The Role of RCM in Health Equity

Providers, regulatory agencies, and payers alike are striving to achieve health equity by identifying and closing areas of weakness impacting care parity across race and ethnicity, gender, sexual orientation, socioeconomic status, and other factors. We see it at the macro level through the emergence of new quality-based care models requiring participants to address health disparities and support better health outcomes by reducing avoidable utilization, improving quality scores, and ensuring safe care transitions.

The problem for many healthcare organizations is that they are limited by their view of health equity and social determinants of health (SDoH), which tends to focus on initiatives related to patient experience and patient relations within an organization. It is a view that fails to consider how actionable data comes through as a natural occurrence of a patient’s interaction with the health system staff and care team.

Coding, RCM, and SDoH

Every healthcare organization aggregates valuable SDoH information that can ultimately help identify and better understand any inequities in care delivery and inform initiatives to improve health equity across their patient populations – much of which comes from coding and revenue cycle management (RCM).

For example, a wide range of health risks and outcomes are impacted by SDoH, making these data important predictors of care costs. SDoH has been linked negatively with such outcomes as higher hospital readmissions and length of stay (LOS), and increased need for post-acute care including Skilled Nursing Facilities (SNFs), long-term care (LTC), rehabilitation, and home health.

Thus, monitoring for and addressing the socioeconomic issues that have a demonstrated impact on both health and the cost of care to patient and provider is imperative to closing the nation’s health equity gap, while also boosting healthcare organizations’ financial situations.

The Role of RCM in Health Equity?

There is a growing body of evidence supporting RCM’s involvement in achieving health equity. For example, reimbursement is closely linked to quality due to the use of outcome measures by the Centers for Medicare and Medicaid Services (CMS) to determine a hospital’s overall quality, including:?

• Mortality
• Safety of care
• Readmission rate
• Excess stay
• Patient experience
• Effectiveness of care

Readmission rates, utilization, and excess inpatient stays tie back to SDoH. Low literacy is linked to poor health outcomes and less frequent use of prevention and wellness services, leading to more frequent and longer hospital stays. Lack of access to reliable transportation for basic health needs results in 41 percent more excess days in the hospital. Unemployment is linked to declining self-reported health status, increased mortality rates for males and females ages 16-64, quadruple rates of drug and substance abuse and dependence, and double the chances of being diagnosed with a mental disorder such as depression or general anxiety disorder.

These metrics tell an important part of a patient’s SDoH story when physicians and other care team members take the time to enter comprehensive documentation in the patient’s chart. Thoughtful documentation allows coders to assign appropriate codes for use in tracking and trending SDoH patterns, which in turn allows healthcare organizations to better understand their patient populations.

Coders and RCM professionals interact daily with data that is invaluable to inform health equity strategies. This is particularly true since the transition to the ICD-10 code set which created an environment rich with data detailing SDoH. In fact, code sets and coding guidelines have continued to expand over the years specifically to capture SDoH information at a level not possible with other data sources.

With access to this depth of SDoH information, needs can be accurately assessed, and patients can be connected to community services to address them. Ultimately, when SDoH data is standardized within the electronic record, it not only improves health, lowers costs, and advances health equity, but enables healthcare organizations to develop sustainable business models to fund access to community services.

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Learn more about leveraging revenue cycle management and the data it generates in achieving health equity, the business case for doing so, and how the introduction of Z-codes is making it possible by downloading the full white paper today. Download White Paper

Source of the content: https://www.agshealth.com/blog/the-role-of-rcm-in-health-equity/