August 25, 2022
Social Determinants of Health (SDOH) items will now be required as part of the new OASIS-E assessment starting in January 2023. SDOH describes environmental and socioeconomic conditions that affect a wide range of health functioning, quality-of-life outcomes and risks.
Documenting SDOH factors is required for an agency to be in conformance with the 2011 U.S Department of Health and Human Services (HHS) data standards. The collection of more standardized reporting of SDOH information is long overdue. SDOH information will help payers understand how individual and community disparities associated with living conditions, food security, access to healthcare, employment and education impact quality of care and health outcomes.
However, identifying these health disparities is only the first step. Home health agencies will need to be prepared to respond when they identify patients with social, economic, or environmental barriers to care. Agencies can overcome SDOH barriers and improve access by:
- Providing spoken and written instructions in languages understood by your patients. If your patients speak and read languages other than English, does your agency provide information in the patients’ languages?
- Offering clear and effective patient education materials at the appropriate literacy level. Can your materials be understood by all users?
- Creating large print materials for patients with visual impairments, braille materials for the blind, and appropriate visual information including sign language interpreters and telephony for those with hearing impairments. Is your information accessible to the sight- and hearing-impaired?
About B1300 Health Literacy
Health literacy is critical to the appropriate provision of services. Health literacy is defined as the capacity to:
- Obtain, process, and understand basic health information and services;
- Make appropriate health care decisions; and
- Access and navigate the health care system.
Poor health literacy is linked to lower levels of health knowledge, worse clinical outcomes, the receipt of fewer preventive services, higher medical costs and increased rates of emergency department use. Low health literacy is not just limited to poor reading skills as higher literacy skills do not always equal comprehension of the healthcare system, treatment and care options.
Health care systems are complex. In today’s environment, patients are faced with many decisions including accessing preventative care (PAP smears, mammograms, dental care, nutrition, exercise, immunizations), managing polypharmacy and understanding medication management, managing one or more chronic diseases, and following up on health care appointments sometimes with multiple specialists and different insurance coverages.
Agencies can improve outcomes by structuring the delivery of care as if everyone has limited health literacy. By making health literacy part of basic services, agencies can reduce the stigma attached to limited comprehension. Instead, agencies can put an emphasis on improving communication to all people. Let’s face it. Everybody benefits from clear communication!
Gathering Health Literacy Data
Home health patients may be embarrassed and not respond truthfully when asked questions about their literacy level (B1300), or they may feel defensive and be evasive in their answers.
To ease delivery of the health literacy question, acknowledge to the patient that health care and medical information is difficult, and that all patients have a need for clearer communication. Communicating this comprehension gap to patients prior to asking B1300, “How often do you need to have someone help you when you read instructions, pamphlets, or other written material from you doctor or pharmacy”, may provide more transparent results and ultimately ensure your agency provides clearer communication to meet all the patient’s needs.
Here are some effective strategies to improve health literacy:
- Focus on “need-to-know” & “need-to-do”
- Use the teach-back method when giving instructions
- Demonstrate and/or draw pictures
- Use clearly written, plain-English or easy-translation educational materials
To get help providing materials and instructions that are compliant with health literacy requirements, the Agency for Healthcare Research and Quality website offers programs to increase health literacy skills, toolkits on how to implement some of the above strategies, and other evidence-based information to help agencies serve their patients with low health literacy.
Use Z Codes to Document SDOH Factors
Agencies need to document patients who are impacted by SDOH factors. SDOH-related Z codes range from Z55 to Z65. The SDOH data can be gathered from the patient and/or any member of a person’s care team including family, home health clinicians, social workers, or providers. Coders can assign SDOH Z codes based on self-reported data and/or information documented in an individual’s health care record by any member of the care team.
Providing accurate SDOH OASIS data along with appropriate Z-codes will help improve the quality of care being delivered by home health agencies. The data will identify the patient’s social risk factors, trigger appropriate referrals, and give the home health and hospice agencies, as well as CMS, accurate data on how various SDOH factors impact patient outcomes.
Assess Your Agency’s SDOH Competencies Now
Agencies should start educating their clinicians now on these health equity gaps and assessing their patient population to determine specific needs of individual clients. If this feels overwhelming, take small steps to make progress. Look at each SDOH OASIS-E item separately and consider the interventions or pathways that will achieve the best outcome and meet the patient’s needs.
At Corridor, we specialize in helping home health and hospice agencies pull their offerings into conformity with evolving CMS requirements. By competently meeting the needs of all patients – disadvantaged or not – agencies will be prepared to adequately address the requirements of OASIS-E in January 2023. Visit our website to learn more about our OASIS-E support services here. We look forward to hearing from you and helping you train your staff to maximize your reimbursement by meeting all the needs of your patients in accordance with CMS regulations.
For over 30 years, Corridor has partnered with home-based care providers, delivering powerful solutions to support the unique challenges of caring for patients in the home. Our team of operating executives, clinicians, and nationally renowned industry experts have run provider organizations and resolved the same challenges you face.
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