officials have finished processing their disability claims.

In late 2003, those concerns prompted her to give technology officials 18 months to automate all procedures for processing disability claims and begin using electronic case folders.

The agency's technology executives promised they could meet the June 2005 deadline, despite reservations expressed by systems auditors at the Government Accountability Office. In reports released in March and July, GAO's auditors said the accelerated schedule could produce disastrous results.

"The agency politely disagrees with some of GAO's recommendations," said Bill Gray, SSA's deputy commissioner for systems, as he pointed out features of the agency's new electronic case folder.

SSA officials call the case folder the centerpiece of automated disability claims processing. But the folder's most difficult feature to automate, Gray said, is medical evidence submitted by physicians.

Most medical offices and clinics keep patients' medical records on paper. This practice is a national problem that has contributed to excessive health care costs, according to Robert Kolodner, acting deputy chief information officer for health at the Department of Veterans Affairs. He said policy-makers must try to solve the problem through financial incentives and technical standards.

To digitize medical records for SSA's electronic disability folders, agency officials have contracted with Affiliated Computer Services (ACS) Inc. to scan medical records submitted on paper and transmit them digitally via a secure network to the agency's centralized image databases in Baltimore.

In Mississippi, one of the first states in Region IV to begin processing disability claims electronically, physicians have surpassed initial expectations by digitizing about 40 percent of the medical evidence they submit in support of disability claims.

SSA has experienced dramatic processing efficiencies from receiving digitized medical evidence directly from physicians, Gray said. As recently as June, when the state's physicians and hospitals were submitting about 40 percent of their medical evidence in a digital format directly to the agency's electronic case folder system, the evidence was available for review an average of 14 days after SSA examiners requested it.

In Region IV, where examiners are helping systems developers work out kinks in the new system, administrators said one problem for examiners and physicians is reading lengthy medical evidence online. It takes longer than reviewing the same material on paper, and it causes eyestrain, said Paul Barnes, Region IV commissioner.

"We're going to have an ergonomist look at this issue for us," Barnes said.

Gray also plans to meet in a few weeks with examiners and physicians who have had the most experience using the electronic case folders to ask them to recommend improvements.

It may be that a modification as simple as letting examiners scroll quickly through the online medical evidence instead of navigating one page at a time is the only needed change, Barnes said. "I really think this is a problem we can fix," he said.

Barnes said the ease with which SSA employees have adapted to using electronic folders appears to split along generational lines. Region IV, which already has experienced a wave of the retirements that are anticipated in the next several years throughout the federal government, has a relatively young workforce. "Fifty-five percent of our claims representatives have five years' or less experience," he said.

"For those people, this is a piece of cake because they are very computer literate," Barnes said. "They don't understand why we haven't been doing this forever."

For the other 45 percent who are longtime employees, he said, the switch to the electronic folders, which began more than a year ago, has been difficult until only recently. "But I can honestly say that our more mature staff has now adjusted," he said.

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Disability progress report

Each year, about 2.5 million people file claims with the Social Security Administration for disability benefits. Agency officials have promised to deliver fully automated disability claims processing to SSA offices in all 50 states by June 2005. As evidence of their progress toward meeting that deadline, SSA officials said they have:

Equipped SSA field offices/Disability Determination Service offices in 10 states with the necessary technology for exchanging electronic case folders. SSA officials, with technical assistance from Lockheed Martin Corp. employees, created the electronic folder system using IBM Corp.'s WebSphere, Content Manager and Tivoli Access Manager.

Accepted 75,000 disability claims filed via the Internet since SSA officials began offering the service in 2003.

Managed 5.5 million disability claims applications in a central database.

Replaced antiquated Wang processor systems nationwide with new IBM iSeries servers in state offices where officials determine who is eligible for disability payments.

Installed new management systems for processing disability cases at SSA's hearings and appeals offices nationwide.

Source: Social Security Administration