Excerpted from page 23 of the November/December 2022 edition of AOA Focus.
The Centers for Disease Control and Prevention define social determinants of health (SDOH) as the “conditions in the places where people live, learn, work and play that affect a wide range of health risks and outcomes.”
Doctors of optometry take SDOH into consideration informally as they provide care, says Zachary McCarty, O.D., chair of the AOA’s Quality Improvement and Data Committee, who practices in Tennessee. For instance, patient intake forms may capture some SDOH-type information voluntarily provided by patients.
Yet, doctors of optometry may be asked or required in the future to be more intentional—to educate themselves on the subject and formally incorporate SDOH into their practices’ electronic health records (EHRs) or more, especially if it means improving the care of patients, Dr. McCarty says.
“It’s an adjustment to our established mindset about how to deliver the best care possible,” he says of SDOH. “If we can change our thinking—so we truly evaluate each patient and their circumstances—it will make all of us better physicians and elevate the care that we provide.
“For instance, how can we convince a patient to buy and take their glaucoma medication if they can’t afford food?” he says. “How about getting the patient to their follow-up appointments if they don’t have reliable transportation? If a patient is depressed, might they choose to ignore treatment advice? Knowing the answer to these questions helps to go beyond basic history that we collect and determine how to better tailor our care for the individual and their life circumstances.”
Dr. McCarty suggests some steps that doctors of optometry might consider now, in preparation for when SDOH are fully integrated into EHRs—so that data can be analyzed in a meaningful way and social service agencies can be partners in finding solutions for those who need them.
These suggested steps are drawn from a chart developed by the Centers for Medicare & Medicaid Services. Of the several steps on the chart, doctors of optometry might consider the following to become more acquainted with incorporating SDOH into their practices:
- Collect SDOH data. Any member of a person's care team can collect SDOH data during any encounter. The data can be collected at intake through health risk assessments, screening tools, person-provider interaction and individual self-reporting.
- Document SDOH data. Data is recorded in a person's paper or EHR. SDOH data may be documented in the problem or diagnosis list, patient or client history, or provider notes. Care teams may collect more detailed SDOH data than current Z codes allow. This data should be retained.
- Use a SDOH screening tool. For practices with a health care team with bandwidth, the chart recommends using a SDOH screening tool. Follow best practices for collecting SDOH data in a sensitive and HIPAA-compliant manner. Consistently document standardized SDOH data in the EHR. Refer individuals to social service organizations and appropriate support services through local, state and national resources.
“At this time, there is no increased reimbursement for utilization of SDOH for optometry,” says Harvey Richman, O.D., who practices in New Jersey and serves on the AOA’s Coding and Reimbursement Committee. “However, medical records shape medical understanding. Insufficient recording of social factors becomes problematic when it hinders a more complete understanding of health. The movement toward value-based care provides a significant opportunity to address social determinants of health while improving value and quality of care.
“Value-based care can allow greater flexibility in terms of what services are delivered while providing accountability for long-term sustainability and population health improvements,” he says. “Although federal, state and commercial payers are launching innovative new payment models addressing SDOH,
questions remain regarding best practices for implementation, impact on costs and outcomes, and ability to scale and spread across different contexts under current policies.”
Social Determinants of Health Screening Tool
The AOA volunteer doctors developed a downloadable screening tool to help practices assess the health-related social needs of patients. Similar to other clinical assessment tools, the results of a screening tool can be used by doctors of optometry to inform patients’ treatment plans and make referrals to community services. The questions are meant to be used for individual respondents who answer the questions themselves. Alternatively, a parent or caregiver can answer the questions on behalf of an individual.
Changes in coding and reimbursements worth knowing. Meanwhile, with the clock winding down on 2024, the AOA continues to press for Congress to act on reforms that would give doctors of optometry an annual, permanent inflationary Medicare payment tied to the Medicare Economic Index.
The federal government and private payers are heavily scrutinizing the use of modifier -25. When used appropriately, it can help to ensure that patients receive appropriate treatment and that doctors of optometry are reimbursed appropriately for their service. If you believe a claim that includes modifier -25 was inappropriately denied, follow appropriate criteria when appealing.