By Erin Heilman October 7, 2022 Regulatory Updates: Hospital
In the 2023 IPPS Final Rule, CMS mandated that hospitals reporting to the Inpatient Quality Reporting (IQR) program submit two brand new measures: SDOH-1 and SDOH-2. These measures are voluntary in 2023 and required by 2024.
If you’ve been around for a bit, you might be thinking this has something to do with Z codes, which are used to identify when a patient has a need, but it’s not exactly a disorder or sickness – like homelessness. While there was a lot of conversation about Z codes and Social Determinants of Health (SDOH) within the final rule, these measures do not use Z codes.
Instead, CMS created two flexible screening measures which they (confusingly) abbreviate as SDOH, Social Drivers of Health.
The Goal of the Measures
The health community has known for a long time that social risk factors can negatively impact a person’s health, including worse outcomes and more time spent in hospitals for longer periods of time. Unfortunately, social risk factors disproportionately impact underserved communities.
These new measures establish a screening for social risk factors and provide a rate of your inpatient population who were identified as having one or more of these social risk factors.
The primary goal is to get all hospitals systematically collecting patient-level social risk factor data to create “meaningful collaboration between healthcare providers and community-based organizations.” Once a patient is identified as having a social risk factor, clinicians can link with community-based organizations to provide a patient with the other resources that are necessary to establish whole person care.
Their second goal is to eventually use the data gathered in these measures to stratify patient risk and hospital performance rates.
They also hope these measures will help clinician burnout by systematically acknowledging patients’ social needs that contribute to adverse health outcomes, which could enhance patient-centered treatment and make discharge planning easier on clinicians.
How the Measure is Scored
There are two measures: SDOH-1, Screening for Social Drivers of Health and SDOH-2, Screen Positive Rate for Social Drivers of Health. These are both process measures and have specific patient populations. The specification CMS provides on QualityNet is very basic, but we’ve provided it for you here.
In essence, the first measure wants to know how many patients you screened and the second wants to know of the screened patients, how many were positive. CMS uses the acronym HRSN to define the five specific social needs to screen for. HRSN means health-related social needs and includes food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety. Any of these HRSNs leads to negative health outcomes.
SDOH-1 Populations
In Layman’s Terms: Of all the patients admitted to the hospital, how many did you screen for SDOH?
Denominator: All patients admitted to your hospital who are 18 years or older.
Exclusions: Patients who opt-out of screening and/or patients who are unable to complete the screening during their stay and have no legal guardian or caregiver who can do so on their behalf.
Numerator: The number of patients who were screened for the five domains of SDOH (listed below).
SDOH-2 Populations
In Layman’s Terms: Of all the patients admitted to the hospital who received a SDOH screening, how many were identified as having one or more social risk factor?
Denominator: All patients admitted to your hospital who are 18 years or older and are screened for the five domains of SDOH.
Exclusions: Patients who opt-out of screening and/or patients who are unable to complete the screening during their stay and have no legal guardian or caregiver who can do so on their behalf.
Numerator: The number of patients who screened positive for any of the five domains of SDOH.
The results of the SDOH-2 measure will be calculated as five separate rates – one for each of the five domains.
The 5 Domains of SDOH Screening
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Food InsecurityFood insecurity is defined as limited or uncertain access to adequate quality and quantity of food at the household level.
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Housing InstabilityHousing instability encompasses multiple conditions ranging from the inability to pay rent or mortgage, frequent changes in residence including temporary stays with friends and relatives, living in crowded conditions, and actual lack of sheltered housing in which an individual does not have a personal residence.
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Transportation NeedsUnmet transportation needs include limitations that impede transportation to destinations required for all aspects of daily living.
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Utility DifficultiesInconsistent availability of electricity, water, oil, and gas services is directly associated with housing instability and food insecurity.
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Interpersonal SafetyAssessment for this domain includes screening for exposure to intimate partner violence, child abuse, and elder abuse.
How to collect and report the SDOH measures
CMS purposefully kept the collection component vague. They wanted to give hospitals flexibility to incorporate this screening in the way that makes the most sense for their situation. Hospitals may use a self-selected screening tool.
CMS points to AHC Health-Related Social Needs Screening Tool which outlines the questions you could put on a form for patients to answer. Here is the Screening Tool PDF CMS recommends that you use. This is recommended, not required.
They also acknowledge that this data could come from multiple sources: administrative claims data, electronic clinical data, standardized patient assessments, or patient-reported data and surveys.
You must report these measures once annually using the web-based data collection tool within the HQR (Hospital Quality Reporting) system online. It’s the same type of submission as the Maternal Morbidity structural measure.
Submitting SDOH-1 requires you to report the denominator (number of inpatients) and the numerator (the number screened). SDOH-2 requires you to submit a rate for all five domains.
CMS has not officially released the submission deadline but in the final rule they said it would follow the same submission schedule as the other structural measures. In the case of the Maternal Morbidity structural measure, you collect the data during the calendar year and submit it by May 15 of the following year. It is likely to work like this.
Voluntary reporting
Collection period: January 1, 2023 – December 31, 2023
Submission deadline: May 15, 2024
Required reporting
Collection period: January 1, 2024 – December 31, 2024
Submission deadline: May 15, 2025
Get Help Now—Before SDOH Measures are Required
If you don’t want to navigate the new Social Drivers of Health measures alone, Medisolv can help. Our platform—combined with the expertise of our clinical quality advisors—gives you the power to collect and report your data to meet 2023’s requirements and beyond.
Schedule a 1:1 session to get started, or browse our Education Center to learn more about what’s next equitable care and quality improvement horizon:
Article: What is Social Determinants of Health (SDOH) Data?
Article: 2024 Hospital IQR Requirements
Article: A Guide to CMS's New Health Equity Measure
Medisolv's Equitable Care Module: Product DemoIn response to the IQR changes, Medisolv has developed a new Equitable Care Module which allows you to track these new measures. In addition, this new module will stratify all eCQMs by race, ethnicity, gender, and payer. In this product demo you will:
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Medisolv Can Help This is a big year for Quality. Medisolv can help you along the way. Along with award-winning software you receive a Clinical Quality Advisor that helps you with all of your technical and clinical needs. We consistently hear from our clients that the biggest differentiator between Medisolv and other vendors is the level of one-of-one support. Especially if you use an EHR vendor right now, you’ll notice a huge difference.
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