History of SSA During the Johnson Administration 1963-1968
OPERATING METHODS
ESTABLISHING NEW SYSTEMS OF APPRAISAL TO IMPROVE THE QUALITY OF CLAIMS
The 1965 reorganization of the Social Security Administration providedwithin
each of the three program bureaus--the Bureau of Health Insurance,
{1} the Bureau of Retirement and Survivors Insurance,
and the Bureau of Disability Insurance--a quality appraisal function,
in addition to but uniquely different from established appraisal activities.
This new function paralleled the new program responsibilities in each
of these bureaus in recognition of the growth and complexities of
the entire social security program, and was designed to measure how
well overall Social Security Administration quality objectives are
met in terms of the results of the social security program.
Appraisal activities of various kinds have always existed in the Social
Security Administration but were oriented in most instances toward
measurement of the effectiveness of particular parts of the Social
Security Administration's total processes and were performed in large
part by supervisory personnel and their delegates. These have served
the Social Security Administration's needs very well and continue
to do so within their limitations. As the complexity of the program
has increased, the capability of the manager or supervisor of a part
of the process to recognize all the interfaces of his operation with
others has lessened. The new appraisal function is geared to larger
and stronger focal points of responsibility, yet in no way impinging
on the supervisor's role in assessing the quality of the output of
his unit. As a matter of fact, the overall quality evaluation is strengthened,
in that appraisal complements the responsibilities of the line supervisors
in helping to maintain quality of the process results.
Outlined below are basic aspects of the system used to conduct the
quality appraisal activity in the Bureau of Retirement and Survivors
Insurance, the office responsible for the largest of the three insurance
benefit programs.
I. How the System Operates
There are four basic steps used to conduct the appraisal on an ongoing
basis:
A. Systematic Sampling of Product
An end of line system for appraising awards and disallowances has
been fully implemented. This is described in greater detail below.
A comprehensive system for appraisal of postentitlement actions at
the end of line is in the developmental stage and will replace several
current studies of various parts of the postentitlement process. Implementation
is expected by the end of 1968.
B. Special Studies
As dictated by experience, aspects of the process not otherwise covered
are subjected to analysis on a scheduled or ad hoc basis.
C. Analysis of Deficiencies and Irregularities in Process Results
Weaknesses in quality identified in the sampling and special studies,
or as a result of other information, are measured for significance
and probable cause. The analysis is intended to be broad-gauged and
positive. To achieve total perspective, appraisal takes into account
all aspects of the RSI process, not just those subject to regularized
or specific study. Further, the aim is to give management a measure
of how it is doing in terms of overall results, as distinguished from
an immediate measure of the quality of each step in the process which
can best be supplied on a day-to-day basis by the line supervisors
and management analysts. Since quality appraisal is designed to measure
achievement against standards, the analysis aims to answer the broader
question of "How are we doing?" as well as such questions
as "When or where are we failing?"
D. Communication of Appraisal Findings
Data, study results, and other significant intelligence about quality
aspects, prepared in statistical and/or narrative form, are disseminated
to appropriate personnel of the Social Security Administration, primarily
for management action in improvingproduct quality. A comprehensive
method of presenting RSI quality data was implemented in July 1968.
It provides for recurring reports to present a unified view of the
entire RSI program, including claims and postadjudicative actions.
There will be a continuous flow of quality information between the
Bureau and the Regional Representative, RSI. In addition, there will
be a monthly report indicating the quality of the RSI program from
the Regional Representative, RSI, to management personnel in the payment
centers and the DOO regions.
II. Staffing of Appraisal Function
The appraisal function is carried out by a central office staff and
a field quality appraisal staff in the office of each of the six RSI
Regional Representatives. Appraisal personnel act as staff to the
Bureau Director, RSI, centrally, and to the Regional Representative,
RSI, in the field. The appraisal staff provides a direct service not
only for employees under the administrative supervision of the Bureau
Director, RSI, or Regional Representative, RSI, but also for others
who have responsibility for part of the RSI process, such as the Regional
Representative, DOO, his staff and the district managers. The general
responsibilities of the central office staff are the development and
maintenance of appraisal systems, and analysis and dissemination of
appraisal results on a national basis. The field staffs conduct appraisal
studies and are responsible for analysis and dissemination of appraisal
information on a regional basis.
