Social Security Administration
Further Actions Needed to Address Disability Claims and Service Delivery Challenges
Gao ID: GAO-09-511T March 24, 2009
For years, the Social Security Administration (SSA) has experienced challenges managing a large disability workload and making timely decisions. In fiscal year 2006, SSA made about 3.7 million disability claims decisions, while over a million were awaiting a decision. Further, SSA has faced staffing challenges and difficulties managing its workloads at its network of approximately 1,300 field offices, where millions of people go to apply for disability and retirement benefits, to obtain Social Security cards, and for a host of other services. The Subcommittees on Income Security and Family Support, and on Social Security, House Committee on Ways and Means, asked GAO to address (1) key service delivery challenges facing SSA, particularly with respect to the backlog of disability claims, and (2) steps SSA is taking to address these challenges. This testimony is based primarily on reports assessing trends in disability claims processing and backlogs, steps SSA is taking to reduce the backlog, and other challenges SSA faces in meeting future service delivery needs. Certain information was updated to reflect recent legislative changes.
In recent years, SSA has experienced a growing backlog of disability claims and deteriorating customer service at field offices. SSA's total backlog of disability claims doubled from 1997, reaching 576,000 in 2006, which has resulted in claimants waiting longer for final decisions. The backlog was particularly acute at the hearings level. SSA also experienced declines in field office service delivery, with average customer wait times in field offices increasing by 40 percent from 2002 to 2006, and over 3 million customers waiting more than 1 hour to be served in 2008. Two key factors likely contributed to the backlog and service delivery challenges: (1) staffing reductions or turnover of field office staff and key personnel involved in the disability claims process, and (2) increased workloads. In particular, initial applications for disability benefits grew by more than 20 percent over the past 10 years. SSA projects further increases in workloads as the baby boom generation reaches its disability-prone years and retires. SSA has taken steps to improve its disability claims process, reduce the claims backlog, and manage its field office workloads, but some efforts were hampered by poor planning and execution while others are too recent to evaluate. In 2006, SSA introduced a comprehensive set of reforms to improve the efficiency, accuracy and timeliness of the disability claims process. However, this initiative produced mixed results and many aspects were suspended to focus on the hearings backlog and other priorities. While final decisions regarding many aspects of this reform are pending, SSA outlined a new plan in 2007 that concentrates on clearing out backlogged cases at the hearings level. GAO is currently reviewing this plan as part of its ongoing work. To address overall workloads and maintain customer service, SSA has shifted workloads to less busy offices and deferred workloads it deemed lower priority. However, deferring certain workloads, such as continuing eligibility reviews, can result in beneficiaries receiving payments who no longer qualify. In response to a recent GAO recommendation, SSA agreed to develop a single service delivery plan to help it better manage future service delivery challenges. However, it remains unclear how SSA will address current and future challenges given its current service delivery infrastructure and resource constraints.
GAO-09-511T, Social Security Administration: Further Actions Needed to Address Disability Claims and Service Delivery Challenges
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Testimony:
Before the Subcommittees on Income Security and Family Support and
Social Security, Committee on Ways and Means, House of Representatives:
United States Government Accountability Office:
GAO:
For Release on Delivery:
Expected at 10:30 a.m. EST:
Tuesday, March 24, 2009:
Social Security Administration:
Further Actions Needed to Address Disability Claims and Service
Delivery Challenges:
Statement of Daniel Bertoni, Director:
Education, Workforce, and Income Security:
GAO-09-511T:
GAO Highlights:
Highlights of GAO-09-511T, a testimony to the Subcommittees on Social
Security and on Income Security and Family Support, Committee on Ways
and Means, House of Representatives.
Why GAO Did This Study:
For years, the Social Security Administration (SSA) has experienced
challenges managing a large disability workload and making timely
decisions. In fiscal year 2006, SSA made about 3.7 million disability
claims decisions, while over a million were awaiting a decision.
Further, SSA has faced staffing challenges and difficulties managing
its workloads at its network of approximately 1,300 field offices,
where millions of people go to apply for disability and retirement
benefits, to obtain Social Security cards, and for a host of other
services.
The Subcommittees on Income Security and Family Support, and on Social
Security, House Committee on Ways and Means, asked GAO to address (1)
key service delivery challenges facing SSA, particularly with respect
to the backlog of disability claims, and (2) steps SSA is taking to
address these challenges. This testimony is based primarily on reports
assessing trends in disability claims processing and backlogs, steps
SSA is taking to reduce the backlog, and other challenges SSA faces in
meeting future service delivery needs. Certain information was updated
to reflect recent legislative changes.
What GAO Found:
In recent years, SSA has experienced a growing backlog of disability
claims and deteriorating customer service at field offices. SSA‘s total
backlog of disability claims doubled from 1997, reaching 576,000 in
2006, which has resulted in claimants waiting longer for final
decisions. The backlog was particularly acute at the hearings level
(see figure). SSA also experienced declines in field office service
delivery, with average customer wait times in field offices increasing
by 40 percent from 2002 to 2006, and over 3 million customers waiting
more than 1 hour to be served in 2008. Two key factors likely
contributed to the backlog and service delivery challenges: (1)
staffing reductions or turnover of field office staff and key personnel
involved in the disability claims process, and (2) increased workloads.
In particular, initial applications for disability benefits grew by
more than 20 percent over the past 10 years. SSA projects further
increases in workloads as the baby boom generation reaches its
disability-prone years and retires.
