How to Integrate a SDoH Coding and Quality Question

by Tiffany Ferguson, LMSW, CMAC, ACM
Published on Oct 12, 2022

This article appeared in on October 12, 2022

Last week I reported on the social determinants of health (SDoH) requirements for 2023, with many Monitor Mondays listeners being familiar with the Z code discussion. However, based on our listener survey, most respondents had not started working on the quality requirements under the social drivers of the health measure. So today, I would like to discuss how this can be incorporated into your workflow, and what will be needed from an electronic medical record (EMR) and documentation perspective.

To recap, the social drivers of health data submission is voluntary for 2023, which means it is a great time to test out workflows before 2024 – when reporting will be mandatory, and then fall under a payment determination in 2026. 

Although there are many options for SDoH questions, and our EMR vendors may be creating their own mechanism, the Centers for Medicare & Medicaid Services (CMS) has specifically provided, cited, and recommended (although not required) the Health-Related Social Needs Screening Tool (HRSN). 

Each hospital will need to have a mechanism for providing the HRSN questions that apply to the five domains – housing, transportation, food, utilities, and personal safety – to hospital inpatients who are 18 or older. You will need a mechanism that is discrete to pull data that says “yes” or “no” for questions provided to the patient. You would also need a discrete field to mark if the patient declined or was unable to answer. For those individuals who can complete the questions, hospitals will need to capture the positive screen metric by ensuring they have captured responses in all five domains. 

Many of these questions live in the EMR and are asked in various ways, either by case managers, physicians, and/or nursing. However, are they in easy, discrete fields for quality reporting? And what is the consistency for asking these questions to our patient populations? 

So, if we are considering who sees every inpatient upon admission, these questions fall into two areas: patient registration or the nursing admission assessment.

Once these questions are answered, case management and/or social workers can gladly be routed to follow up with the needed supportive services and elaborate with the patient on any of the responses. Like the ambulatory clinics, the medical assistant collects the information and then the chronic care manager does something with the information obtained. 

I would recommend you maintain a consistent process for collection, capitalize on shared fields in the EMR that go across disciplines, and work with your coders so they can easily view this information to capture the Z codes. 

For our listener survey, I would like to ask: Are you familiar with the Health-Related Social Needs Screening Tool (HRSN)? 

  • Yes, very familiar
  • Somewhat
  • Not at all

The responses from the Monitor Mondays Listeners Survey may surprise you; they can be viewed here.

Programming Note: Listen to Tiffany Ferguson’s live reporting on the SDoH every Monday on Monitor Mondays at 10 a.m. EST.