III. End of Line Appraisal of Awards and Disallowances
The end of line appraisal of awards and disallowances, the first major
RSI appraisal study, was established in September 1967. This system
provides for quality review of a scientifically selected sample of
2 percent of all awards and disallowances of new claims for RSI benefits.
The sample selection is made and the review conducted at the end of
line, that is, after completion of all Social Security Administration
processing to inform the Treasury Department of the payment due or
for mailing by the Social Security Administration of the notice of
decision in cases where payment is not due. The review is conducted
by the field appraisal staffs.
The primary objective of the study is the measure of the extent of
compliance with established policy and procedure. The system is not
designed to measure the effectiveness of the policy and procedure
although a by-product of the system can be a finding that a deficiency
or irregularity in the process resulted from a
weakness in policy or procedure rather than from the way they were
followed. Data on accuracy and processing time are gathered on the
same case sample. The testing of all aspects of the process on the
same set of cases permits more precise correlation of data than was
possible witch previous quality studies.
Another objective is to ensure a reasonable degree of uniformity among
payment centers in the application of policy and procedure. This is
achieved through a method of exchange review among the field appraisal
staffs. Each month approximately one-fourth of the sample cases from
one region are reviewed by the appraisal staff of another region.
Analysis of these data is useful in detecting indicators of basic
differences among payment centers
in applying national policy and procedure.
The quality data derived from the end of line review are transmitted
daily from each region by wire (the Advanced Record System). Computer
tabulations of the data are done centrally. The advantages of these
methods are the elimination of time-consuming manual tabulation and
the ability to publish data more promptly.
Appraisal Program---Bureau of Disability Insurance
The present Bureau of Disability Insurance appraisal program also
took its impetus from the 1965 reorganization of the Social Security
Administration when an appraisal component was established in the
Bureau's Division of Management and Appraisal. The Appraisal Branch
developed an appraisal program for the entire Bureau of Disability
Insurance complex of disability operations, including activities performed
in the central office, the State agencies, and the district offices.
Plans have been made for assessing the correctness and timeliness
of disability claims determinations, as well as for the succeeding
authorization or denial actions, benefit payment and other related
actions. In this assessment, the efficacy of the procedures and policies
governing determinations of allowance or denial are examined as well
as the disability decision itself. Other plans have been developed
to measure and evaluate operating experience, manpower utilization,
processing time and production rates; and to evaluate organizational,
managerial, operational and administrative systems. In carrying out
the responsibility dealing with the status and quality of Bureau operations,
the basic approach of the Appraisal Branch has been to develop a broad
overall cohesive picture of Bureau operations. In essence, the expanded
Bureau of Disability Insurance appraisal program encompasses every
facet of the disability insurance program, administrative and operational.
One of the earliest of the Bureau of Disability Insurance's continuing"evaluation"
efforts was the Medical Consultant Staff "Sample." Unlike
the "on-line" work product review systems, the Medical Consultant
Staffsample does not provide line management with immediate "feedback"
for corrective action. Rather, the system provides information on
the quality of the Bureau of Disability Insurance's and the State
agencies' application of medical evaluation and development criteria,
with a view to assessing the adequacy and effectiveness of the current
medicalguides in the disability decision making process.
A significant feature of the Bureau of Disability Insurance's expanded
appraisal program is an end-of-the-line quality review system. In
this system the entire adjudicative claims process is viewed as an
entity from initial filing of the claim through its final disposition.
Included are the district office and State agency development and/or
determination processes, the central office review-determination-authorization
process, the reconsideration process, the postentitlement process,
and all related benefit payment processes.
An additional feature of the Bureau of Disability Insurance's expanded
appraisal program is a systematic review of a sample of cases at the
State agency point of intake for the purpose of measuring district
office performance, the effectiveness of operating procedures, and
to identify training needs and provide feedback to district offices.
Through a continuing monthly reporting system each region is kept
currently informed of the number and nature of additional development
requests which have been returned to district offices by the Bureau
of Disability Insurance on the nondisability issues of proof of age,
representative payee, etc.
