By Angela Mounsey, BSN, RN, CCM, CPHQ, CMAC
Who plans to report your Social Drivers of Health for Calendar Year 2023 to the Center for Medicare and Medicaid (CMS)? This reporting is voluntary for Calendar Year 2023 now but becomes mandatory in Calendar Year 2024. The reporting time for Calendar Year 2023 is April 1st to May 15th, 2024, and includes all 2023 data you have available. The numerator is the total number of patients screened for five health-related social needs: food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety. The data/denominator includes all those who are 18 years or older and admitted to the hospital as inpatient with some exclusions such as expired, patients who opt out of screening, and patients unable to complete or do not have a legal guardian or power of attorney to answer for them.
The second part of the Social Drivers of Health measure is patients who screened as positive for the Social Drivers of Health. Again, this includes patients who are 18 years or older and screened for all the five health-related social needs listed previously. The same exclusions apply as in the first measure. But the numerator is those patients who screened positive for the five health-related needs and a breakdown of what those needs were. They may screen positive for one or all five health-related needs. CMS is looking to see how many of your patients have these 5 health-related social needs and whether you or your community have resources for those patients.
The important part to remember is the data is required to be reported for calendar year 2024. Are you ready for this (as it does affect your payment from CMS beginning in 2026)?
Case Managers have been working with Social Drivers of Health for many years. Our current President of CMSA, Dr. Colleen Morley, states, “Case Managers are the Masters of Social Drivers of Health and we have been working on them longer than they have been a buzzword.” Social Drivers of Health are very important for our patients in addressing their needs such as the ones being collected by CMS. If we do not address and give resources to our patients for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety then our patients may be readmitted to our facilities which in the end affects hospital payment. All these indicators affect the health of our patients in many ways and therefore are very important to address. We must provide our patients with the resources to assist them and educate them on available resources.
Our hospital has been completing an assessment for Social Drivers of Health since October 2022, collecting data, and giving out resources to our patients. However, as CMS gave more direction, we moved to an assessment that would collect the data that they were asking to be submitted. Therefore, we have decided to submit for Calendar Year 2023 for the voluntary submission. We hope others will also be submitting.
Get your copy of the CMSA Standards of Practice for Case Management (2022) to ensure you're meeting industry standards: https://cmsa.org/about/standards-of-case-management-practice/
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Bio: Angela Mounsey, BSN, RN, CCM, CPHQ, CMAC is the Manager at Marion General Hospital DBA Marion Health in Marion, Indiana. She covers Quality Improvement, working with CMS Quality Measures, Anthem Scorecard, and Leapfrog. She also covers Clinical Documentation Improvement Specialists, Case Managers, Social Workers, and Discharge Planners at the hospital. Her previous experience includes Long Term Care and Coronary Care/Critical Care in the hospital before moving to Case Management for several years prior to moving to her current position.