Figure: Total Backlogged Claims, by Level of Adjudication, Fiscal Years
1997 to 2006:
[Refer to PDF for image: stacked vertical bar graph]
Fiscal year: 1997;
Backlogged initial claims: 0;
Backlogged hearings: 183,712;
Backlogged Appeals Council: 74,655.
Fiscal year: 1998;
Backlogged initial claims: 16,378;
Backlogged hearings: 84,313;
Backlogged Appeals Council: 83,045.
Fiscal year: 1999;
Backlogged initial claims: 54,367;
Backlogged hearings: 11,958;
Backlogged Appeals Council: 107,792.
Fiscal year: 2000;
Backlogged initial claims: 135,407;
Backlogged hearings: 46,756;
Backlogged Appeals Council: 90,323.
Fiscal year: 2001;
Backlogged initial claims: 165,673;
Backlogged hearings: 135,904;
Backlogged Appeals Council: 57,827.
Fiscal year: 2002;
Backlogged initial claims: 192,692;
Backlogged hearings: 200,757;
Backlogged Appeals Council: 21,968.
Fiscal year: 2003;
Backlogged initial claims: 181,929;
Backlogged hearings: 291,562;
Backlogged Appeals Council: 13,641.
Fiscal year: 2004;
Backlogged initial claims: 224,658;
Backlogged hearings: 364,276;
Backlogged Appeals Council: 8,546.
Fiscal year: 2005;
Backlogged initial claims: 160,529;
Backlogged hearings: 411,284;
Backlogged Appeals Council: 3,614.
Fiscal year: 2006;
Backlogged initial claims: 155,071;
Backlogged hearings: 415,568;
Backlogged Appeals Council: 5,559.
Source: GAO analysis of SSA data.
[End of figure]
SSA has taken steps to improve its disability claims process, reduce
the claims backlog, and manage its field office workloads, but some
efforts were hampered by poor planning and execution while others are
too recent to evaluate. In 2006, SSA introduced a comprehensive set of
reforms to improve the efficiency, accuracy and timeliness of the
disability claims process. However, this initiative produced mixed
results and many aspects were suspended to focus on the hearings
backlog and other priorities. While final decisions regarding many
aspects of this reform are pending, SSA outlined a new plan in 2007
that concentrates on clearing out backlogged cases at the hearings
level. GAO is currently reviewing this plan as part of its ongoing
work. To address overall workloads and maintain customer service, SSA
has shifted workloads to less busy offices and deferred workloads it
deemed lower priority. However, deferring certain workloads, such as
continuing eligibility reviews, can result in beneficiaries receiving
payments who no longer qualify. In response to a recent GAO
recommendation, SSA agreed to develop a single service delivery plan to
help it better manage future service delivery challenges. However, it
remains unclear how SSA will address current and future challenges
given its current service delivery infrastructure and resource
constraints.
To view the full product, click on [hyperlink,
http://www.gao.gov/products/GAO-09-511T]. For more information, contact
Daniel Bertoni at (202) 512-7215 or bertonid@gao.gov.
[End of section]
Mr. Chairmen and Members of the Subcommittees:
I am pleased to have the opportunity to discuss challenges facing the
Social Security Administration (SSA) with respect to its disability
claims processing and field office service delivery. SSA provides a
number of services that touch many lives. In particular, each year
millions of Americans who believe that they can no longer work because
of severe physical or mental impairments, apply for cash benefits
through the Social Security Administration's (SSA) two disability
programs--Disability Insurance (DI) and Supplemental Security Income
(SSI). In addition, SSA annually processes millions of applications for
retirement benefits through its Old-Age and Survivors Insurance (OASI)
program, issues millions of Social Security cards, and provides many
other services through its large and decentralized workforce. In fiscal
year 2008, SSA had an administrative budget of over $11 billion, and
employed about 63,000 employees, 44 percent of whom are located in
approximately 1,300 field offices across the country.
For more than 20 years, SSA has faced challenges managing a large
disability claims workload and making timely decisions. During fiscal
year 2006, SSA made about 3.7 million disability claims decisions, and
some 1.5 million disability claims were awaiting a determination. SSA's
data show that disability applicants can wait years for their claims to
be resolved at the final administrative appeals level.[Footnote 1]
Disability claims--as well as retirement claims--are expected to
increase further as the baby boom generation continues to enter its
disability-prone years and begins to retire. The current economic
downturn may prompt even more people to apply for SSA benefits as a
source of income security. Constrained budgets and staffing reductions,
coupled with increases in retirement and disability filings, have also
challenged field offices' ability to meet the demand for services.
For today's hearing, you asked us to address (1) key service delivery
challenges facing SSA, particularly with respect to the backlog of
disability claims, and (2) steps SSA is taking to address these
challenges. My statement draws on a number of prior GAO reports that
were conducted in accordance with generally accepted government
auditing standards. (See related GAO products.) We updated information
as appropriate to reflect recent legislative changes.
Summary:
In summary, SSA has experienced a growing backlog in disability claims,
as well as deteriorating customer service. From fiscal years 1997 to
2006, SSA's total backlog of disability claims--the number of claims
exceeding the amount that should optimally be pending at year end--
doubled, reaching about 576,000 in 2006. The backlog was particularly
acute at the hearings level. Backlogs, in turn, resulted in claimants
waiting longer for a final decision from SSA. In addition, at field
offices, SSA customers experienced longer wait times and unanswered
phones. For example, between 2002 and 2006, average customer wait times
in field offices increased by 40 percent, and in fiscal year 2008, more
than 3 million customers waited over 1 hour to be served. Two key
factors likely contributed to these disability claims backlogs and
service delivery challenges. First, SSA experienced reductions or
turnover in field office staff and key personnel involved in the
disability claims process, such as disability examiners and
administrative law judges (ALJ). Second, SSA experienced an increase in
workloads. In particular, from 1997 to 2006, initial applications for
DI and SSI disability benefits increased more than 20 percent, spurred
by, among other factors, the aging of the baby boom generation,
downturns in the economy, increased referrals from other programs, and
changes in disability eligibility requirements in prior years. SSA
projects that its workloads will continue to increase over the coming
years as the baby boom generation retires.
