What Are the Social Determinants of Health and Why Are They Significant?

1. What Are the Social Determinants of Health and Why Are They Significant? Records created by a medical transcription company are important to ensure optimum patient care. So are the social determinants of health or SDoH factors. Medical Transcription Services www.medicaltranscriptionservicecompany.com 918-221-7809 United States

2. Accurate healthcare documentation, preferably with the support of medical transcription services is an important requirement to provide appropriate and ongoing healthcare services. But accurate medical records alone are not enough for doctors to treat their patients. They also need to know the social determinants of health to provide optimum care. Social determinants of health or SDoH are considered to be strong influences on health. SDoH factors include nutritious food and clean water, education, housing, and transportation resources that influence a person’s health outcomes. Medscape, in partnership with the American Academy of Family Physicians (AAFP), surveyed physicians, nurse practitioners (NPs), and physician assistants (PAs) working in adult and pediatric primary care to know whether identifying the social, economical and environmental factors of a patient is the duty of the healthcare community or not. Participants said that they recognized the importance of social determinants affecting patients’ health and they also added that it was their duty to report factors in their communities. However, they varied in their opinion as regards the importance of taking these actions. Only a small number of participants considered it as essential while a third of physicians and around half of NPs/Pas considered it as a high priority. To identify these social determinants, participants either referred patients to community-based resources, or documented these factors in the EHR, or referred patients to other departments or healthcare professionals in their own organization. To understand the challenges faced by providers in this regard, Medscape spoke to Karen M. Isaacs, MD, MPH, a family physician at Coastal Family Medicine in Wilmington, North Carolina. According to her, the major factors that affect a patient’s health include upstream factors such as racism, classism, housing, and food insecurity as well as downstream factors such as diagnostic facilities, patient access to medications, and ongoing care. These factors have a significant impact on an individual patient's health and medical students and residents are getting more exposed to these factors now through training programs. Documenting social determinants of healthcare in the EHR, the strategy followed by some providers, is possible but not easy. At Coastal Family Medicine in Wilmington, they decided on certain SDoH screening questions and found that their EHR had similar questions built in that would provide discrete data fields that could be captured for reporting purposes. However, they realized later that any revised wording of those EHR questions would create more work and potential complications if a future EHR upgrade or update was done. So they compromised by adopting the EHR wording for their SDoH screens assuming that they would still capture the intent of their original set of questions. The SDoH results can be viewed by other EHR users in their healthcare www.medicaltranscriptionservicecompany.com 918-221-7809

3. system. However, since they are located in a rather obscure spot in the EHR, the data does not readily pop out; users will have to where to look for the data. Clinicians could take advantage of coding strategies that would allow for improved remuneration. To make documentation of EHR easier, there are ICD-10 diagnostic codes to reflect food insecurity, transportation problems, economic hardship, or whatever social determinant the patient may be facing. Most of these codes are Z codes - factors influencing health status and contact with health services. Depending on these codes used by the clinician, the payer can determine reimbursement. But these codes cannot be linked to hierarchical condition category (HCC) codes that help communicate to the Medicare the complexity of a patient’s medical status and care. In the future, payers may also start using their own calculable indices to reflect SDoH burden affecting patients, recognizing the financial difference needed to help reduce health inequalities among those who are disproportionately facing SDoH. Coastal Family Medicine is planning to set up a kiosk in the waiting room that allows patients to check in for their appointments and also complete indicated screens before they are called to be roomed. Patient portals may be also used to provide screens to be completed at home before coming to the clinic. It is important to be aware that technology can be a double-edged sword and could increase the divide for patients who are most affected by SDoH. Another risk is the possibility of eliminating elderly patients who may not be aware of advanced technology such as electronic screening procedure. As a medical transcription company serving the healthcare industry, we support the idea that the industry should promote interdisciplinary team effort involving physicians, advanced practice providers, nurses, care managers, and community liaisons to get positive outcome from the population. A focus on SDoH screening can help develop clean data that can be shared among community leaders and organizations. This will help them better understand the actual needs of people living in that community and work towards making those available to deserving people. www.medicaltranscriptionservicecompany.com 918-221-7809