One way to prepare for IRF-PAI 4.0: Prioritize social determinants of health
The following blog post was created using a transcript from a recent webinar presented by Angela M. Phillips, PT, President & Chief Executive Officer of Images & Associates
COVID-19 has made it clear that social determinants of health (SDoH) can have a significant impact on an individual’s general health, their likelihood of severe illness, and their access to care — all of which can impact overall health outcomes.
SDoH will be a major component of the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) 4.0, which goes into effect on October 1, 2022. The latest IRF-PAI updates will require data collection on several SDoH indicators as part of new quality measures, and inpatient rehabilitation providers will be expected to use this data to establish plans that positively impact patients’ health outcomes.
What are SDoH?
SDoH are defined as the economic and social conditions that can influence health disparities and inequities among people. These are factors like safe housing, transportation, education, and job opportunities, which can impact an individual’s health, well-being, and quality of life.
Data about SDoH has recently been identified as valuable for inpatient rehabilitation providers to achieve better patient health outcomes. The IRF-PAI 4.0 assesses for several SDoH elements, including age, ethnicity, preferred language, interpreter services, hearing, vision, isolation, transportation, and health literacy. The latter three are especially important as they are required to be assessed for patients at both admission and discharge as part of the IRF-PAI 4.0.
How is SDoH data captured?
SDoH data will be collected at admission and discharge. The delta between scores at admission and discharge data is what will be reported according to IRF-PAI 4.0 and is what will ultimately drive health and payment policy.
How do I prioritize SDoH data collection?
If SDoH data is not collected, you may receive a reduction in payment for failure to collect — meaning that if quality is not met today, reimbursements may be less for that same level of care in the future. Make sure your staff is trained on scoring and collecting data and that you audit data collection regularly.
How are Z-codes affected?
Z-code guidelines dictate that coders will be able to use documentation of social needs from other clinicians to assign codes. This further reiterates the need to ensure staff are initially and continuously trained. It also suggests involving coding staff in building templates for collecting data on codes and to ensure that you can incorporate everything into your electronic medical record as discrete data fields to streamline collection of and analyzation of data.
Ready to learn more?
Watch our on-demand webinar to dive deeper into those topics, and to learn more about ways that you can positively impact other SDoH in the IRF setting.
About the Author: Angela M. Phillips, PT, is President & Chief Executive Officer of Images & Associates. A graduate of the University of Pennsylvania, School of Allied Health Professions, she has almost 45 years of experience as a consultant, healthcare executive, hospital administrator, educator, and clinician. Ms. Phillips is one of the nation’s leading consultants assisting inpatient rehabilitation facilities in operating effectively under the Medicare Prospective Payment System (PPS) and in addressing key issues related to compliance. Images & Associates provides consultative services to IRFs and other post-acute care settings related to operations, compliance, billing, and reimbursement.