You’ve probably heard of Social Determinants of Health (SDOH). But hearing about it and understanding how it can benefit you as you capture your evaluation and management level for the services you provide are two different things!

Social Determinants of Health is defined by the Centers for Medicaid Medicare (CMS) as “the range of social, environmental, and economic factors that can influence health status — conditions that can often have a greater impact on health outcomes than the actual delivery of health services.”

What this means for you as a provider is that if you have a patient that has a determining factor that prohibits them from either seeking the care they need or from obtaining the recommended care, they may qualify for the SDOH risk factor.

Here are a few sample scenarios that justify credit in the risk section of the medical decision making grid as long as it is appropriately documented:

• Availability of resources to meet daily needs (safe housing, ability to obtain groceries)
• Access to educational, economic and job opportunities
• Access to healthcare services
• Quality of education and job training
• Transportation
• Public safety
• Social support
• Socioeconomic conditions (poverty, stressful conditions that accompany)
• Language/Literacy
• Access to emerging technology (cell phone)
• Availability of community-based resources
• Underinsured

Example: A patient with a recent traumatic fracture is unable to properly care for his fracture due to his homelessness and inability to ambulate/mobilize from a flat service (street level). His housing situation does not allow for proper fracture healing. Sample smart phrase: “The patient’s {insert diagnosis} is at a higher risk for social determinants of health due to {indicate what is causing them to be at a higher risk}.”