2024 MIPS Measure #487: Screening for Social Drivers of Health

Quality ID 487
High Priority Measure Yes
Specifications Registry
Measure Type Process
Specialty Allergy/Immunology Audiology Cardiology Certified Nurse Midwife Chiropractic Medicine Clinical Social Work Dermatology Emergency Medicine Endocrinology Family Medicine Gastroenterology General Surgery Geriatrics Infectious Disease Internal Medicine Interventional Radiology Mental/Behavioral Health Nephrology Neurology Neurosurgery Nutrition/Dietician Obstetrics/Gynecology Oncology/Hematology Ophthalmology Orthopedic Surgery Otolaryngology Pediatrics Physical Medicine Physical Therapy/Occupational Therapy Plastic Surgery Podiatry Preventive Medicine Pulmonology Rheumatology Skilled Nursing Facility Speech/Language Pathology Thoracic Surgery Urgent Care Urology Vascular Surgery

Measure Description

Percent of patients 18 years and older screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety.

 

Instructions

This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

NOTE: Patient encounters for this measure conducted via telehealth (including but not limited to encounters coded with GQ, GT, 95, POS 02, POS 10) are allowable.

Measure Submission Type:

Measure data may be submitted by individual MIPS eligible clinicians, groups, or third-party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third-party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third-party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

 

Denominator

Number of patients 18 years and older with an encounter during the performance period

DENOMINATOR NOTE: *Signifies that this CPT Category I or HCPCS code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs.

Denominator Criteria (Eligible Cases):

Patients aged 18 and older on date of encounter

AND

Patient encounter during the performance period (CPT): 59400, 59510, 59610, 59618, 78012, 78070, 78075, 78102, 78140, 78185, 78195, 78202, 78215, 78261, 78290, 78300, 78305, 78315, 78414, 78428, 78456, 78458, 78579, 78580, 78582, 78597, 78601, 78630, 78699, 78708, 78725, 78740, 78801, 78803, 78999, 90791, 90792, 90832, 90834, 90837, 90839, 90845, 90945, 90947, 90951, 90952, 90953, 90954, 90955, 90956, 90957, 90958, 90959, 90960, 90961, 90962, 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970, 92002, 92004, 92012, 92014, 92507, 92508, 92521, 92522, 92523, 92524, 92526, 92537, 92538, 92540, 92541, 92542, 92544, 92545, 92548, 92549, 92550, 92557, 92567, 92568, 92570, 92588, 92622, 92625, 92626, 92650*, 92651, 92652, 92653, 96116, 96156, 96158, 97129, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 97802, 97803, 97804, 98960, 98961, 98962, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99231, 99232, 99233, 99236, 99242*, 99243*, 99244*, 99245*, 99281, 99282, 99283, 99284, 99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99429*, 99495, 99496, 99512*, D0120, D0140, D0145, D0150, D0160, D0170, D0180, D7111, D7140, D7210, D7220, D7230, D7240, D7241, D7250, D7251, G0101, G0108, G0136, G0270, G0271, G0402, G0438, G0439, G0447, G0473, G9054

 

Numerator

Number of patients 18 years and older screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety

NUMERATOR NOTE: The patient is required to have a standardized health-related social needs (HRSN) screening done once per performance period. Documentation that a review of a previous performed standardized HRSN screening during the performance period is acceptable for meeting the numerator criteria.

Examples of standardized HRSN screening tools include but are not limited to:
Accountable Health Communities Health-Related Social Needs Screening Tool (2017)
Accountable Health Communities Health-Related Social Needs Screening Tool (2021)
The Protocol for Responding to and Assessing Patients’ Risks and Experiences (PRAPARE) Tool(2016)
WellRx Questionnaire (2014)
American Academy of Family Physicians (AAFP) Screening Tool (2018)

Numerator Options:

Performance Met: Patient is screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety (M1207)

OR

Denominator Exception: Patient reason for not screening for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety (e.g., patient declined or other patient reasons) (M1237)

OR

Performance Not Met: Patient is not screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety (M1208)

 

Rational

An estimated 20 percent of health outcomes are linked to medical care; the remaining 80 percent stem from socioeconomic, environmental and behavioral factors referred to as drivers of health (DOH) (Magnan, 2017). These factors such as homelessness, food insecurity, and exposure to intimate partner violence (IPV)–are linked to poorer health, disproportionately impact communities of color, and have escalated due to COVID-19. Research demonstrates that 66 percent of physician practices are screening for one or more of the 5 DOH domains specified in this measure (Fraze et al., 2019). A 2022 survey by the Physicians Foundation found that 65 percent of U.S. physicians believe that implementing DOH quality measures are important to improve health outcomes and to ensure high-quality and costefficient care (Physicians Foundation, 2022). In a cross-sectional analysis of physicians who participated in the first year of the MIPS program, physicians caring for patients with increased social risk had significantly lower MIPS scores compared with other physicians (Khullar et al., 2020). Given MIPS’s intent to implement performance-based payment adjustments, not accounting for DOH – which are associated with approximately 38 percent of the geographic variation in per beneficiary Medicare spending (Zhang et al., 2021) – in MIPS is likely confounding these adjustments (Byrd &Chung, 2021).

 

Clinical Recommendation Statements

In COVID-19’s wake, food insecurity, housing instability, IPV, and other basic DOH have reached unprecedented levels – and revealed searing racial disparities. In 2021, 17 percent of Black adults and 16 percent of Latino adults reported that their household did not get enough to eat, compared to 6 percent of white adults. Likewise, 28 percent of Black, 18 percent of Latino, and 20 percent of Asian renters are not caught up on rent, compared to 12 percent of white renters (Center for Budget and Policy Priorities, 2021).

Secretary Becerra has pledged “to take a department-wide approach to the advancement of equity, consistent with President Biden’s charge to federal departments and agencies, and this would include examination of ways to address the social determinants of health” (Senate Finance Committee, 2021). In particular, he has noted the importance of collecting more robust DOH data to address the disparities exposed by COVID-19 and leveraging the data and experience from the CMMI Accountable Health Community (AHC) model, which has screened nearly one million beneficiaries (Senate Health Committee, 2021).

CMS has recognized the importance of making DOH measures standard across programs, identifying the development and implementation of “measures that reflect social and economic determinants” as a key priority and measurement gap to be addressed through Meaningful Measures 2.0 (Centers for Medicare & Medicaid Services, 2022).

A growing set of constituencies have called on CMS to provide leadership in measuring and addressing DOH, citing various rationales for doing so. Healthcare experts have increasingly recognized that equity is unachievable without addressing DOH (Dutton et al., 2021), calling for CMS to require program “participants to uniformly screen for and document drivers of health” and “build DOH measures into MIPS and all APMs” (Navathe et al., 2021). The Health Care Payment Learning & Action Network (LAN) – a group of public and private health care leaders providing thought leadership, strategic direction, and ongoing support to accelerate adoption of APMs – has identified promoting equity and addressing DOH as key facets of APM resiliency (Health Care Payment Learning & Action Network, 2020).

Likewise, physicians and other providers have called on CMS to create standard patient-level DOH measures – beyond socioeconomic status (SES), hierarchical condition category (HCC) score, or duals status – recognizing that these risk factors transcend specific subpopulations (Berkowitz et al., 2017); drive demand for healthcare services (Physicians Foundation, 2020); and escalate physician burnout (Marchis et al., 2019).

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