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SDOH are now widely recognized as important predictors in clinical care and positive conditions are associated with improved patient outcomes and reduced costs. Conversely worse conditions have been shown to negatively affect outcomes, such as hospital readmissions rates, length of stay, and use of post-acute care but SDOH data collection lacks standardization and reimbursement across clinical settings."
Carla Hodge, Office of Minority Health, CMS

A Study on Z Code Utilization and SDOH in the Medicare Population
The just released March Analytics Technology Edition of Care Analytics News included an article "CMS Analyzes Medicare FFS Data: Z Code Utilization Under Spotlight" that examined a recent Centers for Medicare & Medicaid Services report – “the first analysis of Medicare FFS claims data for the utilization of Z codes” --which identified 467,136 unique beneficiaries with Z code claims in 2017, representing only 1.4% of the total FFS population. But, a CMS statement says, “the findings may represent an undercount of patient social needs;” it cites a recent study that found 24% of hospitals and 16% of physicians screening for food insecurity, housing instability, utilities, transportation and interpersonal violence.

What exactly are Z Codes? The article tells us that "Z codes are a subset of ICD-10-CM codes, “used as reason codes to capture factors that influence health status and contact with health services.” They apply to all settings and “must be accompanied by any performed procedure codes.” Within the full set of Z codes, Z55 through Z65 specifically assess SDOH by “identifying individuals with potentially hazardous socioeconomic and psychosocial circumstances.” There are nine categories related to SDOH and several sub-codes, for a total of 97 granular codes."

The article summarizes these key findings from the report:
  - Among the 33.7 million Medicare FFS beneficiaries in 2017, approximately 1.4% had claims with Z codes.
  - Of the 467,136 Medicare FFS beneficiaries with Z code claims that year, 72% had hypertension and 53% had depression.
  - 75% were not dual eligible; 25% were.
  - Of the 467,136 Medicare FFS beneficiaries with Z code claims, 35% were under 65 years of age.
  - Z59.0/homelessness was the only Z code with a higher utilization for males than females.
  - Significant disparities are observed in Z59.0/homelessness among blacks, Hispanics and American Indians/Alaska Natives as well as in Z63.4/disappearance & death of family members among American Indians/Alaska Natives.

Top 10 Chronic Conditions among Medicare FFS Beneficiaries with Z Codes in 2017
Top 10 Chronic Conditions among Medicare FFS Beneficiaries with Z Codes in 2017

Other tidbits from the article included:
  - “While more screening may occur,” the statement adds, “it is less clear to what extent needs are being documented and shared among providers.”
  - Data collection using social determinants of health screening tools “is quite common across settings,” it says.
  - But the captured information “is not consistently translated to standardized data due to lack of technical specifications based on industry consensus.”
  - Relying less on clinicians to capture SDOH data, improving provider and medical coder education and filling gaps in codes -- among other policy-based interventions – “would likely improve reporting of SDOH coding across care settings.”
  - International Classification of Diseases, 10th Revision, Clinical Modification – ICD-10-CM -- codes present “an opportunity to capture standardized data and quantify the proportion of beneficiaries impacted by SDOH by way of the Z codes.”
  - There is a “growing awareness of the importance of SDOH in patient health outcomes and the need for collection and documentation of data in clinical settings” – and notes that “Z codes did not exist prior to implementation of the ICD-10-CM codes.”
   The precursor V codes were replaced by the “new, more expanded Z codes;” the unique beneficiary count for Z code utilization increased by 4.69% to 467,136 from 2016 to 2017.
  - “A number of challenges and potential solutions exist to increase the recording of SDOH with Z codes so that health plans, EHR vendors and providers can gain a better understanding of the factors that contribute to low utilization.” Participants noted a general lack of awareness of the Z codes, and confusion as to who could document social needs.

For More Information:

CMS Analyzes Medicare FFS Data: Z Code Utilization Under Spotlight
Care Analytics News, Analytics Technology Edition, March 2020

Z Codes Utilization among Medicare Fee-for-Service (FFS) Beneficiaries in 2017
CMS Data Highlight, January 2020
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By Clive Riddle, March 6, 2020

mHealthIntelligence reminds us that the emergency spending now passed by Congress "will waive Medicare’s geographical restrictions on telehealth during a public health emergency, enabling providers to use telehealth in urban and rural areas as well as in the patient’s home .... Click to continue

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