Even if you aren’t already familiar with the acronym SDOH, you have likely encountered the notion of “social determinants of health.” The term is splashed all over the health care media as it relates to value-based reimbursement. It’s a fancy term for a topic that your practice has been juggling for many years. SDOH are the economic and social conditions that impact and/or influence a patient’s health. Conditions include housing, economic status, food security, and other non-medical risk factors. SDOH constitutes the non-medical profile that, accompanied by medical condition, impacts the patient’s overall health.
Medical practices have been on the forefront of identifying and assisting patients in navigating these challenges. Efforts have been difficult, however, as the U.S. reimbursement system contributes nothing for these non-medical activities.
That is changing – and this may be a trend that can benefit your practice. Under risk-based reimbursement, it’s crucial to understand not only your patients’ medical acuity but also their external risk factors. In its simplest format, medical acuity could be measured by analyzing the ICD-10 codes you use. But quantifying the complexity inherent in the patient’s non-medical situation can be difficult.
Although there are some Z codes that define social determinants, a comprehensive documentation of SDOH is much more difficult. Your practice may want to start with an economic analysis based on your patients’ zip codes. Language and religious preferences are other areas you could assess, and some practices can examine their charity care applications for detailed economic conditions. The latter, of course, would represent only a subset of patients. And, those Z codes that most providers ignore – like Z59.9 “Problem related to housing and economic circumstances, unspecified” – can be integrated into your documentation and coding.
Understanding the patient’s situation must commence long before a diagnosis code is chosen, however. The National Association of Community Health Centers® offers the tool PRAPARE (Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences) to jumpstart your initiative. It is designed to help providers collect the data needed to better understand and act on their patients’ social determinants of health. It is also helpful to mull over other meaningful and appropriate methods to gather SDOH to benefit your practice – and your patients.
If you are looking for more information on social determinants of health, including best practices, communication, and the latest on SDOH, this recent article, “A New Way to Talk about the Social Determinants of Health," provides information.
Next, if you can identify opportunities to engage with social services in your community, take advantage of these programs. While your efforts may not yet be financially rewarded, the system is on the cusp of changes. Having a workflow in place when those risk-based contracts come your way will prove advantageous – to your practice and to your patients’ health and well-being.
Elizabeth Woodcock is the founder and principal of Woodcock & Associates. She has focused on medical group operations and revenue cycle management for more than 20 years and has led educational sessions for the Medical Group Management Association, the American Congress of Obstetricians & Gynecologists, and the American Medical Association. She has authored and co-authored many books. She is frequently published and quoted in national publications including The Wall Street Journal, Family Practice Management, MGMA Connexion, and American Medical News. Elizabeth is a Fellow in the American College of Medical Practice Executives and a Certified Professional Coder. In addition to a Bachelor of Arts from Duke University, she completed a Master of Business Administration in healthcare management from The Wharton School of Business of the University of Pennsylvania.