How do social determinants of health play out in physician practice?


Social determinants of health – access to nutritious food, safe housing, prescription drugs and transportation to medical appointments – affect a patient’s ability to adhere to a medical treatment plan. Initiatives are underway to capture and chart these data in order to connect patients with the services they need and to measure the results of those efforts.

Pablo Buitron de la Vega, MD, an internist at Boston Medical Center Courtesy Boston Medical Center

Dr. Pablo Buitron de la Vega

But how can these tasks be accomplished by physicians with too little patient time and too many administrative responsibilities?

In a series of interviews, those developing and evaluating screening tools and proposed codes for social determinants of health said that physicians are unlikely to see direct financial rewards for documenting social determinants of health.

The ability to capture social factors through coding could, however, become more relevant under value-based care and population health payment models, which reward physicians and other providers for improved outcomes. They could also be used for risk adjustments to the physician’s caseload and for automatically steering community resources more precisely, such as through the EHR, by triggering referrals for social programs, said Sue Bowman, MJ, RHIA, CCS, FAHIMA, senior director for Coding Policy and Compliance at the American Health Information Management Association (AHIMA).

According to several sources interviewed for this article, documenting social determinants of health will become increasingly important for Federally Qualified Health Centers, accountable care organizations, large health systems, Medicare Advantage plans, and Centers for Medicare & Medicaid Services and Medicaid managed care pilots.

An initiative for new codes that would better document and standardize how social determinants of health data are collected, processed and integrated was unveiled earlier this year at a meeting of the U.S. ICD-10 Coordination and Maintenance Committee of the National Center for Health Statistics. The proposal came from UnitedHealthcare and has been endorsed by the American Medical Association. It includes 23 new codes that would be incorporated into the ICD-10-CM. By combining traditional medical data and social determinants of health data, the codes would trigger referrals to local and national resources in patients’ communities. A ruling on adopting the proposal is not expected until next year, with possible implementation of the codes in October 2021.

Sue Bowman senior director for Coding Policy and Compliance at the American Health Information Management Association

Sue Bowman

In the interim, there are 11 existing ICD-10-CM codes that can be used today to capture some of the social, nonmedical patient needs that might affect outcomes of care. These 11 “Z” codes (Z55-Z65) identify social problems related to education and literacy, employment, housing and economic circumstances, and psychosocial circumstances, but they don’t incorporate the data into a person’s overall care plan.

Mobilizing the EHR

Pablo Buitron de la Vega, MD, MSc, an internist at Boston Medical Center (BMC), has spearheaded the THRIVE social determinants initiative at BMC. THRIVE (Tool for Health and Resilience in Vulnerable Environments) is an EHR-based intervention that facilitates an automatic printout of referrals for resources in the community and in the hospital to address identified social factors.


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