Updated on: May 7, 2020

SDoH and COVID-19

Original story posted on: May 6, 2020

Patients dealing with factors related to the SDoH are rapidly growing in number amid the viral pandemic.

It has been several years since the social determinants of health (SDoH) went viral and became a top priority for healthcare organizations. Initially, those non-clinical factors impacting health outcomes were attributed to issues affecting society’s most vulnerable and disenfranchised populations: unemployment, food insecurity, homelessness and housing insufficiency, barriers to health and behavioral health care (as in, transportation and health insurance), etc. The original at-risk populations, from the purview of public and safety net hospitals and Federally Qualified Health Centers (FQHCs), now span every rural, suburban, and urban provider of care.

Countless studies inform the industry of the harsh clinical and fiscal realities associated with the SDoH, eclipsing national health expenditures of $3.6 trillion annually and prompting over 50 percent of readmissions. Yet a new reality impacts every organization providing care today: rapidly expanding numbers of “have’s” are now “have-nots,” with insufficient resources becoming the norm.

The healthcare industry never accounted for a global pandemic, prompting the population as a whole to become at risk of, or experiencing, one or more of the social determinants. Consider:

  • Over 30 million people have filed unemployment claims, with another 2 million at risk of losing health insurance.
  • Free and charity clinics are overburdened by record numbers of patients.
  • Rising numbers of family and interpersonal violence, by as much as 40 percent, have been seen in areas. Pre-COVID-19, last year’s Journal of the American Medical Association (JAMA) study on the assessment of the SDoH identified interpersonal violence as the one issue consistently assessed by providers and practitioners.
  • Food insecurity is rampant in the U.S.; a broken food supply chain is prompting escalating problems in areas already experiencing dramatic challenges. Rural states of Alabama, Arkansas, Tennessee, and Kentucky have close to 50 percent of their populations now classified as food-insecure. Food pharmacies grow in popularity at hospitals, ambulatory, and community clinics.
  • Executive orders may block evictions, but homeless numbers are rising. Quarantine shelters for the housing insecure have opened across the country, with large waiting lists.
  • Finally, questions about what services will and won’t be reimbursed plague every practice setting. My esteemed Monitor Mondays panelists keep up with every Centers for Medicare & Medicaid Services (CMS) regulation and reimbursement shift. Yet I wait with bated breath for one obvious fix: approved reimbursement of ICD-10-CM Z codes 55-65, which address the SDoH. What a benefit this would be, in light of the current plight; reimbursement for healthcare rendered due to homelessness, family abandonment, interpersonal or family abuse, neglect, or exploitation would be several positive factors, to mention a few. Of course, I am known to cloud the issue with logic, and am reluctant to hold my breath.

That brings us to this week’s Monitor Mondays survey: the question asks, Approval of which ICD-10-CM Z code would be the biggest asset to your organization?

  • Z56: Problems related to employment and unemployment
  • Z59: Problems related to housing and economic circumstances
  • Z60: Problems related to social environment (e.g. living alone, life cycle transition)
  • Z63: Other problems related to a primary support group (e.g., disappearance/death of a family member, addiction/substance use, dependent relative needing care)

I may hold my breath after all!

Programming Note: Ellen Fink-Samnick is a permanent panelist on Monitor Monday. Listen to her live reporting every Monday at 10-10:30 a.m. EST.

Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP

Ellen Fink-Samnick is an award-winning healthcare industry expert. She is the esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on the Social Determinants of Health, her latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management,  Social Determinants of Health: Case Management’s Next Frontier (with Foreword by Dr. Ronald Hirsch), and End of Life Care for Case Management are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk-Ten-Tuesdays, and member of the Editorial Advisory Boards of Professional Case Management, Case Management Monthly, and RAC Monitor. Ellen also serves as the Lead for Rise Association’s Social Determinants of Health Community.

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