Introduction
The CMS (Centers for Medicare & Medicaid Services) now mandates that hospitals and health systems screen for five common social determinants of health (SDOH) for inpatient admissions. For professionals like Katie Hren, LCSW, Associate Director of Community Health at Cedars-Sinai, this requirement formalizes work that has been integral to social work and nursing for decades.
The Importance of Social Determinants of Health
Social determinants of health encompass the conditions in which people are born, grow, live, work, and age. These factors significantly impact health outcomes, and addressing them is crucial for holistic patient care. “As a social worker by trade, it excites me that this is a hot topic,” says Hren. “But we’ve been doing this for a long time; it just has a fancy new name now.”
Cedars-Sinai’s community health department has leveraged decades of experience to design an effective SDOH screening and referral system, addressing significant challenges like access to social services and integrating these processes into clinician workflows.
Building Out Social Services Referral Networks
Many healthcare organizations acknowledge the role of SDOH in patient well-being but lack the systems to address these factors effectively. Cedars-Sinai tackled this by developing an electronic resource and referral platform. This system allows providers to access a list of resources, ensuring patients are not left without support after screening.
Hren emphasizes the importance of offering solutions: “We knew that if we were going to screen, we needed to also have solutions.” This approach includes a community health worker program that ensures patients connect to necessary resources post-discharge.
Building trust with community-based organizations (CBOs) is also vital. Cedars-Sinai employed a program manager to engage with CBOs, addressing their concerns and fostering a collaborative environment.
Tapping Frontline Workers for Screening Planning
Cedars-Sinai’s strategy involved consulting the providers most affected by the new SDOH screening and referral processes. According to a 2023 Physicians Foundation survey, while 61% of doctors feel they lack time for adequate SDOH screening, 87% recognize its importance.
Hren’s team formed a multidisciplinary operations committee, including social workers, nurses, patient navigators, and physicians, to guide the implementation of the SDOH screening process. This committee developed the screening tool, determined appropriate questions, and identified the best staff for patient follow-up.
“We all know it’s important. We all know no one has capacity, but we’re going to do it,” Hren said, describing the committee’s energy. Engaging frontline workers ensured that the workflow was practical and focused on patient well-being.
Adapting SDOH Work for CMS Policies
In 2021, Cedars-Sinai launched its SDOH screening system, which aligned well with its population health initiatives. However, the 2024 CMS IPPS final rule posed a new challenge, requiring all inpatient acute hospitalizations to include SDOH screening across five domains: transportation, food, utilities, interpersonal violence, and housing.
While this mandate symbolized progress, it required Cedars-Sinai to reconcile its existing SDOH framework with the new Medicare mandates.
Moving from Checkbox to Meaningful Practice
Hren and her team were determined not to let SDOH screening become a mere checkbox exercise. They aimed to maintain meaningful practice to ensure better patient outcomes. This required examining existing SDOH domains and integrating the five Medicare-required domains.
“We did have to grapple with the issue that we’re asking 12 questions. We’re only required to ask five,” Hren recounted. The team decided to continue their comprehensive screening while complying with Medicare requirements to avoid missing crucial patient needs.
Currently, each inpatient undergoes SDOH screening. If any needs are identified, an automatic referral to social work is made. The social work team then assesses the necessary services upon patient discharge, ensuring continuous support.
Conclusion
Aligning SDOH work with CMS rules requires balancing regulatory compliance with meaningful practice. Cedars-Sinai’s approach demonstrates how healthcare organizations can integrate federal mandates into their existing frameworks without compromising on comprehensive patient care. As the industry evolves, maintaining this balance will be crucial for improving health outcomes.
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FAQs
What are social determinants of health (SDOH)?
SDOH are conditions in which people are born, grow, live, work, and age, affecting their overall health and well-being.
Why is SDOH screening important in healthcare?
Screening for SDOH helps identify non-medical factors that impact patient health, allowing healthcare providers to address these needs and improve outcomes.
What are the five CMS-required SDOH domains?
The five domains are transportation, food, utilities, interpersonal violence, and housing.
How does Cedars-Sinai address SDOH needs?
Cedars-Sinai uses an electronic resource and referral platform, community health worker program, and comprehensive screening processes to address SDOH needs.
What challenges do clinicians face with SDOH screening?
Clinicians often face time constraints and lack resources to adequately screen and address SDOH, making it challenging to integrate these processes into their workflows.
