Few Hospitals, Practices Self-Report Screening Patients for SDOH, Research Finds

Sept. 25, 2019
Researchers said that despite the spotlight on the importance of social needs, there appears to be little consensus about responsibility for addressing social needs or the best approaches to the problem

About one-quarter of U.S. hospitals and 16 percent of physician practices self-report screening patients for social determinants of health such as food, housing, transportation, utilities, and interpersonal violence needs, according to a new analysis.

The research, published recently in JAMA Open Network, included responses from more than 2,100 physician practices and nearly 800 hospitals across the country. As the researchers from University of California, Berkeley, Dartmouth, and the University of North Carolina noted, “Social needs, including food, housing, utilities, transportation, and experience with interpersonal violence, are linked to health outcomes. Identifying patients with unmet social needs is a necessary first step to addressing these needs, yet little is known about the prevalence of screening.”

These were the five social determinants of health analyzed as they are part of the Centers for Medicare & Medicaid Services’ (CMS)  Accountable Health Communities model.

The study’s findings suggested that most U.S. physician practices and hospitals do not report screening patients for key social needs, and it appears that practices serving more economically disadvantaged populations report screening at higher rates. What’s more, federally qualified health centers and physician practices participating in bundled payments, primary care improvement models, and Medicaid accountable care organizations screened more than other hospitals, and academic medical centers screened more than other practices, according to the findings.

Though up to 90 percent of health outcomes are a result of social, behavioral, and economic factors, historically, systematically identifying and addressing patients’ social needs has not been part of medical practice, the researchers wrote. “Although physicians and hospitals may recognize the association of social needs with patient outcomes, they may be reluctant to assume responsibility for social needs given the complexity of addressing these needs coupled with increasing clinical demands,” they added.

However, state and federal policymakers, as well as private payers, are now designing programs aimed at integrating social services into clinical care. For example, CMS’ Accountable Health Community model has been launched, and multiple states have recently established waivers that allow Medicaid dollars to pay for services that support patients’ social needs, the researchers pointed out.

That said, “The role of physicians and hospitals in meeting patients’ social needs is likely to increase as more take on accountability for cost under payment reform. And, physicians and hospitals may need additional resources to screen for or address patients’ social needs,” they stated.

The study used data from the National Survey of Healthcare Organizations and Systems (NSHOS), supplemented by additional data from the OneKey database (IQVIA Inc), the American Hospital Association’s (AHA) Annual Survey, and the U.S. Census to characterize physician practices and hospitals that screen patients for social needs.

Key questions such as “Does your practice have a system in place to screen patients for food insecurity (yes/no), housing instability (yes/no), utility needs (yes/no), transportation needs (yes/no), or interpersonal violence (yes/no)?” were asked to survey respondents.

The data revealed that most U.S. physician practices and hospitals are screening patients for at least one social need (most often, experience with interpersonal violence), and most are not screening patients for the five social needs that CMS has prioritized.

The researchers stated, “Hospitals and physician practices have different capabilities, needs, and motivations, which may influence the differential uptake of screening by hospitals. Physician practices may be motivated to screen patients for social needs to help provide more coordinated, comprehensive care in lower-cost settings (particularly if they participate in payment reform models and believe that addressing social needs will reduce healthcare spending), but they may lack the financial or staffing resources to routinely screen in the course of clinical care. Hospitals may also be more likely to screen patients for transportation and housing needs as part of their discharge processes because they are subject to federal regulations on patient safety as part of their certification from CMS.”

They also noted that despite the spotlight on the importance of social needs, there appears to be little consensus about responsibility for addressing social needs or the best approaches to the problem.

They concluded, “Physicians and hospitals, who are already strapped for time and have competing priorities, may be hesitant to screen patients for social needs when they have no real capacity or ability to address those needs, especially given the lack of robust studies behind screening,” while adding, “We believe systematic use of screening is a required first step to attend to social needs and improve health; addressing resource barriers, such as time, information, and money, may be a key element in supporting physicians and hospitals in efforts to screen patients for social needs.”