Clinician expertise and quality assurance enhance disability determinations

January 18, 2018

To be successful at disability evaluations, public agencies must have access to reviewers with clinical expertise, quality assurance and knowledge of complex federal and state regulations, notes Peter C. Lindblad, MD, medical director UMass Medical School’s Disability Evaluation Services.

Most public agencies do not employ medical experts, but they can receive assistance from entities like Disability Evaluation Services, which has a staff of nearly 80 clinicians.

“The value we supply is a variety of expertise,” says Dr. Lindblad, also assistant professor at UMass Medical School and president of Primary Physician Partners, where he is a practicing internist. “We work at the state level and we can work at the municipal level to help organizations determine disability.”

The team includes 25 multi-specialty psychologists and physicians, including cardiology, occupational medicine, neurology and nephrology. The team also has 28 licensed nurses and licensed allied health specialists, and 24 masters-prepared vocation rehabilitation professionals.

They have extensive experience with federal disability regulations and determining a person’s ability to continue to do the work they have done in the past and other work as well. That knowledge is crucial for judging whether a patient qualifies for disability assistance under Social Security and Medicaid.

The Disability Evaluation Services team also is able to assess and sort out potentially conflicting rules of various state and federal disability programs.

Along with assessing disability cases, the team also works with state agencies and other clients to build a multi-specialty network of doctors and psychologists who can help vet disability claims.

Disability Evaluation Services has provided services to the Massachusetts Medicaid program and the Massachusetts Department of Transitional Assistance since 1990. They have also worked closely with agencies and programs in New Hampshire, Ohio and the Missouri Government Employees Retirement System.

The team has established a track record of accuracy and timeliness, with 96 percent clinical and vocational accuracy on the tens of thousands of disability reviews conducted for Massachusetts and New Hampshire agencies. Team members routinely turn around reviews for New Hampshire’s Aid to the Permanently and Totally Disabled in 30 days or less, while in Ohio it has averaged as little as three days.

At the foundation of UMass Medical School’s Disability Evaluation program is a thorough training course and on-going quality assurance checks, Dr. Lindblad notes.

All incoming clinicians and staffers undergo “robust” training that ranges from six months to a year. Team members face rolling reviews over the year for all the disability determinations they have performed and paperwork they have filed to ensure the correct decisions were made, Dr. Lindblad says.

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