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nยบ1 - Spring 2020
Most Commonly Used Codes
Learn the newest codes that are affecting social determinants in a big way Click to see other articles
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RISE Nashville, National Summit on Social Determinants of Health postponed to late June 2020
Deft Research report: Social determinants drive ‘convenience use’ of emergency rooms – but not for the reasons you may think
The National Summit on Social Determinants of Health: Jacob Reider, M.D., on the progress made so far with social determinants and what to expect in 2020 Select progress on social determinants of health harms other essential safety-net programs Study confirms strong link between socioeconomic status and health for older adults
Social determinants in the news: Social distancing may put those most vulnerable at risk; rural communities more likely to skip preventive care; and more Despite new doubts, ‘hotspotting’ help for heavy health care users marches on
6 things Medicare Advantage health plans must do in response to the coronavirus
Social distancing may exacerbate loneliness in older adults, putting their health at serious risk RISE Association announces the launch of research project on social determinants of health
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Social Determinants of Health Newsletter
WELCOME TO RISE’S NEW SDoH VIRTUAL COMMUNITY The RISE Association is excited to introduce the inaugural issue of the Social Determinants of Health (SDoH) quarterly newsletter. The issue features the latest news on COVID-19 and its impact on SDoH as well as the Centers for Medicare & Medicaid Services’ report on the use of diagnostic codes for SDoH in Medicare claims since the Z codes were implemented in 2016. The newsletter is part of the launch of RISE’s new SDoH virtual community, a virtual space for cross-sectional thought leaders to learn and share strategies, tactics, and how-to knowledge to achieve better outcomes for the most vulnerable populations. In addition to this quarterly publication, community members will have access to live webinars, user groups, a discussion board, a job board, conference discounts, and a directory of solution partners. You can learn more about the SDoH community and member portal on page 6.
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C MS RE P O RT:
MOST COMMONLY USED CODES FOR SOCIAL DETERMINANTS OF HEALTH The Centers for Medicare & Medicaid Services (CMS) recently released its first report on the use of diagnostic codes for social determinants of health (SDoH) in Medicare claims since the Z codes were implemented in 2016. The main finding: It’s difficult for the government to capture consistent data because providers aren’t assigning Z codes even when patients reveal their SDoH concerns. 4
Social Determinants of Health Newsletter
It’s been four years since CMS introduced ICD-10-CM codes that capture non-medical factors that influence a patient’s health status. But a new report reveals that providers aren’t consistently using the Z codes that identify a patient’s struggle with food insecurity, housing circumstances, transportation, and education and literacy. CMS has pushed for the use of
Z codes in response to a growing awareness of the importance of SDoH in patient health outcomes. The agency wants providers to collect and document this data in clinical settings to improve patient care. So far, it’s been difficult to collect the data because of inconsistent use of the codes, according to the report. The report does have several limitations as it only evaluates
Medicare fee-for-service (FFS) claims through 2017 without taking Medicare Advantage into consideration. But as the first analysis of the 97 Z codes for SDoH, it provides insight into the industry’s understanding of SDoH factors that influence a patient’s overall health. Key findings According to the report: • There was a 4.7 percent increase in the use of Z codes between 2016 and 2017 • Only 1.4 percent (467,136) of the 33.7 million Medicare FFS beneficiaries in 2017 had Z code claims • Twenty-five percent of these beneficiaries were dual eligible for Medicare and Medicaid • Thirty-five percent of them were under the age of 65 The top five Z codes documented in 2017 were: • Homelessness (Z590) • Problems related to living alone (Z602) • Disappearance and death of family member (Z634) • Other specified problems related to psychosocial circumstances (Z658)
• Problems in relationship with spouse or partner (Z630) The only Z code with a higher utilization for males rather than females was homelessness
these codes are the only standardized mechanism that the industry has to gain deeper insight into the nonmedical factors that contribute to patients’ health.
The proportion of black and American Indian/Alaska Native beneficiaries who experience homelessness was more than three times higher than non-Hispanic white beneficiaries
Meanwhile, two big industry players are working to expand ICD-10 Z codes to capture other SDoH, such as access to nutritious food, adequate and safe housing, available transportation, financial ability to pay for medications, financial ability to pay for utilities, and caregiver needs. UnitedHealthcare and the American Medical Association said they also want the codes to trigger referrals to social and government services, connecting patients directly to local and national resources in their communities. The codes were proposed last year to CMS’ ICD-10 Steering and Maintenance Committee and, if adopted, could take effect by Oct. 1.