SSA has taken steps to improve its disability claims process and reduce
the backlogs as well as to manage its overall workloads, but some
efforts have been hampered by poor planning and execution while others
are too recent to evaluate. One of SSA's more recent efforts to improve
its disability claims process--a comprehensive set of reforms called
the Disability Service Improvement (DSI) initiative that was piloted in
the Boston region in 2006--produced mixed results. Many aspects of DSI
were ultimately suspended to focus on the hearings backlog and SSA's
electronic processing system. In May 2007, SSA outlined a new plan for
eliminating the hearings level backlog. We are currently evaluating the
extent to which the hearings backlog reduction plan includes components
of sound planning and the potential effects it may have on the hearings
backlog and other SSA operations. In addition, to address overall
workloads and maintain customer service in field offices, SSA shifted
workloads to less busy offices and deferred work that the agency deemed
as lower priority. However, deferring key workloads, such as reviews of
continuing eligibility for benefits, means that beneficiaries who no
longer qualify may still receive payments erroneously. More recently,
in response to our recommendation that SSA develop a detailed service
delivery plan, SSA is consolidating its various planning efforts into a
single planning document. SSA stated this document will reflect its
efforts to address service and staffing challenges related to the
disability and retirement wave of the baby boom generation. However, it
remains unclear how SSA will manage growing workloads with its current
infrastructure of approximately 1,300 field offices and resource
constraints, while minimizing the deferral of key workloads and
declines in customer service.
Background:
SSA administers three major benefit programs: Old-Age and Survivors
Insurance (OASI), which provides benefits to retired workers and their
families and to families of deceased workers; (2) Disability Insurance
(DI), which provides benefits to eligible workers with disabilities and
their family members; and (3) Supplemental Security Income (SSI), which
provides income for aged, blind, or disabled individuals with limited
income and resources. In addition to paying benefits through these
three programs, SSA also issues Social Security cards, maintains
earnings records, and performs various other functions through a
network of field, state and headquarter offices.[Footnote 2]
SSA's field offices are the agency's primary points for providing face-
to-face service to the public. In addition to processing new disability
and retirement claims, field offices manage other workloads related to
program integrity, such as determining whether certain individuals with
disabilities remain eligible to receive disability payments based on
program criteria. Besides field offices, SSA operates Social Security
Card Centers, which issue Social Security numbers; Teleservice Centers,
which offer services nationally via a toll-free telephone number; and
Program Service Centers, which maintain earnings records, in addition
to other functions. In 2008, SSA's administrative budget for managing
its operations was $11.1 billion.
Disability Process:
The process for deciding who is eligible for SSA disability benefits is
complex, consuming a large portion of SSA's administrative budget.
Several state and federal offices, and several adjudication levels are
involved in determining whether a claimant is eligible for benefits.
The process begins when an individual files an application for
disability benefits at an SSA field office, online or over SSA's toll-
free number. In each case, an SSA representative determines whether a
claimant meets the non-medical eligibility criteria of each program,
such as ensuring that an SSI applicant meets income requirements, or
determining if a DI applicant has a sufficient number of work credits.
If applicants meet the non-medical eligibility criteria, field office
personnel will help claimants complete their applications and obtain
claimants' detailed medical, education, and work histories. The
completeness of the information gathered at this time can affect the
accuracy and speed of the decision.
After the field office determines that an applicant has met SSA's non-
medical eligibility requirements for disability benefits, up to four
adjudicative levels may review the applicant's claim for eligibility
generally based on medical criteria. The first adjudicative level is
the state Disability Determination Services (DDS),[Footnote 3] where a
disability examiner, working with medical staff, must make every
reasonable effort to help the claimant get medical reports from
physicians, hospitals, clinics, or other institutions where the
claimant has received past medical treatments.[Footnote 4] After
assembling all medical and vocational information for the claim, the
DDS examiner in consultation with appropriate medical staff determines
whether the claimant meets the requirements of the law for having a
disability. In doing so, the DDS examiner uses a five-step, sequential
evaluation process that includes a review of the claimant's current
work activity, severity of impairment, and vocational factors. See
figure 1.
Figure 1: SSA's Five-Step Sequential Evaluation Process for Determining
Disability:
[Refer to PDF for image: illustration]
Step 1: Work test: Is the claimant working and earning more than
substantial gainful activity?[A]
Yes: Benefits denied;
No: Go to next step.
Step 2: Severity test: Does the claimant have a severe impairment that
significantly limits his or her ability to do basic work activities and
that also meets the duration requirements?
Yes: Go to next step;
No: Benefits denied.
Step 3: Medical listings test: Does the condition meet SSA‘s medical
listings, or is the condition equal in severity to one found on the
medical listings?
Yes: Benefits awarded;
No: Go to next step.
Step 4: Previous work test: Can a person with the claimant‘s residual
functional capacity perform any of the claimant‘s past work?
Yes: Benefits denied;
No: Go to next step.