Increasingly, the Appraisal Branch has also undertaken a variety of
important special "ad hoc" studies and is expected to provide
Bureau leadership and expertise in the more sophisticated techniques
of program and managerial appraisal. Some recent examples of the ad
hoc studies carried out by the Branch include: (1) an appraisal of
the "pilot" multi-shift disability operations in terms of
claims production rates, adjudicative quality, and a wide variety
of personnel and general administrative management concerns; (2) an
experimental joint medical-technical "team" evaluation of
the quality of the initial State agency and Bureau of Disability review
of disability decisions; (3) a series of individual Bureau of Disability
Insurance work-station processing time analyses; (4) an assessment
of the value of the revised disability interview report, Form SSA-401;
(5) design of a system for conducting a "less-than-a-100%"
review in the central office of certain initial State agency disability
determinations; (6) an assessment of the direct routing of certain
childhood disability cases to the payment centers, etc.
Management Information and Appraisal
In, the administrative area, in 1966, to provide for a greater emphasis
and improved capability in management information and appraisal, the
Management Information and Appraisal Branch was established in the
Division of Administrative Appraisal and Planning, Office of Administration.
This activity, as a concomitant to the reorganization of the Social
Security Administration in 1965, was to be strengthened in line with
actions in the Bureaus of Retirement and Survivors Insurance, Disability
Insurance and Health Insurance to increase attention on improving
claims processing through quality appraisal. Management information
activities emphasize determining the data needed by top management
to assure appraisal and control of program administration, developing
the specifications for obtaining data, and developing and managing
a program for exhibiting and reporting these data to top management.
More emphasis is given to identifying significant shortand long-range
objectives and management and operating goals so as to measure progress
and overall effectiveness of administration; to identifying significant
trends and indicators; to bring to management's attention the actual
or potential problem, or trouble areas; and prepare "state of
the organization" reports and briefings for top management.
The Evaluation and Measurement System
Another project to improve the efficiency of operations came with
the establishment of an Evaluation and Measurement System on November
20, 1964.{2} It was designed to and does continuously
assess the validity of the assumptions underlying claims policy.{3}
The initial impetus for planning the Evaluation and Measurement System
was identified in the Commissioner's comments of November 27, 1963,
on the General Accounting Office draft report, "Review of Selected
Requirements for Establishing Entitlement to Insurance Benefits, Bureau
of Old-Age and Survivors Insurance, Social Security Administration,
Department of Health, Education, and Welfare." The Evaluation
and Measurement System program proposal was prepared and submitted
for comments to each of the SSA components on December 6, 1963.{4}
After all components submitted comments, a memorandum "Submittal
for decision", January 15, 1964, together with an analysis of
the comments, were sent forward for consideration by the Commissioner.{5}
After further analysis of comments, proposals for modification, and
intercomponent discussions, the Commissioner held a meeting on October
29, 1964. This led to the Commissioner's decision and the announcement
of November 20, 1964. The program was initiated with a pilot project
of 150 cases for two months. A status report of experience in the
pilot period was made to the Commissioner and the system continued
as a permanent operating program, starting with a one-fourth percent
and gradually moving up to a sampling rate of one-half percent of
initial Old-Age and Survivors Insurance claims. The details of the
concepts and measurement techniques are described in the publication
"Concepts and Measurement". {6} Results
of the Evaluation and Measurement System have been issued for SSA
administrative use both in preliminary form and in final form, as
noted in the description given in footnote {3}.
Optical Scanning
One of the most recent improvements in the area of automation which
the Social Security Administration has been able to adapt to its recordkeeping
operations is that of optical scanning equipment.
Within 30 days after the close of each calendar quarter, the Social
Security Administration receives from employers, through the Internal
Revenue Service, approximately 3.4 million tax returns and 3.1 million
related continuation sheets. On these forms employers have listed
the social security account number, name, and earnings for each employee
to whom wages were paid during the quarter. The average number of
employees reported each quarter is approximately 60 million.
These reports are prepared by 3.4 million different employers using
whatever method of machinery they choose. These methods include handwriting,
typewriter, posting-bookkeeping machines, Addressograph plates, punchcard
tabulators, electronic printers, etc.; thus they represent a wide
variety of type sizes and styles.
The Social Security Administration is now using an optical page reader
which reads and automatically transfers to magnetic tape approximately
18 million of the 60 million earnings reports received each quarter.
