Impact of centers for Medicare & Medicaid services screening mandate on inpatient Z-code documentation of social drivers of health

Social drivers or determinants of health (SDOH) influence patient outcomes with an estimated 80% of health outcomes linked to socioeconomic, environmental, or behavioral factors. We evaluate the implementation of SDOH reporting and change in SDOH documentation via ICD-10 codes at hospitals nationwide.

We performed a cross-sectional analysis of de-identified inpatient claims in the Vizient Clinical Data Base, restricting to US hospitals that reported in every quarter (2022 Q1–Q4, 2023 Q1–Q4, 2024 Q1–Q2). These periods were defined as baseline (2022), recommended screening (2023), and mandated screening (2024 Q1–Q2). De-identified ICD-10 Z-codes were extracted from the Vizient Clinical Data Base with permission of Vizient. 

A total of 1039 hospitals met the continuous-reporting criterion, representing 20% of US hospitals and approximately 40% of national inpatient discharges (about 14 million of 35 million annually). The majority of hospitals were non-AAMC teaching hospitals (83%) and located in urban environments (74%) (Table 1). The median number of staffed beds per hospital was 175 (IQR 70–344).

The CMS SDOH mandate likely led to a modest growth in claims-based documentation of social risks. SDOH documentation rates were higher in AAMC teaching and urban hospitals, and gaps with non-teaching and rural hospitals widened after the mandate.