Striving for Equity

In 2023, regulatory bodies took a more direct approach. At the federal level, the U.S. Department of Health and Human Services identified equity as a goal in its strategic plan and published an equity action plan. The Centers for Medicare and Medicaid Services (CMS) has been updating its quality reporting programs to include health equity and incentivize hospitals to provide care to under-represented populations, such as unhoused people. The CMS Joint Commission in Minority Health dictates equity mandates to hospitals and other health organizations, with more than 30 mandatory standards for health equity, such as adequately screening patients. Health organizations held to these standards must demonstrate that they have an equity plan in place and the ability to implement it or face a financial penalty. Dr. Rose-Smith added that one of CMS’s top priorities is to collect, report and analyze data concerning social determinants of health.

Dr. Rose-Smith closed with a few recommendations to medical professionals. For example, clinicians can document Z codes in each patient’s electronic health record. (Note: Z codes are an International Classification of Disease subset used to capture factors that influence health status and contact with health services and can facilitate Medicare reimbursement.) She also emphasized the importance of community partnerships and outreach.

Screening for Social Determinants of Health

Ms. Flores

Melissa Flores, MPH, MSW, assistant director of the Office of Health Equity at the Hospital for Special Surgery, oversaw her workplace’s yearlong process of developing and implementing a comprehensive social determinants of health screening process. She observed that her hospital has experienced a culture shift in the past few years, with the creation of a new Office of Diversity, Equity and Inclusion (DEI) in 2020 and an Office of Health Equity in 2023.

The process began with a multidisciplinary workgroup dedicated to developing a standardized strategy for addressing social determinants of health. This team met biweekly and collaborated to decide on a phased approach to both screening and intervention. In 2022, it implemented a pilot project in the outpatient and pediatric departments, in which screenings were conducted via paper-based materials. The following year, an electronic component was rolled out and expanded to the inpatient adult sections of the hospital. Finally, the effort expanded to include the ambulatory adult areas as well.

When standardizing the screening questions, the workgroup considered several accredited screening tools, including Protocol for Responding to & Assessing Patients’ Assets, Risks & Experiences (PRAPARE) and the ACH Health-Related Social Needs Screening Tool. Ultimately, the team combined elements from several tools into a simple questionnaire featuring eight multiple choice questions. Each question addressed one significant social determinant of health: food insecurity, housing, utilities, transportation, interpersonal safety, employment, health literacy and income.