Step 5: Any work test: Can the claimant perform other types of work
that exist in the national economy?
Yes: Benefits denied;
No: Benefits awarded.
Sources: GAO analysis of SSA data.
[A] In 2007 the substantial gainful activity (SGA) threshold was $1,500
per month for blind recipients and $900 per month for individuals with
other disabilities.
[End of figure]
Claimants who are dissatisfied with the initial DDS determination have
up to three additional levels of adjudicative appeal. The claimant may
request a "reconsideration" of the claim, which is conducted by DDS
personnel who were not involved in the original decision. If the
reconsideration team concurs with the initial denial of benefits, the
claimant then has 60 days from the time of this decision to appeal and
request a hearing before an administrative law judge (ALJ).[Footnote 5]
ALJs, who are based in 140 hearing offices located throughout the
nation, can consider new evidence and request additional information
including medical evidence or medical and vocational expert testimony.
A claimant who is dissatisfied with the hearings decision may request,
within 60 days of the ALJ's decision, that the Appeals Council review
the claim. The Appeals Council is SSA's fourth and final adjudicative
appeals level and is comprised of administrative appeals judges. The
Appeals Council may uphold, modify, or reverse the ALJ's action, or it
may return the claim back to the ALJ for another hearing and issuance
of a new decision. The decision of the Appeals Council is the
Commissioner's final decision. To appeal this decision, the claimant
must file an action in Federal Court.
Measuring Performance:
SSA measures its performance in managing its workloads in various ways.
For its disability claims process, at each level of the claims process
SSA tracks the number of claims pending a decision each year and the
time it takes to issue a decision. The agency also uses a relative
measure to determine the backlog by considering how many cases should
optimally be pending at year-end. This relative measure is referred to
as "target pending" and is set for each level of the disability process
with the exception of the reconsideration level. From 1999 to 2006,
SSA's target pending was 400,000 for claims at the initial stage and
300,000 and 40,000 for the hearings and Appeals Council stages,
respectively.[Footnote 6] The number of pending claims that exceed
these numbers represents the backlog. With respect to service delivery,
SSA uses various measures of performance, including work productivity
(average work units performed per year, per employee), customer wait
times at field offices, and overall customer satisfaction with service
delivery.
SSA Has Faced Challenges with Disability Claims Backlogs and Field
Office Service Delivery:
SSA has experienced increased backlogs and processing times associated
with disability claims in recent years, as well as declines in measures
of field office service. These trends are likely due to rising
workloads and staffing shortfalls.
Disability Claims Process Challenges:
The total number of backlogged disability claims in SSA more than
doubled over the last decade, with the greatest accumulation of claims
occurring at the hearing level. By the close of fiscal year 2006, the
total number of backlogged disability claims, by SSA's measure, reached
576,000, which represented an overall growth rate of more than 120
percent from fiscal year 1997. As shown in figure 2, backlogs of
varying degree have occurred at all stages of the claims process where
backlogs are calculated. However, since fiscal year 2001, these claims
were concentrated most heavily at the hearings level and, to a lesser
extent, at the initial processing level within the DDS
offices.[Footnote 7] The hearings level accounted for the largest share
of backlogged claims for 7 of the 10 years we reviewed. In fiscal years
2000 and 2001, the DDS level accounted for the largest share of the
backlog. The Appeals Council had the largest backlog in fiscal year
1999, but dramatically reduced these numbers by 2006.
Figure 2: Total Backlogged Claims, by Level of Adjudication, Fiscal
Years 1997 to 2006:
[Refer to PDF for image: stacked vertical bar graph]
Fiscal year: 1997;
Backlogged initial claims: 0;
Backlogged hearings: 183,712;
Backlogged Appeals Council: 74,655.
Fiscal year: 1998;
Backlogged initial claims: 16,378;
Backlogged hearings: 84,313;
Backlogged Appeals Council: 83,045.
Fiscal year: 1999;
Backlogged initial claims: 54,367;
Backlogged hearings: 11,958;
Backlogged Appeals Council: 107,792.
Fiscal year: 2000;
Backlogged initial claims: 135,407;
Backlogged hearings: 46,756;
Backlogged Appeals Council: 90,323.
Fiscal year: 2001;
Backlogged initial claims: 165,673;
Backlogged hearings: 135,904;
Backlogged Appeals Council: 57,827.
Fiscal year: 2002;
Backlogged initial claims: 192,692;
Backlogged hearings: 200,757;
Backlogged Appeals Council: 21,968.
Fiscal year: 2003;
Backlogged initial claims: 181,929;
Backlogged hearings: 291,562;
Backlogged Appeals Council: 13,641.
Fiscal year: 2004;
Backlogged initial claims: 224,658;
Backlogged hearings: 364,276;
Backlogged Appeals Council: 8,546.
Fiscal year: 2005;
Backlogged initial claims: 160,529;
Backlogged hearings: 411,284;
Backlogged Appeals Council: 3,614.
Fiscal year: 2006;
Backlogged initial claims: 155,071;
Backlogged hearings: 415,568;
Backlogged Appeals Council: 5,559.
Source: GAO analysis of SSA data.
[End of figure]
In concert with changes in the total claims backlog, average processing
times for disability claims at most adjudicative levels increased. As
shown in figure 3, although processing times decreased dramatically at
the Appeals Council level, they increased markedly at the hearings
level, and somewhat at the initial and reconsideration levels.[Footnote
8] For example, from 1997 to 2006, processing times increased about 20
days at the DDS level and 95 days at the hearings level. Further, in
fiscal year 2006, 39 percent of all hearing decisions took between 365
to 599 days to process; 28 percent took 600 to 999 days to process; and
2 percent took over 1,000 days. For two regions (region 5 in Chicago
and region 10 in Seattle), nearly half of all hearing decisions made in
fiscal year 2006 took longer than 600 days to complete.
