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Simon&Co. Overview: Possible Data Metrics for Consultative Examination

  • Total costs incurred for the purchase of consultative examinations (CE)
  • Total costs incurred for Medical evidence of records (MER) including the costs in obtaining school records for childhood disability claims
  • Backlog of CE
  • Measure of appointment availability
    • Number of times DDS has tried to schedule appointment, but CE physician was unavailable,
    • Time it takes DDS to schedule appointment with a particular CE physician
  • Distance Measure: from a claimant’s home to the CE;
    • Average of all claimants;
    • Outliers with long journeys.
  • Personnel measure: Number of FTEs involved in conducting CE in each state
    • Including physician, nurses and clerks
  • CE Specialization: Is the CE performed by a physician from the medical field in which the claimant is alleging a disability
  • Duration of the CE appointment:  given complaints of appointments of 5-10 minutes
  • Report turnaround time:  from having seen the patient to submitting the CE report to DDS
  • Accuracy and completeness of the CE report
    • Does the report reflect medical history, relate to other evidence in the case file;
    • Does report account for abnormalities;
    • Does report of malingering have substantiating evidence;
    • Does the report reference objective medical evidence;
    • Does the conclusion statement account for all of the above.
  • Appeal rates: Measure of the rate the DDS decision using a particular CE are overturned by appeal
  • Appeals Pending
    • Number of CE appeals reconsidered by the state DDS’
    • Number of CE appeals heard by an administrative law judge (ALJ); 
    • Number of CE appeals reviewed by Appeals Council; and
    • Number of CE appeals reviewed by federal court.
  • Appeals Backlog
    • Number of CE appeals awaiting reconsideration by the state DDS;
    • Number of CE appeals awaiting hearing by an ALJ;
    • Number of CE appeals awaiting review by the Appeals Council, and
    • Number of CE appeals awaiting federal court review.