Connecting the dots through SDOH capture
by Nicole Nodal-Rodriguez, MSN, RN, CCDS
The term “social determinants of health” (SDOH) has become a buzzword in the CDI space over the last several years. There has been increased interest in, and emphasis on, capturing a holistic picture of the patient’s life and how such capture can impact health outcomes. When clinical teams have had the opportunity to deep dive into these discussions with their patients, we have found that there is so much value to what is often thought to be a mere simple assessment.
SDOH connects the dots between an individual’s medical, economic, environmental, and social status. Through identifying and documenting this information in the patient record, there is a trickle-down effect on treatment plans, identification of health disparities, and community services. When formulating treatment plans, providers can use this information to obtain a patient’s healthcare literacy and to determine if they have a safe environment to return to post-discharge. It is also used to determine if patients can afford their medications, follow-up care, and necessary treatments.
When a patient is underfunded or doesn’t have transport, social workers and/or case managers (in some organizations) can provide patients with a 30-day supply of medication, help them apply for assistance, schedule their follow-up appointments, and arrange transportation; all of which is integral to preventing unnecessary readmissions and/or poor outcomes.
Not only do providers use this information when formulating their own treatment plans, but, with the adoption of widespread electronic medical records, this information continues to follow the patient from provider to provider through various clinical settings.
Social issues often get left out of the conversation when providers/caregivers/patients are busy, stressed, and focused on the immediate problem that occasioned a visit or admission; however, having SDOH carried through the record ensures that all providers with access to the electronic health record can use this information to care for their patients and further determine if any special needs or considerations need to be met.
SDOH data also has a significant community impact when it comes to addressing health disparities. Documenting things like income, level of education, race, ethnicity, illicit drug use, and homelessness translates into data used for preventative care, early intervention, and necessitating community resources to address potential obstacles. This information also helps with local advocacy, policy development, and interventions to decrease healthcare inequities.
In short, capturing SDOH literally entails so much more than documenting a few ICD-10 codes.
With the recent proposal from CMS to remove the Hospital Commitment to Health Equity measure, a question emerges as to how this will impact the reduction of health disparities and equitable care delivery. This release comes on the heels of the 2024 CMS proposed change regarding homelessness, which stated:
After review of our data analysis of the impact on resource use generated using claims data, CMS is proposing to change the severity designation of the seven ICD-10-CM diagnosis codes that describe inadequate housing and housing instability from non-complication or comorbidity (NonCC) to complication or comorbidity (CC), based on the higher average resource costs of cases with these diagnosis codes compared to similar cases without these codes
Given CMS' acknowledgement that social issues increase the complexity of care and resource use, is the proposed removal of this measure aligned with the same thought process?
Nevertheless, whether CMS removes this measure or not, from a CDI perspective, we still have work to do. Our role remains the same: we should continue to scour the record, looking for instances of incomplete or missing documentation, while ensuring that the overall patient’s picture, in all its detail and nuance, is crystal clear.
We should continue to support the clinical teams by providing education on the importance of capturing social determinants of health and how they impact health equity and patient outcomes. All of these are examples of how we can continue to live out the “integrity” part of our role despite ever-changing rules and guidance.
Editor’s note: Nodal-Rodriguez is a CDI education specialist for ACDIS/HCPro. This article originally appeared in CDI Strategies, ACDIS’ weekly e-newsletter.