Emergency Departments Must be Included in Funding for Social Determinants of Health Screenings and Interventions

In our commentary for the Journal of Public Health Management and Practice, we review emerging reimbursement policies that support addressing social determinants of health (SDOH) in health care settings. Emergency departments (EDs) serve as healthcare safety nets for Americans, particularly those who are publicly insured or uninsured. It is estimated that over half of patients seen in the ED experience at least one SDOH. Yet, payers continue to underestimate the significant role that EDs play in screening for ED and providing subsequent interventions.

We review several ED-based SDOH interventions that have proven to improve health outcomes while being cost-effective. These pivotal SDOH programs will not be sustainable without payers explicitly including the ED in reimbursement mechanisms. Thus, we propose the following next steps:

• Achieve national consensus on standards for SDOH screening, documentation, and data elements for integration in electronic health record systems to facilitate information exchange between agents of health care delivery and community-based organizations.

  
  

• Support research investigating operationalization of ED-specific workflows for SDOH screening and interventions. Existing guidelines focus on inpatient or ambulatory settings and neglect to adequately consider the dynamic and fast-paced nature of the ED environment.

  
  

• Develop ED-specific value-based care models to support investment in transitions of care programs to improve health outcomes while reducing healthcare utilization and costs.

Tehreem Rehman, MD, MPH, MBA, is an Assistant Professor and Assistant Medical Director at The Mount Sinai Hospital Department of Emergency Medicine. She has a nationally recognized and published track record in work on clinical operations, social drivers of health, quality improvement, transitions of care, informatics, and reimbursement policy. 

Jennifer L. Wiler, MD, MBA, is Chief Quality Officer at UCHealth Denver Metro, Co-Founder of the UCHealth CARE Innovation Center, and Tenured Professor at the University of Colorado School of Medicine. She is nationally recognized as an expert in quality and safety, healthcare operations, payment policy, and was named by Becker’s Healthcare a “Top 26 Patient Safety Expert to Know” in 2022. Dr. Wiler was appointed by the U.S. Governmental Accountability Office to serve on the Physician-Focused Payment Model Technical Advisory Committee (PTAC), a federal expert panel within the Department of Health and Human Service which consults to the Centers for Medicare and Medicaid Innovation (CMMI). She has also served in numerous state and national leadership positions including Chair of the American Medical Association Women Physicians Congress which represents all women physicians and representative for the American College of Emergency Physicians to the AMA RBRVS Updates Committee (RUC) an expert advisory panel to the Centers for Medicare and Medicaid Services (CMS) for nearly a decade. Dr. Wiler has authored over 70 peer-reviewed papers and is senior editor of the book Value and Quality Innovations in Acute and Emergency Care (Cambridge Press, 2017), and has won numerous national awards including being named the “Emergency Physician of the Year” for Pennsylvania, a “Nation’s Top Emergency Physicians 45 Under 45,” an American Medical Association “Inspirational Physician,” and the American Medical Women’s Association (AMWA) “Inspire Award.”