Rene Kinder

The social determinants of health, understanding what they are, their impact on patient care, and their impact on effective transition from one institution to another, are essential for rehabilitation centers.

This area is also receiving increasing recognition from the Center for Medicare and Medicaid Services, as outlined in several forms in this year’s proposed rule.

Let’s start with definitions.

The World Health Organization defines social determinants of health (SDOH) as non-medical factors that influence health outcomes.

These are the conditions in which people are born, grow, work, live and age, as well as a wider set of forces and systems that shape the conditions of everyday life. These forces and systems include economic policies and systems, development programs, social norms, social policies and political systems.

In addition, the social determinants of health have an important impact on health inequalities. which are unfair and avoidable health disparities observed within and between countries. In countries of all income levels, health and disease follow a social gradient: the lower the socioeconomic position, the worse the health.

The following list provides examples social determinants of healthwhat can influence health equity positive and negative way:

  • Income and social protection
  • Education
  • Unemployment and job insecurity
  • working life conditions
  • Food insecurity
  • Housing, basic amenities and environment
  • Early Childhood Development
  • Social inclusion and non-discrimination
  • Structural conflict
  • Access to affordable health care services of decent quality.

Now that we understand the definitions, let’s take a look at what the latest publications from our therapeutic organizations have to say about SDOH.

Let’s start with an article published by the American Speech and Language Listeners Association called HealthCare Equity Interprofessional Defense notes considerations related to communication and the role of the speech therapist.

In particular, communication impairments add an additional barrier that increases medical needs.

This is important given that 10% of US adults have communication impairments. Associated biases significantly influence patient-provider interactions, treatment decisions, treatment adherence, and patient outcomes.

The figure below shows the impact of poor communication between healthcare providers and patients.

The American Occupational Therapy Association has an informative podcast available to watch called Social determinants of health and the role of OT in the new environment.

It features Joy Doll, OTD, OTR/L, FNAP, detailing the importance of health information sharing, social determinants of health, and the role of OT in primary health care and telehealth.

And the American Physical Therapy Association published a recently published article on “Using fundamental interventions to address the social determinants of health“.

In this article, PT aims to use a socio-ecological model to go beyond intrapersonal factors in assessing and treating patients and clients.

At the heart of all these recommendations, we see a common theme with the WHO definition of a people-centered approach.

A person-centered approach sees the person as a multi-faceted entity and not just as a “recipient” of services.

This approach requires health care providers and individuals to share authority and responsibility in setting goals, making decisions, and managing care.

It also requires giving people access to understandable information and decision support tools to equip them and their families with the information to manage their health and well-being, navigate the full spectrum of care, and make their own informed care decisions.

Finally, let’s look at what key areas were present in this year’s proposed SNF rule surrounding SODH.

A Request for Information was submitted specifically addressing health equity data considerations.

In this RFI, CMS stated that it believes a targeted health equity measure will provide specific equity data that will help providers design innovative and targeted interventions for affected groups and further provide transparency to beneficiaries.

They also believe that by giving suppliers access to nonconformity information, they can use that data to make informed decisions about their quality improvement initiatives.

In this RFI, they seek stakeholder feedback on the development and inclusion of health equity quality metrics for the SNF QRP.

In addition, a request for comments on the SNF VBP approach to measuring and improving equity in health was included.

By making it clear that CMS continues to evaluate SNF VBP policy in light of its operation and expansion under the Consolidated Appropriations Act, CMS has sought public comment on policy changes they should consider on the topic of health equity.

CMS specifically requested comments on whether it should consider including cost-based adjustments to the SNF Procurement Program to reflect the different patient populations SNF serves across the country and link health equity outcomes to SNF payments under the Program.

These adjustments can occur at the indicator level in forms such as stratification (eg based on dual status or other indicators) or by including measures of social determinants of health.

These adjustments can also be included at the scoring or incentive level in forms such as modified benchmarks, score adjustments, or modified incentive pay multipliers (e.g. peer comparison groups based on whether the institution includes a high proportion of dual eligible beneficiaries or other indicators). ).

CMS sought commentators’ input on which of these adjustments, if any, would be most effective for the SNF VBP program when considering any health equity issues that CMS may observe in the SNF population.

Rene Kinder, MS, CCC-SLP, RAC-CT, is Executive Vice President of Clinical Services at Broad River Rehab and recipient of the 2019 APEX Award of Excellence in the Conventional Departments and Columns category. In addition, she serves as the Gerontology Professional Development Manager for the American Speech and Language Hearing Association (ASHA) Gerontology Specialty Group, is a community faculty member of the University of Kentucky College of Medicine, and is a CPT advisor on current procedural terminology to the American Medical Association. ® Editorial panel. It can be reached in [email protected].

Opinions expressed in McKnight Long Term Care News guest submissions belong to the author and do not necessarily belong to McKnight Long Term Care News or its editors.

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