ACDIS Tip: Population health primer

Population health is exactly what it sounds like: the health of a given community or population. According to the Centers for Disease Control and Prevention (CDC), population health provides “an opportunity for healthcare systems, agencies, and organizations to work together in order to improve the health outcomes of the communities they serve.”

With public health, federal and state agencies provide education and policy to improve the public’s health (in other words, public health is a top-down initiative), according to the CDC.

Population health, however, encompasses several different initiatives and programs. CDI efforts may have an effect on some of these efforts but not all.

With such a broad scope, shifting CDI programs’ focus to population health initiatives may look like mission creep but “when I talk about population health from the CDI perspective, I’m thinking of how I’m coding the [care provided to the] patient here in the hospital that’s going to affect reimbursement that comes into the community for programs and care,” says Candace Blankenship, RN, BSN, CCDS, a CDI specialist at Mayo Clinic Florida in Jacksonville.

Social determinants of health (SDOH) codes provide one of the most natural entry points for CDI professionals, says to Deanne Wilk, BSN, RN, CCDS, CCS, manager of CDI at Penn State Health in Hershey, Pennsylvania. These codes encompass social and economic risks to a patient’s health status and are covered in Chapter 21 of the ICD-10-CM code set. They are often referred to as Z codes.

While this isn’t an area CDI may be accustomed to reviewing, Wilk says it’s an easy enough lift for CDI professionals and it will provide the greatest results.

And now is the perfect time to start reviewing for SDOH codes, says Blankenship, partly because they weren’t given CC status with the IPPS final rule this year. This gives CDI professionals a bit more of a runway to get accustomed to these reviews and provide the requisite education and work with related departments to develop best practices.

Don’t put off exploring how CDI efforts can help with SDOH, though, Blankenship says: The Agency for Healthcare Research and Quality and the American Hospital Association have asked CMS for more SDOH codes in future years, and she expects that reimbursement will shift accordingly.

Editor’s note: This article is an excerpt from the November/December edition of the Journal. As a special ACDIS gift to our non-member friends, the November/December edition is unlocked for members and non-members alike. Click here to access the edition now.