Figure 3: Average Claims Processing Time for DDS Initial Claims, DDS
Reconsiderations, Hearings, and Appeals Council Decisions, in Days,
Fiscal Years 1997 to 2006:
[Refer to PDF for image: multiple line graph]
Fiscal year: 1997;
Initial claims: 70.4 days;
Reconsiderations: 51.4 days;
Hearings: 386 days;
Appeals Council: 340 days.
Fiscal year: 1998;
Initial claims: 72.6 days;
Reconsiderations: 55.3 days;
Hearings: 371 days;
Appeals Council: 417 days.
Fiscal year: 1999;
Initial claims: 77.5 days;
Reconsiderations: 61.6 days;
Hearings: 314 days;
Appeals Council: 441 days.
Fiscal year: 2000;
Initial claims: 81.5 days;
Reconsiderations: 62.8 days;
Hearings: 274 days;
Appeals Council: 495.
Fiscal year: 2001;
Initial claims: 90.3 days;
Reconsiderations: 68.8 days;
Hearings: 307 days;
Appeals Council: 439 days.
Fiscal year: 2002;
Initial claims: 89 days;
Reconsiderations: 69.9 days;
Hearings: 333 days;
Appeals Council: 404 days.
Fiscal year: 2003;
Initial claims: 84.8 days;
Reconsiderations: 68.3 days;
Hearings: 343 days;
Appeals Council: 288 days.
Fiscal year: 2004;
Initial claims: 85.7 days;
Reconsiderations: 65.8 days;
Hearings: 391 days;
Appeals Council: 247 days.
Fiscal year: 2005;
Initial claims: 87.2 days;
Reconsiderations: 68 days;
Hearings: 415 days;
Appeals Council: 238 days.
Fiscal year: 2006;
Initial claims: 88.9 days;
Reconsiderations: 72 days;
Hearings: 481 days;
Appeals Council: 201 days.
Source: GAO analysis of SSA data.
[End of figure]
One contributor to increased disability claims backlogs has been spikes
in new applications. For example, the number of initial applications
for DI and SSI benefits increased by 21 percent overall from fiscal
years 1997 to 2006, contributing to the claims backlog and adding
additional pressures to field office personnel who initially review
these claims. These increases can be attributed to a number of
influences: periodic downturns in the economy, the aging of the baby
boom population, increased referrals from other programs, previous
changes in program eligibility requirements and regulations, and
increased program outreach. Officials in one region recounted one
initiative that targeted outreach to the homeless, which increased
applications and also added to processing times. They also attributed
some processing delays to the time required to track homeless
candidates and help them document their disabilities. With respect to
the economy, SSA officials, DDS senior managers, and our prior work all
attest to the fact that economic downturns from a failing industry or
natural disaster can precipitate new disability applications.
The growth in the disability claims backlogs has also coincided with
losses in key personnel associated with the disability claims process.
For example, although DDS staff increased about 4 percent from 1997 to
2006, DDSs have experienced high rates of staff turnover and attrition.
Attrition rates for DDS disability examiners, who are state employees,
were almost double that of SSA federal staff. Many DDS senior managers
we spoke with said that turnover of experienced disability examiners
has affected productivity. For example, from September 1998 to January
2006, over 20 percent of disability examiners hired during that period
left or were terminated within their first year. DDS officials said the
loss of experienced staff affects DDS' ability to process disability
claims workloads because it generally takes newly hired examiners about
2 years to become proficient in their role.
Further, at the hearings level, SSA generally experienced shortfalls in
ALJs and support staff--decision writers, staff that prepare case files
for review, attorneys, and claims technicians. The number of ALJs
available to conduct hearings ranged from a high of 1,087 in 1998 to a
low of 919 in 2001, ending at 1,018 in 2006. Although SSA has had fewer
than 1,100 ALJs over the last 10 years, in May 2006, SSA's Commissioner
noted that the agency requires no less than 1,250 ALJs to properly
manage its current pending workload. With respect to support staff,
numbers ranged from a high of 5,500 in 1999 to a low of 4,700 in 2006.
Although SSA managers and judges would like to see a ratio of 5.25
support staff per ALJ, the actual ratio has more often been lower,
ranging from a ratio of 4.59 in 1997 to 4.12 in 2006. Only in 2001,
when the number of ALJs was at its lowest point, was the target ratio
achieved.
Finally, a number of initiatives undertaken by SSA to improve the
disability process and potentially remedy backlogs have faltered for a
variety of reasons, including poor planning and execution. In fact,
some initiatives had the effect of slowing processing times by reducing
staff capacity, increasing the number of appeals, or complicating the
decision process. Several other initiatives improved the process, but
were too costly and subsequently abandoned. This was the case for
several facets of a major 1997 initiative, known as the "Disability
Process Redesign," which sought to streamline and expedite disability
decisions for both initial claims and appeals. In the past, we reported
that various initiatives within this effort became problematic and were
largely discontinued due to their ineffectiveness and high cost.
Further, implementation of an electronic system enhanced some aspects
of the disability claims process, but also caused delays due to
systemic instability and shutdowns at the DDS and hearings offices.
