Looking Beyond Reimbursement: Capturing SDOH Data in The Revenue Cycle

SDOH capture can result in improved patient satisfaction scores and reduced provider burnout.

The CDC recently announced 42 new ICD-10-CM diagnosis codes for 2023 effective April 1. Taking the spotlight for these changes are new codes for reporting certain social determinants of heath (SDOH).

With increasing attention on population health and quality initiatives, organizations have turned their focus on SDOH and how capturing those ICD-10-CM codes impacts their patient population and their success in caring for that population.

Capturing SDOH is critical for revenue cycle teams. SDOH data can provide revenue cycle leaders with a better understanding of patient populations to inform revenue planning and strategy.

The caveat though, is that SDOH codes are not currently tied to reimbursement, meaning SDOH capture isn’t on the list of priorities for leaders. But, as Eric Penniman, DO, executive director of Summit Medical Group, recently said, there are many more positives to collecting this data, including reduced provider frustration and burnout.

“I’ve seen many family doctors over the years get frustrated because the patient didn’t show up for the appointment. Or they showed up for the appointment and they hadn’t started their meds,” Penniman explained during the 2023 CPT/RBRVS Annual Symposium, Part B News reported.

“And ultimately you see the lightbulb come on for them when [the provider realizes], ‘Oh, the patient didn’t show up for their appointment because they didn’t have a ride to the appointment, because they live in a homeless shelter and couldn’t access a ride,’” he said.

Documenting and coding a patient’s SDOH can create a shorthand that alerts the care team to challenges the patient is facing, Part B News said. In the example of the patient who lives in a homeless shelter, the diagnosis codes for transportation insecurity and sheltered homelessness explain why the patient regularly misses appointments.

SDOH codes for a patient’s intentional underdosing of medication regimen due to a financial hardship can explain why a patient didn’t get a prescription filled or isn’t taking the medicine as directed.

In both cases, the SDOH codes turn frustrating events with no solution into situations that can be addressed.

“These are the things we’re focusing on,” added Ericka Panek, MHIM, MSSW, LCSW, data analyst for the Summit Medical Group, during the same presentation, “getting that person to their appointment and making sure that everyone’s aware that is a barrier. And if it is, can we work with community resources and partners and can we get that patient a ride, or can we get in-home services that allow them to be able to do that?”

In turn, that can lead to better patient care.

“The pieces about our patients that we don’t understand. . . actually lead physicians toward burnout, because they get frustrated. And when you better understand your patients, and you begin to empathize a little bit with their circumstances, I think it can help reduce burnout in primary care as well as—obviously—provide better care for our patients,” Penniman said.

“Everyone deserves that fair chance at care. And documenting that brings more attention to where this barrier may lie,” Panek said.

Better understanding patients’ needs and preferences can result in improved patient satisfaction scores, a key factor in revenue reimbursement. Capturing SDOH information will create the opportunity for your revenue cycle to make informed decisions that will help to improve reimbursement rates while providing quality care for patients.