Community Hospitals have risen to the challenge of the past two years with fast thinking, quick evolutions and continual adaptations. Fortunately, not all shifts have taken us by surprise, including the changing discussion on healthcare payment models in a value-based care context. The conversation on both patient care and monetary reimbursement has been fundamentally refocused on how providers can secure better health outcomes and close the coverage gap1 on a person-by-person basis.
While setting ambitious goals, the ideal path to accomplish them can sometimes be unclear. For many community hospitals, the pressure is very high. Often, they can be the Sole Community Hospital (SCH) for miles. By their very nature, they often have to optimize for smaller operating budgets and tighter margins than many of their peers. Further, they often have access to fewer personnel and thus cannot always adapt as quickly to status-quo practices that are being rapidly updated. RCM managers at these hospitals must therefore be experts of finesse and apply cost saving solutions wherever they find them.
Social Determinants of Health: Vital for Everyone
Complicating factors like smaller operating budgets, tighter margins, and smaller staff actively impede community hospitals’ abilities to adopt updated best practices and to capture the data necessary to pursue these goals. This leaves both them and their patients open to risks inherent within their communities themselves: Social Determinants of Health. Among these determinants are factors like a patient’s access to transportation and healthy food as well as their financial ability to maintain their medication regimen. These subtle but vital attributes have a surprisingly profound effect on a patient’s health outcomes. In fact, available information shows that these factors are responsible for around 80% of a patient’s overall health2. Therein lies the true challenge for community hospitals to achieve value-based care. Much of a patient’s health and numerous risks of readmission are buried in data that they likely are not currently equipped to capture or optimize for. Vital information is often left behind, which can impact a patient’s outcomes and also open a crack for revenue to leak out.
Of course, the opposite is also true. While community hospitals, especially eligible Sole Community Hospitals (SCHs), may be some of the most vulnerable to the impact of SDoH, they can also be among those most benefited by its capture and application. Financial impact aside, for many, the push towards capturing Social Determinants of Health (SDoH) data can be defined in one phrase: health equity. Health equity is belief in motion: pursuing even healthcare outcomes regardless of class and socioeconomic status. Fortunately, these dual concerns of health equity and risk / loss reduction can not only be tackled simultaneously, but they are in fact complementary to each other.
One takeaway is truly important to note: there is no shortcut to value-based care. There are, however, numerous tools available to community health systems to optimize their data capture and to continually provide improving health outcomes for the populations that they serve.
Reaching Future Goals with an SDoH Audit
The most common data capture tool used by hospitals of all sizes and scopes is the Electronic Health Record (EHR). These have been in use since the 1970s, and on the surface, they seem to capture everything directly medically relevant to the patient. However, the recent shift in considerations has further highlighted EHRs’ shortcomings with tracking the non-medical factors that truly influence most of a patient’s health outcomes. Consequently, EHRs very often require additional integrations to become interoperable systems. Nevertheless, even the most advanced AI applications and software programs are merely facilitators; they always require a coder’s manual edits and reviews. In the end, a certified human professional with multi-specialty experience should be the final gatekeeper and intermediary responsible for all stages of this process starting from patient record accuracy, to notifying teams about software coding gaps, to validating risk capture and analyzing data for improved quality outcomes, to much, much more.
While capturing the data technologically is not a complete solution, the issue is even further complicated at the ground level by human factors. Many of those tasked with gathering the necessary SDoH information simply are not trained in what to ask or how to ask it. While, on its face, this may seem like an easy issue to correct, very often it proves otherwise. By its very nature, SDoH data, details concerning a patient’s private living circumstances and their socioeconomic status, is highly personal information about a patient’s life circumstances. Therefore, information collection must be handled with the utmost tact and discretion.
Therefore, the way to truly gain insight is through a case-by-case analysis by seasoned coding experts who can perform thorough retrospective third-party audits to capture the individual patients' historical trends on a case-by-case basis. Credentialed coding professionals can flag gaps that can lead to both poorer patient outcomes and revenue losses and can offer instructions and advice on how to close them for a brighter and more optimized future for all.
ECLAT: Your Coding Quality Solution
At ECLAT Health Solutions, we are committed to supplying our peers at Community Hospitals throughout the nation with every tool they need to achieve a value-based future. Among these are skilled auditors and coders to help you optimize your resources and to help prevent, manage, and capture dollars from preventable risk losses. However, there is much more to the ECLAT Advantage. Our incredible team of experts includes specialists in every facet of the RCM, allowing us to create substantial returns on your investment by ensuring top-quality coding, reducing billing denials and errors, and relieving the burdens on your team. Our high-quality results are fueled by ECLAT’s proprietary 3-Tier Quality Assurance Process – a uniquely powerful system of best-in-class quality measures that offer a one-of-a-kind value proposition you can't find anywhere else. Moreover, our 3-Tier Quality Assurance process offers 24-hour turnaround time with certified coders who code while you sleep. This unique advantage make us a true and brilliant extension of your team.
To learn how you can achieve these goals and build long-term ROI with ECLAT:
- https://www.hfma.org/podcasts/addressing-the-social-determinants-of-health.html | Healthcare Financial Management Association
- https://carejourney.com/social-determinants-of-health/ | Care Journey