[Footnote 9] Further, the "Hearings Process Improvement" initiative,
implemented in 2000, involved reorganizing hearing office staff and
responsibilities with the goal of reducing the number of appeals.
However, many of the senior SSA officials we spoke with expressed the
opinion that this initiative left key workloads unattended and was
therefore responsible for dramatic increases in delays and processing
times at the hearings level.
Field Office Service Delivery Challenges:
In addition to disability claims backlogs and increased processing
times, other aspects of SSA's service delivery at field offices have
declined in recent years. From fiscal year 2002 to 2006, the average
time customers waited in a field office to speak with an SSA
representative increased by 40 percent from 15 to 21 minutes. In fiscal
year 2008, more than 3 million customers waited for over 1 hour to be
served. Further, SSA's 2007 Field Office Caller Survey found that 51
percent of customers calling selected field offices had at least one
earlier call that had gone unanswered. Because SSA based its results
only on customers who were ultimately able to get through, the actual
percentage of customers that had unanswered calls was likely even
higher. Overall these factors may have contributed to a 3 percent drop
in SSA's overall customer satisfaction, from 84 percent in fiscal year
2005 to 81 percent in fiscal year 2008.
Declines in field office service delivery measures coincided with a
period of staff turnover and losses agency wide. From fiscal year 2005
to 2008, SSA experienced a 2.9 percent reduction in total employees and
a 4.4 percent reduction in field office employees. At the same time,
employees and managers reported high levels of stress. We asked 153
employees at 21 offices to rate the stress they experienced in
attempting to complete their work in a timely manner and 65 percent
reported feeling stress to a great or very great extent on a daily
basis, while 74 percent of office managers described high levels of
stress.
Declines in service delivery measures also coincided with increased
workloads. For example, the number of annual field office visitors
increased by about 2.5 million customers, from 41.9 million in fiscal
year 2006 to 44.4 million in fiscal year 2008. In addition, SSA's field
offices experienced growth in other types of workloads. Between 2005
and 2008, SSA performed more work related to managing beneficiary rolls
[Footnote 10] and assigning Social Security numbers. Finally, the work
SSA performs on behalf of other federal agencies has grown. For
example, new elements of the Medicare prescription drug program and new
state laws requiring federal government verification of work
authorization are resulting in additional work and field office visits.
Future Workload and Staffing Challenges:
SSA projects an increase in disability claims and other workloads over
the coming years while at the same time anticipates the retirement of
many experienced workers. Specifically, SSA projects:
* An overall 13 percent increase in retirement and disability claims
from fiscal years 2007 to 2017.
* A growth of 22 percent in the number of retirement and disability
beneficiaries from 2007 to 2015.
* That nearly 40 percent of its current workforce will be eligible to
retire in 5 years and 44 percent will retire by 2016.
SSA Continues to Take Steps to Address Disability Claims Backlogs and
Service Delivery Challenges:
SSA continues to take steps to address disability claims backlogs and
service delivery challenges, including efforts to improve its
disability claims process, redistribute workloads across field offices,
and develop a plan for addressing future growth in disability and
retirement claims. Some of these efforts have been hampered by poor
planning while others are too recent to evaluate.
Improving the Disability Evaluation Process:
SSA has pursued a number of initiatives to improve the overall
efficiency and effectiveness of its disability claims process. For
example, the DSI initiative, piloted in 2006, was designed to produce
correct decisions on disability claims as early in the application
process as possible, with the expectation that DSI would reduce both
appeals of denied claims and future backlogs. The plan involved several
envisioned changes to improve the disability determination process.
However, results of the initiative by early 2007 were mixed. (See table
1 for examples of these initiatives and their results.) In general, we
found that implementation of these and other DSI initiatives were
hampered by rushed implementation, poor communication, and inadequate
financial planning. Overall, the DSI initiatives cost more than the
agency had originally estimated.
Table 1: Examples of DSI Initiatives and Their Results:
Name of initiative: Quick Disability Determination Process;
Description: Used an automated screening function to identify cases
that have a high probability of being approved for expedited
processing;
Results: Generally produced timely and accurate decisions and is
targeted for national roll-out.
Name of initiative: Federal Reviewing Official;
Description: Replaced the reconsideration level with attorneys that
review appealed initial decisions;
Results: Achieved positive decision accuracy and documentation;
experienced staffing challenges; contributed to increased pending
claims and processing times; cost more than originally estimated.
Name of initiative: Medical and Vocational Expertise Initiative;
Description: Provided medical expertise to the Federal Reviewing
Official;
Results: Experienced staffing challenges; experienced difficulty
entering into contracts with medical professionals; contributed to
increased pending claims; cost more than originally estimated.
Source: Based on information presented in GAO-08-40.
[End of table]
The future of DSI currently remains uncertain. While the Quick
Disability Determination will likely be implemented nationwide, SSA
suspended national roll-out of most portions of the DSI initiative, and
issued a proposed rule to suspend the Federal Reviewing Official and
Medical and Vocational Expertise initiatives in the Boston region. SSA
has said that it will continue to conduct an evaluation of DSI
initiatives to determine whether they should be reinstated. Because
SSA's assessment of DSI components to date has been limited, in 2007 we
recommended that SSA conduct a thorough evaluation of DSI before
deciding which elements should be implemented or discontinued. SSA
noted that it would continue to collect data and monitor outcomes to
evaluate DSI, but that, due to constrained resources, it may not be
able to collect sufficient data to ensure the reliability of the
results.
