How Does Your Colorado DDS Compare Nationally?
There is a myth in the general community that the Disability Determination Services (DDS) denies cases routinely and that an individual cannot get an allowance without going to an Administrative Law Judge (ALJ). This is the most persistent fallacy about our Agency. The fact is that nationally, over 70% of all cases allowed by Social Security are allowed at the DDS level. We work hard to provide the right decision at the earliest possible time. The Social Security Disability Regulations are very strict requiring objective medical documentation of an individual’s condition, not just an unsubstantiated opinion. Therefore, Social Security expects methodical appropriate application of these regulations, and not all claims will be allowed. It is inevitable that some claims will be denied. When one hears DDS denies every claim that we review, it is not factual. In addition, when an ALJ reviews a case it may be more than a year older than when the DDS last reviewed the case and is essentially a different case. The DDS continues working with various stakeholders to improve the process.
Colorado's DDS has typically been in the top twenty when compared to the performance of the 52 other DDSs in other States and territories. Our emphasis has always been to make the most accurate decision possible while containing costs and consistently providing excellent customer service.
The most important measurement of our performance – accuracy – comes from an independent review of our decisions—both allowances and denials—by Social Security’s Disability Quality Branch. This case sample results in a report of how accurately we make our decisions. Our cumulative accuracy (no decisional or documentation errors) is above the national average when compared to all other 52 State DDSs. In fact, Colorado has performed above the national average in this quality measurement for fifteen of the past sixteen years. In Federal Fiscal Year-2014 our accuracy was 97.2%, or 1.3 points above the national norm. In Federal Fiscal Year-2015 our accuracy was 96.3% versus a national average of 95.5%. So far, in FFY-2016, Colorado's accuracy is 99.1% versus 96.2% nationally among other State DDS agencies and ranks #1 out of 52 State DDSs.
The second most important measurement of our performance is our productivity. According to SSA, high productivity with great accuracy reflects an efficient and cost effective operation. Productivity is defined by the number of cases completed per worker. In FFY-2014, Colorado was around the national average and ranked 4th best of the similar Prototype State DDSs (ten states that per Social Security use a “no reconsideration level of appeal” format). In FFY-2015 DDS was again around the national average and ranked in the top half of prototype states. Currently, in FFY-16, Colorado exceeds the national average, and is third best of the Prototype State DDSs.
One other measurement is DDS Average Processing Time. This is the average amount of time from when Social Security sends us the case until we send it back to them with a medical decision. We have been challenged in this performance measure as the volume of claims being received is outpacing our capacity. In fact, our initial case receipts over the past four years are up by as much as 25% while agency staffing has remained nearly at the same level as 2007. Despite these challenges, DDS has maintained an average case processing time that has been as many as 10 days below the national average in FY-2015.
We have taken several actions to improve our productivity, processing times, and accuracy while working with Social Security. Our overall average processing time in FFY-2014 had risen to 142 days; however, in FFY-2015 it declined to as low as 67 days. In FY-2015, the CO DDS average processing time was 73 days while the national average has been about 85 days during that same period. We continue to use screening tools to be able to fast track cases that require expedited handling. A specific subset called QDD (Quick Decision Determinations) were processed on average in just 13 days.
We have a case Development Unit of technicians who are striving to prepare and document cases as quickly and accurately as possible. We are receiving assistance from federal work sites as well. We continue to process claims as promptly as possible under the circumstances that exist (high case volume and insufficient and inexperienced adjudicator staff).
The Colorado DDS administers one of the largest and most efficient Military Casualty caseloads in the nation. We have several key initiatives and partnerships in place to provide expeditious service to our disabled soldiers. In addition, we are working on several special projects including but not limited to homeless initiatives, pre-release individual cases, and participation in the regional Cooperative Disability Investigation Unit under the jurisdiction of the Office of the Inspector General (OIG). When possible the DDS uses the Presumptive Disability decision, which allows us to expedite certain proposed allowance cases.
Social Security has completed a conversion to a nearly paperless, or electronic, format for new case files. This has been a challenge for the entire staff, but has resulted in better customer service and quicker access to medical files for all Social Security staff that need to review the cases. We have implemented several fast tracking initiatives such as the Quick Decision Determinations and Compassionate Allowances on specific cases that Social Security sends to us. We are national leaders in the quality and timeliness on these cases. We were one of the first DDSs that implemented an electronic initiative of more formally rationalizing our decisions to help all stakeholders understand our decisions. Colorado DDS is active in planning for the next generation case processing application (DCPS), and is one of four pilot states for the Department of Defense's Health Information Technology (HIT) effort which focuses on centralizing electronic access to health records.