Most U.S. physician practices and hospitals are screening patients for at least one social need, but only a small percentage are screening for all five social needs recommended by the federal government, a new study found.
Nearly a quarter of hospitals and 15.6% of physician practices screened patients for all five social determinants of health prioritized by the CMS — food insecurity, housing instability, utility needs, transportation needs and interpersonal violence, according to the study published in JAMA Wednesday.
Screening for interpersonal violence was the most common, while checking patients for utility needs was the least common.
Providers with higher screening rates were federally qualified health centers, academic health centers, bundled payment participants, primary care improvement programs, Medicaid accountable care organizations and physician practices in Medicaid expansion states.
The study by Dartmouth University researchers is one of the first to examine the adoption of social risk screening in U.S. healthcare settings. It's increasingly recognized that social risks are linked to poorer treatment adherence, worse health outcomes and higher costs of care, an accompanying JAMA commentary noted.
"Attention to the association of social needs with medical outcomes is widespread, but dissemination of care delivery innovations in physician practices and hospitals is notoriously slow," the study authors wrote.
The authors surveyed 2,333 physician practices and 757 hospitals from June 2017 to August 2018, asking them whether they have a system in place to screen patients for the five conditions that are part of the CMS' Accountable Health Communities model.
Physician practices may lack the financial or staffing resources to routinely screen for social determinants, while hospitals are more likely to screen due to greater resources as well as federal patient safety requirements, they wrote.
The authors suggested that payers should support providers financially in implementing screening and referral processes for addressing social needs such as food security.
Several organizations including the National Association of Community Health Centers, the American Academy of Family Physicians and the American Academy of Pediatrics have developed tools to help physicians and hospitals identify patients with social needs and offer them community-based support.
NACHC launched a protocol called Prapare that's currently used by many health centers, physician practices and hospitals. Embedded in electronic health records, it offers a series of questions that staff ask patients to discover social conditions that may harm their health, such as lack of transportation. NACHC makes the tool available for free to all types of providers.
Prapare enables providers to address the social needs of individual patients. It can also be used to identify systematic social risk factors in a community and develop resources for addressing them for a broader population, said Michelle Proser, NACHC's research director.
Once social needs are identified, a number of payers, including the CMS and some state Medicaid programs, have established programs to pay for services that support patients' social needs, though services like housing may be scarce.
Other provider organizations have their own screening processes.
Dr. Chris Chen, CEO of ChenMed, which operates more than 50 senior-care clinics across the country, said every patient receives an initial comprehensive screening which covers a broad range of social risk conditions, including social isolation and loneliness. This is repeated at regular intervals. Physicians and other patient care staff are evaluated based on their patient screening performance.
Noting that medical services are responsible for only a small part of health outcomes, Chen said primary care providers aren't doing their job if they aren't checking for social conditions that determine a large part of patient health.
The accompanying JAMA commentary said social risk screening will increase with the adoption of well-designed financial incentives and through strong leadership that recognizes the value of screening in improving patient health outcomes.