SSA suspended DSI, in part, to refocus on reducing its hearings
backlog, which had reached critical levels. In May 2007, SSA outlined a
new hearings backlog reduction plan that focuses on reducing the
existing backlog and preventing its recurrence through a series of
steps that employ some prior innovations and also new initiatives.
However, officials we spoke with at SSA emphasized that the hearings
backlog reduction plan is not meant to replace the DSI initiative but
to complement it until a final decision is made regarding the future of
DSI. Steps in the plan include updating SSA's medical eligibility
criteria, expediting cases for which eligibility is more clear-cut,
improving hearings office capacity and performance, and other actions.
Also in the plan, the Commissioner proposed dedicating $25 million to
improve SSA's electronic processing system. SSA's efforts to reduce the
hearings backlog may be supported by additional funds through recent
legislation. Specifically, the American Recovery and Reinvestment Act
of 2009 (ARRA) allocated $500 million to SSA to assist with processing
workloads and related technology acquisitions.[Footnote 11] SSA has not
yet determined how it will use this money for its various workloads.
In December 2007, we recommended that SSA take the necessary steps to
increase the likelihood that new initiatives will succeed, such as
performing comprehensive planning to anticipate challenges of
implementation, including the appropriate staff in the design and
implementation stages, establishing feedback mechanisms to track
progress and problems, and performing periodic evaluations.[Footnote
12] SSA agreed with the intent of this recommendation, noting that it
would take necessary steps to improve the likelihood of success of
future initiatives. Accordingly, we are currently evaluating the extent
to which the hearings backlog reduction plan includes components of
sound planning and the potential effects of the plan on the hearings
backlog and other SSA operations. As part of this review, we will (1)
examine the plan's potential to eliminate the hearings-level backlog,
(2) determine the extent to which the plan includes components of sound
planning, and (3) identify potential unintended effects of the plan on
hearings level operations and other aspects of the disability process.
We expect to complete our work later this year.
Shifting Workloads and Maintaining Staffing Levels:
To address overall workloads and maintain customer service, SSA is
shifting workloads to less busy offices. For example, if a field office
has work demands that it cannot immediately cover, that office can
request that some work be transferred to another office. Offices that
have a particular expertise in that particular type of work will make
themselves available, as they can process this work more quickly. These
efforts likely contributed to increased productivity levels.[Footnote
13] Specifically, the average amount of work produced by field office
employees increased by 2.9 percent between fiscal years 2005 and 2008.
Managers also are addressing workloads by using claims processing
personnel to perform the duties typically conducted by lower-graded
employees, and in some cases, office managers take on duties of their
employees. Such duties include answering the telephone, providing
initial services to arriving customers, processing requests for new or
replacement Social Security cards, and conducting some administrative
duties. Although visiting customers need attention, this practice may
reduce time spent on other workloads, such as claims processing or
managing the office. Moreover, as we noted earlier, the stress of
expanding workloads and staffing constraints can negatively impact
morale.
With fewer staff available, SSA has deferred some workloads, although
this practice may have significant drawbacks. Specifically, SSA has
focused on field office work it considers essential to its "core
workloads," such as processing new claims for Social Security benefits
and issuing Social Security cards, while deferring other types of work
including changes of address, changes to direct deposit information,
and reviews to determine beneficiaries' continuing eligibility for DI
and SSI benefits. Reviews of continuing eligibility, however, are key
activities in ensuring payment accuracy. Such reviews yield a lifetime
savings for both DI and SSI of $10 for every dollar invested, according
to SSA. In recent years, SSA has reduced the number of reviews
conducted, citing budget limitations and an increase in core work. When
reviews of benefits are delayed, some beneficiaries continue receiving
benefits when they no longer qualify.
SSA has used a variety of strategies to maintain adequate staffing
levels overall, although it faces challenges with hiring, training and
retaining staff. For example, SSA: offers recruitment, relocation, and
retention bonuses to individuals with needed skills; offers workplace
flexibilities; uses dual compensation waivers from the Office of
Personnel Management for certain hard-to-fill positions; and developed
recruiting efforts to reach out to a broader pool of candidates,
including retired military and veterans with disabilities. SSA may also
use ARRA money to hire additional staff to help manage some of its
workloads.[Footnote 14] However, in the past, SSA has encountered
obstacles that delay hiring. For example, SSA's ability to hire
sufficient ALJ's has been hindered by the length of the Office of
Personnel Management's review process. In addition, field office
managers and staff at many locations we visited stated that it
typically takes 2 to 3 years for new employees to become proficient
after being hired. For disability examiners, this process can take
about 2 years, according to SSA staff, while at the same time turnover
is high.
Developing a Consolidated Plan to Address Future Growth:
More recently, in response to our recommendation that SSA develop a
detailed service delivery plan,[Footnote 15] SSA stated that it intends
to consolidate its various planning efforts into a single planning
document. SSA commented that its consolidated document will, at
minimum, include comprehensive plans for expanding electronic services
for customers; increasing the centralization of receiving phone calls
and working claims from customers while maintaining the network of
local field offices; enhancing phone and video services in field
offices (where applicable) and piloting self-service personal computers
in the reception areas of those offices; and continuing to assess the
efficiency of field offices. While a consolidated planning document
will better reflect the variety of planning efforts SSA has to improve
its operations, it remains unclear how SSA will manage growing
workloads with its current infrastructure of approximately 1,300 field
offices, while minimizing the deferral of its workloads and declines in
customer service.
Concluding Observations:
By all accounts, the operational challenges that SSA faces are
projected to become more acute in the coming years as our society ages.