Although the Social Security Administration began studying and talking
about the possibilities of optical scanning equipment for its operations
in the early 1950's, it was not until 1960 that the Social Security
Administration began to search for such equipment in earnest.
In 1960, the Social Security Administration sent a statement of requirements
to 33 companies and asked them to submit their proposals. At that
time these were the only known companies working in the field of optical
character recognition.
The Social Security Administration received and evaluated proposals
from 8 of the 33 companies. Time was then spent preparing invitations
for final proposals. In May 1963, invitations were sent to 71 companies.
(In this short span of time many more companies had become interested
in optical scanning research.) Nine final proposals were received.
Several months were spent analyzing and evaluating the proposals.
Primary consideration was given to the technical requirements of the
suggested system and the savings to be realized. Recommendation for
award of contract was approved in June 1964. In August 1966, the Optical
Page Reader became operational.
The Optical Page Reader is a highly versatile unit containing the
latest advances in the fields of document handling and multifont character
recognition. The recognition and interpretation of a character is
performed completely by the page reader. In addition, it incorporates
an electronic control system which places the page reader under control
of a small computer stored program.
The electronic scanner consists of (1) a controlled cathode ray tube
beam, (2) a high resolution optical system, and (3) photomultipliers.
A flying spot is focused on the document by the optical system. As
thespot traverses a defined area, white to black transitions are sensed
by the photomultipliers and converted to an electronic image. The
electronic image is then analyzed by the character recognition circuitry.
This action results in the derivation of sets of measurements of the
character. The set of measurements from the scanned data is conformed
with a predetermined set of measurements in the reader. The result
is analyzed on a decision base to determine the character.
As each character is identified, it is sent from the scanner to the
computer memory. If a character cannot be identified, a special character
is sent to the computer memory to take the place of the unidentified
character. The reader also remembers the line containing the bad character.
The scanner reads character by character from right to left at a rate
of 500 characters per second. This speed enables the system to process
approximately 64,000 lines per hour.
This process--read, compare, decide, transmit--is repeated until the
scanner senses the end of the line. It then returns to the start of
the next line. At the same time, the line it has finished reading
is moved to an output area in the computer's memory.
When the bottom of the page is reached, the sheet is ejected and a
new document is fed in. As the page is being ejected, all lines containing
bad characters are marked, and the information recorded in the computer
storage is written on tape. {7}
Disability Case Control System Operating Methods
The Disability Case Control System is the product of 5 years' use,
refinement, and improvement, in the headquarters operation of the
Bureauof Disability Insurance. It was designed to speed the processing
ofdisability claims and to permit prompt location of sensitive cases
fromamong the 350,000 claims folders in circulation.
In 1966, BDI acquired an IBM 360/30 Data Collection System, consisting
of a central processing unit and a flexible number of remote input
card readers. Folder locations were recorded directly onto magnetic
tape inthe central computer, through use of a control card which stayed
with acase as it moved through the processing procedure.
While the magnetic type system enabled the Bureau of Disability Insurance
to record folder locations practically instantly, getting information
from thetape was a "next day" matter. It took the computer
a couple of minutes to search through a reel of tape for a particular
case, and this tied up the computer. Therefore, the retrieval of information
was postponed until the night shift when new folder locations were
not being fed into the computer.
This meant an overnight delay in getting folder data, printed in the
form of a freeze list and broken down or segmented by locations to
facilitate the next day's searching.
The Bureau of Disability Insurance's use of magnetic tape as the best
means for storing folder control information was short-lived, for
early in 1967 a new type of equipment was installed that reduced the
time it took to get information on folder location from the overnight
delay of the magnetic-tape system, down to what in effect is--nothing.
The "nothing" that this equipment takes to do its job is
measured in millionths of a second, termed microseconds. Engineers
refer to this equipment's speed of operation in terms of "real
time," which is the actual amount of time it takes from query
to response.
Where the magnetic tape system could record data in terms of real
time, the new system can not only do this, but of equal importance,
can find and retrieve information previously stored, upon request,
also in real time. This ability to answer queries on folder locations
instantly is known as the "answerback" technique.
The great speed with which the system operates means that mistakes
which stop the process, even for a few minutes, are much more costly
than ever before. This underscores the great reliance that the Case
Control System places on the accurate work performance of nontechnical
personnel. The design of the system, in fact, has been primarily influenced
by the human factor and has given first consideration to the personnel
who will work with it.