The top five chronic conditions of beneficiaries with Z code claims were: • • • •
Hypertension (72 percent) Depression (53 percent) Hyperlipidemia (48 percent) Rheumatoid arthritis/ osteoarthritis (45 percent) • Chronic kidney disease (38 percent) • Obstacles and possible solutions CMS acknowledged in the report that there are several barriers to widespread use of SDoH codes, including the absence of a standardized EHR-based screening tool, the lack of and multiplicity of codes, and inadequate knowledge among providers and medical coders. In a post on JDSupra, lawyers from Faeger Baker Daniels said that even though the existing Z codes don’t align perfectly with SDoH, they encouraged providers to use them as
More widely adopted and consistent documentation is needed to more comprehensively identify social needs.”
The increased use of Z codes throughout the health care industry is critical, according to CMS. To improve the reporting of Z codes, CMS suggests providers implement policy-based interventions, reduce reliance on clinicians to capture SDoH, improve provider and medical coder education, and fill gaps in codes. “More widely adopted and consistent documentation is needed to more comprehensively identify social needs, and monitor progress in addressing them,” the report concluded. “Collaboration between beneficiaries, community groups, and health care providers will be necessary to adequately address the social determinants of health, and ultimately to improve health outcomes.”
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THREE COMMUNITIES ONE ASSOCIATION
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Login once to access any community to which you belong
The Social Determinants of Health community will allow cross-sectional thought leaders to share strategies to achieve better outcomes for the most vulnerable populations. 6
Social Determinants of Health Newsletter
The RISE Association today launched two new virtual member communities to help facilitate networking and education among health care professionals throughout the year so they can continue to collaborate after they return from off-site events. RISE, which conducts national conferences for health care professionals year-round, had planned to launch the communities this month at RISE Nashville and the National Summit on Social Determinants of Health, but the events were postponed in the wake of the coronavirus outbreak. The virtual communities are now more important than ever due to the need for social distancing. The Quality & Revenue Community is for health care professionals who are responsible for quality and revenue. The community focuses on the transformation to value-based care to bring health care toward an accountable and sustainable model for government-financed care. Members of the community include health care professionals employed by organizations that support government health care programs including Medicare, Medicaid, and commercial health plans, health care providers, community-based organizations, and government agencies. Members have roles in quality improvement, risk adjustment, compliance, HCC coding, data management, value-based care, and
network management. The second community is devoted to health care professionals responsible for addressing social determinants of health (SDoH), the conditions in the places that people live, learn, work, and play that impact health risks and outcomes. These health-relates behaviors, socioeconomic factors, and environmental factors are the primary drivers of a person’s health. The SDoH community includes health care professionals employed by organizations that support government health care programs, such as federally qualified health centers, safety net providers, Medicare special needs plans for dually eligible individuals, Medicaid plans, and, community-based organizations, and government agencies. Members are professionals involved in population health, care/case management, complex populations, community outreach, and policy and government relations. The new communities reflect The RISE Association’s mission to provide a place for like-minded professionals to come together to network, learn, and collaborate to stay ahead and advance their careers. The RISE Association has had to postpone its national conferences for these members until late June due to the coronavirus but is dedicated to providing members with resources.
Last month the RISE Association launched its first community, the Medicare Member Acquisition & Experience Community for local and regional Medicare Advantage health plans looking to differentiate from national carriers and grow and retain their membership base. Membership in the communities is free. “We wanted to create a distinct experience and tailor content so members could focus on the community that they identify with and the issues they care most about,” said Kevin Mowll, executive director, RISE Association, noting that members can join multiple communities. Community members will have access to a new member portal that provides exclusive content, live webinars, user groups, quarterly newsletters, discussion board, a job board, conference discounts, and a directory of solution partners. “We are thrilled to launch the new member portal to our membership base. As the hub for all community activity, the member portal enables members and community partners to engage, learn, and interact not just at our live conferences, but on a 24/7/365 basis,” said Kristen Smith, vice president, marketing for RISE.
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UPCOMING EVENTS
RISE
S u m mit
Population November 2020 Health
June 28-30, 2020 Learn more at risehealth.org/snpsummit
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Social Determinants of Health Newsletter
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