SSA's aging workforce and our faltering economy may exacerbate these
challenges. Over the years and across many fronts, SSA has taken
numerous and varied steps to address its backlog of disability claims
and its service delivery challenges, but often with mixed results or at
the expense of some other key services. Funds that SSA receives through
the ARRA may relieve staffing shortages and potentially improve
electronic case processing, but more concerted efforts will likely be
needed to get in front of the challenges ahead. We have recommended
that, to increase the probability of success for any new initiatives
aimed at reducing the backlog of claims, SSA focus on comprehensive
planning that anticipates implementation challenges by involving key
staff in design and implementation, establishing feedback loops, and
performing periodic evaluations to ensure that reforms are executed
effectively. We have also recommended that SSA develop a service
delivery plan that addresses in detail how it will successfully deliver
quality customer service in the future while managing growing work
demands with constrained resources. SSA agreed that it should take
necessary steps to improve the likelihood of success of future
initiatives and to develop a comprehensive service delivery plan, and
noted that they are taking steps toward these ends. We look forward to
SSA's progress as it moves forward with these efforts.
Mr. Chairman and Members of the Subcommittee, this concludes my
remarks. I would be happy to answer any questions that you or other
Members of the Subcommittee may have.
GAO Contact and Acknowledgments:
For further information, please contact Daniel Bertoni at (202) 512-
7215 or Bertonid@gao.gov. Also contributing to this statement were
Michele Grgich, Erin Godtland, and Jessica Orr. Advisors included Blake
Ainsworth, Barbara Bovbjerg, Julianne Cutts, Shelia Drake, Cindy
Fagnoni, Sal Sorbello, and Paul Wright. Roger Thomas provided legal
advice.
[End of section]
Related GAO Products:
High-Risk Series: An Update [hyperlink,
http://www.gao.gov/products/GAO-09-271], January, 2009.
Social Security Administration: Service Delivery Plan Needed to Address
Baby Boom Retirement Challenges [hyperlink,
http://www.gao.gov/products/GAO-09-24], January 9, 2009.
Social Security Disability: Better Planning, Management, and Evaluation
Could Help Address Backlogs [hyperlink,
http://www.gao.gov/products/GAO-08-40], December 7, 2007.
Social Security Disability: Management Controls Needed to Strengthen
Demonstration Projects [hyperlink,
http://www.gao.gov/products/GAO-08-1053], September 26, 2008.
[End of section]
Footnotes:
[1] In light of these and other disability program challenges at SSA
and other agencies, we designated federal disability programs a high-
risk area in 2003. GAO, High-Risk Series: An Update, [hyperlink,
http://www.gao.gov/products/GAO-09-271] (Washington, D.C.: January
2009).
[2] In addition to these services, SSA performs work related to
verifying employment eligibility and Medicare program assistance.
[3] Although SSA is responsible for the program, the law calls for
initial determinations of disability to be made by state DDS agencies.
The work performed at DDS offices is federally financed and carried out
under SSA disability program regulations, policies, and guidelines. See
42.U.S.C. §421(a)(1).
[4] The examiner may also ask the claimant to take a special
examination called a "consultative examination," where physicians or
other medical professionals hired by SSA gather more information on the
claimant's condition.
[5] As part of one of SSA's process improvement initiatives, SSA
eliminated the reconsideration step in 10 states. In these states,
claimants who are dissatisfied with their initial decision would have
their appeal reviewed by an administrative law judge.
[6] SSA stated that it had never communicated the target pending amount
of 400,000 to DDSs. Further, they stated that they had set a new target
pending of 577,000 for 2006 and 2007. SSA indicated that they had
funded the DDSs at a level consistent with 577,000 claims pending in
recent years.
[7] We do not report backlogs for the reconsideration stage because SSA
could not provide data that would allow us to do so.
[8] Processing times reported in this report do not reflect time spent
working on a claim prior to it reaching a DDS office (such as time
spent at an SSA field office).
[9] In 2000, SSA revived a prior plan to transform its paper-based
processing system to a national, fully integrated electronic processing
system. The initiative had several goals including (1) reducing delays
caused by losing paper folders during transfers to other offices, (2)
providing more complete disability information on claimants, and (3)
reducing keying errors as well as storage and mailing costs.
[10] The number of people receiving monthly benefits from SSA rose from
nearly 53 million in 2005 to 60 million in 2008. Such an increase
affects SSA's postentitlement workload (the workload associated with
actions occurring after customers become eligible for benefits)
including changes of address, benefit recomputations, overpayments, and
reviews of Disability and SSI beneficiaries' status to determine their
continuing eligibility for benefits.
[11] In addition, ARRA allocated $500 million for the replacement of
the National Computer Center. See the American Recovery and
Reinvestment Act of 2009, H.R. 1, Division A, Title VIII, at 71
(enrolled bill).
[12] Social Security Disability: Better Planning, Management, and
Evaluation Could Help Address Backlogs [hyperlink,
http://www.gao.gov/products/GAO-08-40], December 7, 2007.
[13] SSA cites additional reasons for productivity increases, including
automation efforts and simplification of programs and policies.
[14] As noted previously, ARRA allocated $500 million to SSA to assist
with processing workloads and related technology acquisitions; but SSA
has not determined how it will use these funds. See the American
Recovery and Reinvestment Act of 2009, H.R. 1, Division A, Title VIII,
at 71 (enrolled bill).
[15] Social Security Administration: Service Delivery Plan Needed to
Address Baby Boom Retirement Challenges (GAO-09-24, January 9, 2009).
[End of section]
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