In recent years, healthcare policy has evolved to account for factors beyond medical care standards. One study indicated that health equity domains—including social determinants of health (SDOH), physical environment, and behavioral elements—drive 80% of health outcomes. As the largest healthcare payer in the US, the Centers for Medicare & Medicaid Services (CMS) sets the bar for health equity data collection. However, with multiple social risk factors and limited hospital resources, how to measure health equity is anything but obvious to health care leaders. CMS’ larger vision for accessible, complete, and accurate health equity data may seem daunting. By concentrating on the health-related social needs that CMS prioritizes, health systems can plan and implement processes that seamlessly integrate with current organizational operations.
Here are 3 important considerations for health equity data collection in hospitals.
1. CMS mandates 3 Inpatient Quality Reporting (IQR) measures.
Measures include (1) Hospital Commitment to Health Equity (HCHE), (2) Screening for Social Drivers of Health (SDOH-1), and (3) Screen Positive Rate for Social Drivers of Health (SDOH-2). HCHE is a structural measure to understand if an organization has made health equity a strategic priority, whereas the two SDOH requirements are process measures. SDOH-1 reviews the number of screened patients, and SDOH-2 assesses how many of those screened were positive for social risk factors. In the past, CMS only mandated HCHE. However, all three measures are mandatory in 2024. Additionally, CMS will reimburse health care providers for time spent conducting SDOH risk assessments and delivering patient navigation services.
2. CMS advocates for data points on every hospital patient.
It is not new for hospitals to screen for some SDOH elements in their case management and discharge planning processes. What is new is that CMS wants data points captured for every hospitalized adult. The primary goal is to get all hospitals to systematically collect patient-level social risk factor data, facilitating meaningful collaboration between health care providers and the community. Identifying patients with social risk factors enables clinicians to connect them with community-based organizations and other resources needed for preventative, whole-person care. Furthermore, the data gathered in these measures can help stratify patient risk, measure hospital performance rates, and track progress toward achieving health equity.
3. CMS encourages hospitals to leverage Z codes as evidence of compliance.
Hospitals can now capture data on the social needs of a patient population using International Classification of Diseases, 10th Revision (ICD-10-CM) code categories Z55-Z65, commonly known as Z codes. Leveraging Z codes to capture standardized SDOH information offers an opportunity to expand on an organization’s existing infrastructure rather than create a new one. Moreover, this practical application brings SDOH into a clinician’s workflow and becomes a part of the patient’s electronic medical record and claims history. Although Z codes offer a practical way to adhere to the CMS mandates (SDOH-1 and SDOH-2), they are not required. However, as payers increase their focus on improving health equity, many have been encouraging practices to report Z codes. Moreover, SDOH-1 and SDOH-2 data will most likely be used to adjust future requirements, implement publicly reported health equity scores, and lobby Congress for new initiatives or programs.
New processes can feel complicated and overwhelming, but iterative changes create momentum for each organizational goal. CMS offers tools and guidance (such as this map) to help organizations get started on health equity process changes. For health care leaders who need additional help navigating the evolving health equity landscape, The Kinetix Group (TKG) offers full strategic support and insights through our advisory network of 245,000+ physicians.
For organizations that need assistance identifying data-based strategies to advance their health equity goals, The Kinetix Group (TKG) can be your trusted partner by leveraging our insight-driven platform and advisory network. Contact us at inquiries@thekinetixgroup.com or here.