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Home-based care providers are constantly looking for new ways to prove their value. One way they’re doing so is through Z-codes.
Z-codes – encounter reason codes that document social determinants of health (SDoH) data – are relatively new. They are also rarely used, appearing in less than 1% of all medical claims. But some of the organizations documenting them the most are home health providers.
Of the 10 health care providers using Z-codes most frequently, three of them are home health providers, including the top two, according to a LexisNexis data analysis.
Health care experts see Z-codes as a way to break down silos, up data tracking and create a larger seat at the proverbial health care table for home-based care providers. Because of their access to patients’ homes – the most intimate and telling setting – documenting SDoH concerns through Z-coding is a unique opportunity for providers.
“Home health providers have a very close-knit relationship with the patients that they serve; they see them more regularly and in their homes, rather than in a traditional clinical setting,” Diana Zuskov, the associate VP of health care strategy at LexisNexis Risk Solutions, told Home Health Care News. “It makes sense that it’s easier for them to ask questions about SDoH. When you’re in someone’s home, it’s a more natural conversation to say, ‘What did you eat today, and who else lives in this home?’”
LexisNexis Risk Solutions is a data and analytics company that also provides technology services and predictive insights for multiple industries, including health care.
While Z-coding can begin with a simple question, such as the ones mentioned above, they can also kickstart a more holistic and smart health care journey for patients. Once those concerns are documented, the rest of the providers on the continuum can adjust their care with them in mind.
Those concerns can include food insecurity, lack of transportation access, pest problems and other issues with housing.
Home-based care providers across the spectrum have touted their ability to track and address SDoH issues, especially of late. Though home health operators are generally considered post-acute care providers, Z-codes allow them to impact a patient’s health in a proactive – and not just reactive – way.
“With SDoH, we obviously don’t want to put them really high up on our list because usually, that’s not our focus of care,” J’non Griffin, principal and SVP of coding at SimiTree, told HHCN. “However, it does play a part in the overall care planning of that patient, and [using Z-codes] makes it individualized. So, if the patient doesn’t have running water or if they have food insecurity, our care plan needs to be around some of those social determinants of health.”
Griffin believes that Z-codes are just one avenue the Centers for Medicare & Medicaid Services (CMS) is taking to get providers to look more holistically at patients.
In the past, home health providers were more focused on a specific task at hand – a wound, or specific post-surgery recovery plan. Now, that mindset is changing.
It’s also another argument for more service lines, or for more partnerships. With those, home health providers can play a part in closing some of the gaps in care they recognize.
“Back 30 years ago, we did a lot of social work; we had full-time social workers, and now a lot of agencies contract that,” Griffin said. “They don’t have full-time social workers. They may be relying on their clinicians for that, but the clinicians already have a lot to do. So, I’d tell providers that they should probably have good social worker resources.”
As providers move more toward value-based care – and pitch themselves as value drivers to Medicare Advantage (MA) plans – Z-coding is one relatively easy way to reduce hospitalizations and poor patient outcomes.
A Z-code uptick
While still rare, Z-code utilization has grown by 36% over the last two years alone.
There’s also more than one reason home health providers are using those codes, according to Zuskov.
“I would hypothesize that one of the reasons we’re seeing very high Z-code utilization with home health providers is because it also allows them to bill and be reimbursed for some of those additional services through Medicare and Medicaid,” she said. “There’s also more acceptability about the need to address social determinants in those CMS populations than there are in some of the other more traditionally commercial populations.”
It’s being financially incented to address SDoH, in Zuskov’s view. And home health providers are in the perfect spot to capitalize off of that.
But Z-codes can also ensure that providers’ are being properly reimbursed now for all of the services they are providing.
“In certain populations and certain financial models, they can say, ‘Well, this patient cost me more time or cost me more money,’” Zuskov said. “Having the Z-codes on the patient’s record shows that relationship. I think that’s why, too, we’re seeing more adoption in home health care, where the providers are doing more of that work. They want to be fairly reimbursed for it.”
It’s important to note all of the steps required for home health providers’ Z-code usage to actually make an impact.
The Z-code needs to be documented. But that SDoH information also has to reach the next provider that is working with that patient.
“Some of the coordination and interoperability between those different providers would help a lot, because there might be something that a care coordinator or a home health worker knows that maybe a surgeon or hospital-based provider needs to know,” Zuskov said. “That data needs to be exchanged more often. The biggest piece, in my opinion, is also using other sources to inform how we learn more about someone’s social determinants of health. Using the Z-codes model really requires that someone has a interaction with a provider in the first place.”
That’s also an argument for greater home- and community-based services (HCBS) funding and access, given that those services can be provided without an acute event. There are still lengthy waitlists in some states for HCBS.
The highest home health Z-code utilizers were not identified. Multiple home health providers told HHCN that they are still exploring how to best use Z-codes, but that they’re intrigued by the possibilities that they could offer.
“They’re fairly new codes,” Griffin said. “I do think that CMS will reintroduce more and more of these sorts of codes related to social determinants. Because it’s not only important in home health, it’s important across the health care industry.”
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