As a result of the successful operation of the Disability Case Control
System, the Social Security Administration has had similar systems
installed in the payment centers located in Birmingham, New York,
Philadelphia, Chicago, San Francisco, and Kansas City.
Now plans are being developed to expand the Case Control Systems to
control and report on not just the claims folders, but also the processing
of the individual claims and the post-entitlement actions contained
in the folders. {8}
Tape Reporting of Earnings by Employers
Since 1956 when the Social Security Administration first received
quarterly FICA (Federal insurance contributions Act) earnings reportson
magnetic tape, there has been a large increase in the number ofcompanies
reporting on tape. The volume of wage items reported ontape has also
increased steadily from 18,000 in 1956 to about 10million in the first
quarter of this year. The 10 million wage itemrpresent 538 parent
organizations.
Reporting on tape benefits the Social Security Administration and
the employer. These reports can be introduced directly into the Social
Security Administration's electronic report processing system, thus
saving the government the time and cost required for manual card punching
and verifying. These savings in cost are approximately
$12,000 per million items. Also, because the reports are submitted
directly to the SSA on magnetic tape, the earnings information is
available for posting at an earlier date. Consequently, a person's
account is kept more current for claims and earnings request purposes.
This also avoids having to make corrections of errors made manually.
Employers may also find certain advantages and economies in such a
system. For example, there is no further need to convert from tape
to paper. As a result, there is no need to handle bulk paper. Thus
savings in time and money are realized. The employers also receive
the tapes, after processing, along with a detailed list or microfilm
(at the employer's choice).
In late 1960 the Social Security Administration began actively to
enlist participation of about 300 companies employing 10,000 or more
people quarterly in the tape-reporting plan. The use of computers
was not widespread until this time. The Social Security Administration
notified these employers that a tape-reporting plan was available
to those companies meeting certain requirements. The specifications
included the type of computer tape the Social Security Administration
could accept, the paper forms needed along with the tapes, and the
format and content of the tape record required.
Early in 1962 the Social Security Administration re-contacted the
companies that had indicated an interest in the plan but were not
ready at the earlier date to undertake the project.
The Social Security Administration's last major contact with employers
was through the district offices. In August 1962 the Social Security
Administration began contacting those employers with 5,000 to 10,000
employees per quarter.
The campaign is still going on, but on a different note. The Social
Security Administration sends press releases on a regular basis to
newspapers through the district offices and to over 100 national business
journals. In addition, data are released at meetings of equipment
users. Of course, through correspondence and, upon request, personal
visits, the Social Security Administration maintains direct contact
with the employers using computer equipment.
A most important change has occurred since 1960. Then, only magnetic
tape prepared on the same manufacturer's equipment as used by the
Administration was acceptable. A study was then made of the different
types of tape available on the market. On the basis of findings the
Social Security Administration determined that other types of tapes
as well as tapes exactly like those used by the Social Security Administration
were compatible with its equipment, and therefore, acceptable.
Today the Social Security Administration can accept magnetic tape
reports prepared on a number of computers. However, all of these do
not produce compatible tapes. But arrangements have been made with
other government agencies to convert certain incompatible tapes to
the Social, Security Administration's machine language for processing.
{9}
Footnotes (Footnote numbers not same as in the printed version)
{1} The BHT phase was covered in the Medicare section.
{2} Commissioner's Bulletin, Number 18, November 20,
1964
{3} Office of Research and Statistics, Work Plan,
Fiscal Years 1969-1970
{4} See Below memorandum dated December 6, 1963, on
Evaluation and Measurement Program Proposal
{5} Memorandum to Mr. Ball dated January 15, 1964,
on Evaluation and Measurement System -- Submittal for Decision
{6} Evaluation and Measurement System, Concepts and
Measurement, Series 2, Number 1.
{7} Data Processing in the Social Security Administration--A
series of lectures given by Mr. J. L. Fay in Mexico City, pages 54
and 56
{8} Social Security Administration, Bureau of Disability
Insurance, TheDisability Case Control System.
{9} Data Processing in the Social Security Administration-A
series of lectures given by Mr. J. L. Fay in Mexico City, Pages 54
and 56