Social Determinants of Health (SDoH) are the socio-economic factors that impede healthcare. When this information is documented and coded correctly by providers, they drive appropriate healthcare payments and impact the health and well-being of patients. They also significantly affect population health, disease management, and revenue cycle management for healthcare providers.
Revenue cycle professionals play a key role in ensuring SDoH information is documented and reported accurately to identify population health trends and reduce long-term costs to the patient and the healthcare providers.
In our latest quarterly Experience the Brilliance webinar, “Social Determinants of Health in 2021: Healthcare Considerations for the Most Vulnerable” ECLAT’s Marie A. Thomas, MHA, RHIT, CCS, CCDS, COC (VP, Revenue Cycle Operations), Evelyn Santos, CCS ( Coding and Audit Specialist), and Kara Carlisle, RHIA (Coding and Audit Specialist) spoke on social determinants of health sharing practical and real-life examples for how they impact healthcare outcomes
We understand it takes a lot of courage, patience, and perseverance to identify opportunities for workflow improvement but we all have a role to play when it comes to closing the health equity gaps sooner than later. In summarizing the best practices around SDoH coding, we hope our audience feels more comfortable advocating for the most vulnerable patients as champions of health equity. For those who missed the LIVE discussion, read on to know about some of the highlights of our webinar.
What are the Social Determinants of Health?
We began the discussion by understanding what the social determinants of health are. The social determinants of health are the conditions in which people are born, grow, live, work, and age.
Nearly 80% of a person’s health relates to non-medical issues1, including food, housing, transportation, financial means, education, and utilities. Such factors determine the length and quality of life and are shaped by the distribution of money, power, and resources at the global, national, and local levels.
The Gravity Project
Discussing the topic of SDOH doesn’t go without mentioning The Gravity Project. If you are unfamiliar, this project initiated in 2018 by SIREN2 and spearheaded by the Robert Wood Johnson Foundation, sought to identify coded data elements and associated value sets to represent SDOH documented in electronic health records (EHRs) in four areas - screening, diagnosis, planning, and interventions. The project focused on three specific social risk domains: food insecurity, housing instability and quality, and transportation access. The study found growing evidence that ties social risks to an individual’s health and health care usage.
5 key areas of SDoH
Next, we moved on to understand the five critical areas of social determinants of health and how they impact the overall health and well-being of the population. These are as follows -
- Economic stability
- Education
- Social and Community Context
- Health and Health Care
- Neighbourhood and Built Environment
The goal of documenting and coding SDoH is to achieve health equity.
According to Health equity is best described as
- “Attaining the highest level of health for all people”
- “Ensuring everyone has a fair and just opportunity to be as healthy as possible”
Furthermore, “if patients identify early and get the right treatment, they reduce the burden of disease and associated risk factors and have a better chance at a better health outcome.” We also discussed the preventative health areas that assist in this matter.
Readmissions and No Shows
We also discussed how tracking SDoH reduces the risk of readmissions and no-shows and favourably impacts the bottom-line of the healthcare provider.
No-shows, in particular, cost the healthcare industry $150 billion annually3 but have the most significant impact on the health and well-being of the patient due to interruption in the continuity of care.
Z codes in 2021: ICD-10-CM Coding for Social Determinants of Health
The CMS has mandated the use of ICD-10-CM codes ranging from Z55-Z65 to account for the social determinants of health.
We discussed what each of these codes relates to and how they impact the health and well-being of affected populations.
Guidelines for SDoH Coding
We discussed that -
- Code assignment is based on the documentation by the patient’s provider; however, as an exception, it can also be based on medical record documentation from clinicians, such as community health workers and case managers, who are not the patient’s providers. This is because SDoH represents social information and not a medical diagnosis.
- HIM professionals must consider facility-specific coding guidelines for consistency.
- If the patient’s self-reported information about social needs is signed-off and incorporated into the health record by either a clinician or provider, it would be appropriate to assign codes describing SDoH.
- SDoH coding is always accepted as a secondary diagnosis and not the principal diagnosis.
Below is a friendly practice tip we recommend to help fill in health equity gaps.
- Ask physicians and social workers to determine the SDoH
- Document all social determinants
- Code every SDoH to the appropriate Z code
- Report SDoH information to the payer and other decision-makers
SDoH in the COVID-19 Pandemic - A Call to Action
Next, we discussed how the pandemic has highlighted the vulnerabilities of the population and added to their social woes. In such a scenario, healthcare professionals must -
- Identify who is at risk.
- Manage access
- Improve the quality of care
- Track data and take action to ensure the continuity of care.
Audience Poll
In the middle of the session, we conducted a live poll with the question, “Does your facility have an SDoH initiative in place?”
Only 29% of the respondents reported they have an active SDoH program, while the rest were either planning to implement one, did not have an active SDoH program in place, or were not sure about the same. Clearly, this indicates the lack of awareness, education, and urgency to document and report SDoH.
Real-life Documentation examples Case studies, and a LIVE Q&A Discussion
The webinar also included SDoH coding examples and three case studies. We discussed the principal diagnosis and SDoH documentation and coding requirements for the patients under each of these cases.
We also conducted a Live Q&A session, wherein our experts answered questions raised by the audience about SDoH.
If you missed out on the LIVE session, you can listen to the webinar replay here.
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There was, however, 1 more question we didn’t get to. We’ve addressed it below as promised:
LIVE AUDIENCE QUESTION:
"At our non-profit psychiatric facility, we see a lot of patients that are Spanish speaking only. Could this be an SDOH and how would it be coded?"
OUR RESPONSE:
"This is a great question and one that we recommend revenue cycle professionals discuss internally before implementing a consistent standard of procedure (SOP) addressing how best to code this type of scenario in their Social Determinants of Health coding policy. As we research4, 5 all the Z55 - Z65 options, “Z60.3 Acculturation difficulty” stands out to us. When cultures including language, dress, beliefs impede or cause barriers to healthcare, then this is an acculturation difficulty."
A personal note from Marie:
“We’d love to hear your feedback regarding this all too common scenario that when captured will alert and allow facility and practice decision-makers the opportunity to bridge the gap when language and other cultural barriers are identified that impede health equity for all."
In the end, we shared some of the initiatives taken by the large and small academic centers and healthcare practices to ensure health equity and attain the highest level of health for all people.
Are you in need of SDOH capture assistance?
As an end-to-end revenue cycle management strategies company, ECLAT understands that accurate and complete SDoH coding is crucial to ensure patient health, compliance, and a healthy revenue cycle. Before we are able to provide a solution, we welcome anyone seeking a third-party audit to assess the current documentation and or coding gaps.
To know more about our medical auditing services for social determinants of health (SDOH), please feel free to schedule a personalized consultation with our SDOH experts.
References:
- Racial and Ethnic Health Disparities
- The Gravity Project Recommends Social Risk Codes for ICD-10-CM
- Missed Appointments, Missed Opportunities: Tackling The Patient No-Show Problem
- Coping, acculturation, and psychological adaptation among migrants: a theoretical and empirical review and synthesis of the literature
- Acculturation: When Individuals and Groups of Different Cultural Backgrounds Meet - David L. Sam, John W. Berry, 2010
