The Social Security Administration (SSA) has a performance problem. Although the number of initial disability claims has declined in recent years, the SSA, in conjunction with state-level Disability Determination Service (DDS) agencies, is taking increasingly longer to process cases. On average, decisions for new claims now take 100 days longer than a decade ago.
High turnover rates among state DDS case examiners appear to be a significant contributor to the delays. Improving retention may require offering more competitive salaries, which could necessitate increased administrative funding. However, even if additional funding is not feasible, the claims process can still be improved by doing a better job reaching applicants’ doctors.
In each case sent to state DDS agencies, disability case examiners collect two types of medical information. The first is a Medical Evidence of Record (MER), where the applicant’s treating provider is asked to supply existing documentation related to the claimed disability. If the initial MER does not provide sufficient information to make a determination—a scenario that occurs in roughly 40 percent of cases—a consultative examination (CE) of the applicant is then ordered.
One major challenge with MERs is how this medical information is processed. DDSs have not effectively transitioned to digital operations, and in some cases are stuck between use of their legacy case processing systems and adopting SSA’s platform developed for states. Nearly half of the medical records submitted to DDSs arrive via mail or fax, requiring staff to manually upload the documents into the online system. In contrast, just over 10 percent are uploaded automatically using modern health IT systems. According to an audit by the SSA Office of Inspector General, records processed with health IT were received almost three weeks faster than those handled through more traditional methods.
Technical shortcomings are not the only factor contributing to these delays. After the initial medical evidence request (MER), DDSs navigate cumbersome rules to obtain consultative examinations, which slows down decisions and may also undermine program integrity. Although SSA rules stipulate that claimants’ primary doctors should be asked to serve as the consultative examiners, treating providers face extensive barriers to participation. Payment rates for CEs are low (often below Medicare levels) and providers are required to complete unfamiliar forms, adding to their administrative burden. States may also require treating doctors to sign third-party contracts to serve as consultants—a requirement that not only deters participation but may also prohibit some providers outright due to their non-compete agreements.
In many cases, the obstacle is more basic: Doctors may not even see the requests, or they see them too late because the documents are routed to medical records departments instead. As a result, DDSs often spend weeks waiting for responses from treating providers, only to hear nothing back and then repeat the process with a contracted third party contractor organization.
Although the contracted exams are given the same weight as evidence from treating providers, there are legitimate, well-documented quality concerns. Third party providers have reportedly taken only several minutes to perform exams that are required to take 30 minutes or more. Furthermore, these providers may be asked to perform exams outside their areas of expertise. For example, SSA guidelines for child applicants state that “the medical source we choose may be a pediatrician,” but they do not require it. Non-pediatric doctors end up assessing children they have never treated before, a dynamic that produces inaccurate decisions that get appealed, adding to the workload and delaying case resolutions.
Making it easier for DDS to connect with claimants’ treating doctors would help drive down administrative inefficiencies. MER requests should become more automated rather than the de facto reliance on mail and fax. Doing so will expedite the screening process and improve the likelihood of receiving medical information from the treating doctor. Additionally, DDSs should not force treating doctors to navigate unnecessary hurdles like third party contracts in order to perform CEs when additional evidence is needed. More direct lines of communication, simpler forms, and higher payment rates could better facilitate input from treating providers. The alternative—leaning heavily on low-paid third party contractors with no prior relationship to the applicants—has raised serious concerns about the exam quality.
More comprehensive data is needed to help policymakers understand the severity and nuances of the problem and to respond appropriately, though. There is simply not enough federal-level data available to analyze at the moment. When responding to a Freedom Of Information Act request in early 2024, SSA admitted that it tracks if CEs are requested but not whether the exams occurred nor the medical specialties of the performing doctors. A lack of knowledge on whether CEs are completed thereby limits the knowledge on how much time is spent with claimants. This poor monitoring, seen with other contracted DDS work, opens up vulnerability to improper operations and violations of SSA rules. These practices can be changed.
It is time to put sufficient guardrails in place to ensure SSA offers applicants a quality and efficient process.