SDOH can dramatically impact a patient’s overall health as well as the cost and resources needed to care for the patient.  For organizations and providers to demonstrate the impact of SDOH they must accurately capture the correct coded data.  According to the Centers for Medicare and Medicaid Services (CMS) any member of a patient’s care team can collect SDOH data.  Once documented, coding professionals assign all relevant Z codes to support future quality improvement organizational activities.

To capture coded data, coding professionals should follow the ICD-10-CM Official Guidelines for Coding and Reporting.  The information documented in a patient’s record should be coded. In some cases, this information does not need to be established by a physician or other provider type since the data represents social information rather than medical diagnosis (for example, front desk personnel have documented that the patient is homeless). 

Addressing SDOH is the primary approach to reaching health equity.  Meaning that every person should have the opportunity to attain their full healthcare potential and there are no longer disadvantages due to social positions or circumstances.  Documentation and code assignment is crucial to assist care providers across the continuum quantify the social needs of their patient population and thus, provide a better quality of care to those recipients. 

Currently, the US spends more on health care than almost every other country, accounting for approximately 18% of our gross national product.  CMS has recently disclosed that Medicaid now has the largest beneficiary compensation with over 93 million covered lives.  Let’s think about that for a minute.  Medicaid is a state-level health coverage program for low-income individuals.  If Medicaid is the largest insurance provider, does it stand to reason that SDOH are a fundamental part of patient care today?

While healthcare spending has had a slight decline in the past two years (likely due to a decrease in COVID-19 costs) the overall cost continues to be a source of concern.  The success of current initiatives such as population health and value-based reimbursement in decreasing overall expenditures hinges on accurately coded data.  Understanding SDOH’s impact on patient care is a critical factor in that success. Some experts estimate that SDOH are responsible for as much as 40% of a patient’s overall healthcare status.

The only way to accurately track and trend SDOH is through coded data.  Making coding professionals today an integral part of the solution.  It will be through the accuracy of coded data that the impact of SDOH will be measured.  It will be through the accuracy of coded data that immediate needs can be identified.   Now is the time to begin data mining your coded data to determine how you can mitigate risk.