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Orthopedic surgeons are an integral part of the disability system
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When I entered clinical practice in the 1970s, I became aware of patients taking advantage of the Social Security and Supplemental Security Income Disability Program. At the time, a few attorneys, physicians and patients approached me to openly work with them to help patients get disability benefits from the federal government and their employers.
Most practicing orthopedic surgeons have seen patients who have taken advantage of, not only the disability Social Security programs, but also worker’s compensation and medico-legal cases resulting in disability settlements. Even knowing this, I did not realize how pervasive the abuse had become. This was driven home when I read the percentage of Americans receiving Social Security disability benefits between the ages of 16 years to 64 years is approximately 4.5% of the U.S. population. According to the Social Security Administration, in 2010 West Virginia had the highest percentage of people on Social Security disability at 8.8%. For people receiving benefits, 28.2% are for issues related to musculoskeletal systems.
Cost of the program
The Social Security Administration reported that nearly 55 million Americans received $727 billion in Social Security benefits in 2011. In 2000, the Social Security Administration paid benefits to more that 49 million people, with disability the reason for paying 79% of the beneficiaries. This escalation in the number of people receiving benefits was never anticipated when the program was established, and its size is consistently underestimated by budget forecasters.
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Social Security disability benefits represent an out-of-control entitlement program. Individuals are not coming close to paying enough into the program to cover their benefits. There are currently 2.9 workers for each Social Security beneficiary. By 2036, there will be 2.1 workers for each beneficiary combined with an estimate of almost twice as many older Americans as today – from 41.9 million to 78.1 million. In addition, there are more appeals from people who have been denied Social Security disability benefits. Requests for hearings have increased by 24% from fiscal year 2007 to fiscal year 2010, and by 48% through fiscal year 2011.
Before I receive letters to the editor, let me say that I believe most of our readers do appropriate disability evaluations and there are many legitimate individuals receiving benefits. In choosing a topic, it is always difficult to criticize a federal disability system designed to help people who can no longer work. However, what was once developed as a safety net for people who could not work for legitimate reasons is seeing a flood of applicants who are applying and manipulating the system to receive monthly stipends and health care programs for life. And, unfortunately, some physicians, lawyers and judges are fueling the number of awards.
Financial breaking point
Several situations have come together and resulted in the increased number of people unable to work. These include a high unemployment rate, an economic slump, an aging population, more physicians writing biased reports resulting in too many awards, a raft of attorneys specializing in beating the system and a judicial system that is not policing itself.
Our current Social Security disability system is approaching a financial breaking point. It could run out of reserves within 6 years to 7 years. If it does, it could be the first federal entitlement program to become insolvent in recent times.
A contributor to the problem is the large numbers of lawyers who advertise online for free consultations. They give promises of no legal costs unless an applicant receives disability benefits and suggest high rates of success. The attorneys not only offer to help applicants get the “right physicians,” but also assist with all the paperwork and government dealings.
Also, some physicians have been noted to make favorable ratings and assignments of awards – many after performing only a cursory review of each case. For example, in 2010 the Inspector General investigating complaints reported that a physician in the Alabama Disability Determination Office made 80 to 100 favorable decisions a day. All too often, physicians do not give the applications enough time or consideration as a usual case can take at least 1 hour to review the records, as well as complete a thorough patient history and examination.
To further compound the problem of fair evaluations are increased applications and an appeal system with limited resources. The Social Security Administration is spending millions of dollars annually on medical consultants. Oftentimes, the medical consultants work for an hourly wage, and are retired or semi-retired physicians performing evaluations outside their area of expertise. A large proportion of physicians giving musculoskeletal disability ratings are not board-certified orthopedic surgeons.
As with any entitlement program, there is political pressure to reduce the backlog and deal with favored applicants. It will take real leadership and innovation to reform this cash-strapped program and the influx of applications. We are hearing how the Social Security Administration will overhaul a part of the disability review process and do more with less. A big part of any improvement must be to more effectively limit fraud and abuse. Since such a high percentage of the rating involves the musculoskeletal system, orthopedic surgeons need to consider how they can be more involved by offering new solutions.
The challenges to the Social Security disability program are the same challenges facing our health care system in general. The approaches to limit the red ink have to be similar. There has to be a push to deal with the underlying problems and make the necessary reforms. The running out of funds will force some actions — and hopefully facilitate constructive changes.
References:
- www.ssa.gov/policy/docs/chartbooks/fast_facts/2001/fast_facts01.pdf.
- www.ssa.gov/policy/docs/chartbooks/fast_facts/index.html.
- www.ssa.gov/policy/docs/statcomps/oasdi_zip/2010/oasdi_zip10.pdf.
- www.ssa.gov/appeals/charts/National_Hearing_Receipts_FY2007-FY2011_4th_Qtr.pdf.
- Douglas W. Jackson, MD, is Chief Medical Editor of Orthopedics Today. He can be reached at Orthopedics Today, 6900 Grove Road, Thorofare, NJ 08086; email: OT@slackinc.com.