Course Description:

There are five (5) social determinants that identify factors which healthcare professionals can use to better support individual and population health. These five areas are: economic stability, education, social and community context, health and healthcare access and literacy, and neighborhood environment. This checklist opens opportunities for areas of additional attention from physicians, especially Primary Care Physicians, and other healthcare providers, to consider making referrals for specific screenings and potentially referrals to community agencies. This is, also, applicable to clinicians in acute care facilities (hospitals), who can utilize the identification of SDOH affecting inpatients with referrals to their in-house social workers. Paying attention to SDOH can have tremendous impact on patient outcomes, especially for that patient population in the greatest need.

Once identified, it all needs to be documented in the patient’s chart so it can be coded by medical coding professionals and reported. In some circumstances, this may have a positive impact on reimbursement, in payment models such as QPP (Quality Payment Program) used by CMS (Centers for Medicare and Medicaid Services). In other cases, reporting these conditions and resulting services will be part of research and statistics which can impact government funding and other local, state, and federal policies.

Learning Objectives:

• Define the five categories of social determinants and the potential of each to impact a patient’s health
• Classify specific health conditions influenced by SDOH to clarify treatment plans and referrals
• Explain the use of internal and community resources (both outpatient and inpatient services) to support these patients to improve their circumstances
• Identify key points to be entered into patient documentation to support continuity of care as well as reimbursement for quality-of-care payment models
• Connect the primary criteria for medical necessity to the referral process for additional services
• Report SODH conditions to state and federal agencies to support future policies and government funding

Areas Covered in the Session:

• Overview of SDOH and how each category affects patient outcomes
• Review of SDOH coding guidelines and official code sets
• How to identify patient statements, clinical observations, and screening results that support SDOH documentation
• Practical documentation prompts to help providers capture the right information
• Differences between outpatient and inpatient workflows for collecting SDOH data
• Steps coding professionals can take to ensure accurate SDOH code assignment
• How SDOH data connects to quality measures, population health tracking, and reporting requirements
• Case examples showing how SDOH influenced care plans, referrals, or discharge support
• Overview of internal and community resources to support patients
• How organizations can build standard workflows to improve SDOH data capture at every patient touchpoint
• Live Q&A Session

Suggested Attendees:

• Health Information Management Professionals
• Healthcare Finance Teams
• Health Administration and Management Students and Professionals
• Medical Billing and Coding Specialists
• Reimbursement and Revenue Cycle Management Professionals
• Clinical Documentation Improvement Staff
• Compliance and Audit Teams
• Physicians and Primary Care Providers
• Nurses and Nurse Practitioners Involved in Documentation
• Social Workers and Care Coordinators
• Health Informatics Specialists
• Population Health managers
• Hospital Administrators and Practice Managers