Social Determinants & Chart Documentation

[Apollo1]

With the CMS updates regarding documentation of Social Determinants of Health (SDoH) and the ability to upcode your chart with complexity, how have y'all been addressing this in your charting?

Context here is that I'm EM. From how our group has informed us, you have to list the SDoH affecting care AND list how they're affecting the care provided on that visit to increase the complexity of your chart.

I bring this up b/c several patients I'll see on a shift are frequent flyers, and I'll review previous PA/NP notes to see what was addressed in the past visit(s). There are a couple of my colleagues who will list out every SDoH (or have created a macro that pulls the data in from the last admission), but never in the MDM or diagnosis codes are they documenting conversations with the patient regarding the SDoH (or how they're providing resources/addressing them).

With the above, I get more and more of a feeling this is approaching fraud. Some of these colleagues are obviously higher in RVU/hr generated, and while we all work hard I question whether this should be addressed with leadership.

 

[SedRate]

1 hour ago, Apollo1 said:

With the CMS updates regarding documentation of Social Determinants of Health (SDoH) and the ability to upcode your chart with complexity, how have y'all been addressing this in your charting?

Context here is that I'm EM. From how our group has informed us, you have to list the SDoH affecting care AND list how they're affecting the care provided on that visit to increase the complexity of your chart

Ya know, I haven't heard anything about this and I will need to look into it. Any resources regarding what SDoH are? 

[Apollo1]

https://health.gov/healthypeople/priority-areas/social-determinants-health

https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries#block-sdohinfographics

[sas5814]

The same general rule applies that always applies....if you don't document it then it didn't happen. No documentation of a conversation you shouldn't code it. I suspect it won't stand up to chart/billing review. It won't be an issue until it is and then someone somewhere will start digging into it looking for billing errors and fraud.

[thinkertdm]

This has nothing to do with your question but isn’t having a medical provider downstream attempting to fix multiple societal and social issues upstream a bit inappropriate?  Like a bit like having a plumber ask you about the foods you eat?  We could call it the “the social determinants of plumbing”.  
we do attempt to fix medical problems caused by societal issues like housing but wouldn’t it be better to have a different member of the healthcare system address this?  We could call them something crazy like “social workers”.  
 

[EMEDPA]

It is a single line on my chart now, like this:

Social issues: pt is homeless and can not afford required medications. Social work paged at 2030 to arrange compassionate care RX and discuss housing options.

That's it. I would have put it in before without the new header, so no more work for me to dictate it.

[SedRate]

8 hours ago, EMEDPA said:

It is a single line on my chart now, like this:

Social issues: pt is homeless and can not afford required medications. Social work paged at 2030 to arrange compassionate care RX and discuss housing options.

That's it. I would have put it in before without the new header, so no more work for me to dictate it.

I guess I've also been doing this, just not with a header. 

"Pt on limited income and cannot afford the brace in office today so gave information on where they can buy one." 

"Pt on fixed income and cannot afford formal PT, so demonstrated some exercises they can perform and gave printout of exercises."

[Boatswain2PA]

When the changes first came out I would throw something in like

SDH:  Poor healthcare literacy

But then they (of course) wanted expansion of that to what I am going to do about my patient not understanding that their myriad of complaints is due to their methamphetamine abuse.....which is simply me advising them to "stop doing meth."

Beyond that...nothing.

And in reality, I don't even do that anymore.  I think I get enough complexity for maximum billing without it with real MDM.  Even the USUCKS billers and beancounters haven't complained.

[ohiovolffemtp]

I do EM, here are a number of things that I often write in the social determinates of care, with the general theme being consideration of factors that are going to make it tough for the patient to succeed with "typical" outpatient care:

• lack of transportation to f/u appointments
• homelessness
• lack of utilities to support medical devices like nebulizer machines and/or O2 concentrators - I have many patients that live either "off the grid" or in distant areas of reservations where if there is any electric at all it's solar or generators
• living in a multi-generational household, increasing the risk of infectious disease transmission to vulnerable individuals
• patient works as an over-the-road truck driver or is a migrant farm worker, never in one place long enough for regular follow-up
• limited to no ability to speak English