The Importance of SDOH Data

Collecting Social Determinants of Health (SDOH) data in an electronic health record is necessary because the recognition of the impact that SDOH have on patients’ outcomes is growing, as is the desire to incorporate SDOH factors into patient-care plans.

Here’s an example of how this can impact patients’ health:

If a patient’s blood pressure is found to remain elevated on the current medication during a follow-up office appointment, the provider would want to prescribe a different medication or add another medication for better control.

However, if the patient is experiencing a monetary crisis, the medication is not covered under their insurance, or there is a higher copay and you are unaware of the change in their financial situation, you are unaware that it is highly unlikely the patient will have the prescription filled.

By updating the SDOH questions and actively asking and addressing their issues, the provider can see that the patient may not be noncompliant on taking the medication — they would take it if they could afford it.

This brings us to the “burning” question: Is there a staff member who has the responsibility in the office to follow up on collecting these? Below are a few ways that SDOH can be captured:

• SDOH data can be collected via patients’ interaction with healthcare professionals or it can be self-reported, as long as it is verified by the clinician and incorporated into the official medical record.
• It is important to screen for SDOH at each healthcare encounter to pinpoint circumstances that may have changed since the patient’s previous visit.
• Coding professionals may utilize documentation of social information from social workers, community health workers, case managers, or nurses, as long as the documentation is part of the official medical record.
  
  

Who is responsible for collecting SDOH in the office? This is a requirement that is tracked by the State of North Carolina, CMS, and NCQA! Does your practice currently have a provider, clinician, or other staff member who is held responsible for this collection?

Why do we always seem to be requesting medical records?

Here are a few of the entities that request medical records for review:

• Department of Health and Human Services (HHS) — the top dog in healthcare auditing!
• Office for Civil Rights (OCR)
• Centers for Medicare & Medicaid Services (CMS)
• Office of the Inspector General (OIG)
• National Committee for Quality Assurance (NCQA) — better known as HEDIS Compliance audit
  
  

This is not an all-inclusive list. The next time you receive a request, know that we are asking this to remain in compliance as a health plan, not because we want to create more work for the office. It is also important to note these requests are always time sensitive.

Frailty Codes

Remember to document any frailty codes on patients 66 years of age or older who have an advanced chronic illness, such as:

• Dementia
• Alzheimer’s
• Parkinson’s
• Heart Failure
• CKD stage 5
• Emphysema
  
  

Remember also to document if they require any type of assistance, such as:

• Cane
• Walker
• Wheelchair
• Respiratory assistance
• Oxygen
  
  

Please note: The above is not an all-inclusive list, and these codes should be captured at least once a year.

Send Us Your Feedback

Are there any topics you are interested in learning more about related to Risk Adjustment? Send us an email at: riskadjustment@htanc.com.