Video Transcript: Z Codes: Information for Providers

Screening and coding for social determinants of health is challenging.

But there are solutions that can help.

Let’s go through some challenges and possible solutions.

Screening for social determinants of health takes time.

Consider using a team approach to collect and assess patient information. You also can use patient self-reported information and electronic health record (or EHR) screening tools. Some EHR systems have modules that reduce the time it takes to code social determinants of health.

Your EHR system may already have access to these features.

There’s currently limited reimbursement for documenting social determinants of health Z code issues.

One solution is that health care is moving toward value-based or alternative payment models that tie payment to quality and efficiency.

Nearly all Medicare settings use these models, including hospitals and facilities like outpatient and post-acute.

You may be worried about liability if you can’t treat all the issues captured in a social determinants of health screening.

Many patient issues can be coded without a corresponding intervention. You only need to respond if the issue falls under your state’s mandatory reporting guidelines.

You may also worry that patients might see these screening questions as intrusive.

The good news is that research indicates that patients welcome questions that improve care.

In general, research shows that patients:

• Believe screening for social risks is important
• Understand connections between social risks and overall health
• And accept the importance of social risk screening

Now that we’ve discussed why you should screen for social determinants of health, let’s look at:

• How to screen
• Where and when screening occurs
• And how to collect information

You have to build a trusting relationship with your patients if you want them to tell you about their social circumstances. This information is sensitive and private, and patients need to know you and your facility respect that.

We all have personal and cultural biases. Using a cultural humility approach can improve your relationship with your patients. Acknowledge your patients’ identities and respect and respond to their beliefs.

This can help break down stereotypes and lead to better conversations with your patients. Armed with more accurate and complete information about your patients’ social determinants of health, your health care system can improve their treatment and overall health.

We recommend you:

• Ask patients about their pronouns.
• Never assume. Ask all your patients about their background and culture to avoid stereotyping.
• Reassure your patients with words and actions that you want to understand their circumstances.
• And ask about religious, cultural, or individual convictions that may affect your patients’ choice of treatment.

Some good rules of thumb for screening include:

• Use empathy. Put yourself in the patient’s shoes and think about how you might want to discuss this issue if it were affecting your life.
• Demonstrate respect. Ask your patients about their priorities and goals.
• Acknowledge your patients’ autonomy. Make it clear that your patients decide what social support to accept.

You can also use the Empathic Inquiry conversational approach developed by the Oregon Primary Care Association (OPCA). Empathic inquiry promotes partnership, affirmation, and patient engagement with a patient-centered, trauma-informed method.

You can capture patients’ social determinants of health information during:

• Emergency department visits
• Unexpected visits for acute issues
• Screenings
• Routine check-ups
• And scheduled appointments

You and your health care team can collect this information at any point in a patient visit, including:

• Enrollment or intake
• Assessment
• Diagnosis
• Treatment
• And discharge

You can get this information from patients:

Verbally with a screening tool used by a provider or patient navigator. Talk to patients in person, over the phone, or even via video conferencing.

Via paper questionnaire: Patients can complete the questionnaire, or you can complete it for them based on your discussion with the patient.

Electronically via:

• Screening tools completed by patients at a kiosk
• Tablet-based electronic portal at intake
• And an online patient portal

No matter how you decide to collect social determinants of health information, make sure it’s collected in a non-judgmental and confidential manner and in a physically private space.

Note: Anyone on the patient’s care team can enter information from a paper questionnaire into the EHR.