New ICD-10 medical codes build bridges between care and community
Beyond an upset stomach and increased anxiety, hunger compromises a person’s well-being, increasing the likelihood of chronic illness and perpetuating the cycle of poverty through medical spending.
Almost 60% of households served by Feed America, the largest national organization fighting hunger, has a member with high blood pressure and 33% have a household member with diabetes.
Yet when a person walks into a doctor’s office, food insecurity or unstable housing becomes an invisible but tangible layer – impacting the patient’s well-being but missing their medical history due to lack of medical terminology.
“If you can imagine the frustration of knowing that your patient’s diabetes is not being controlled because they don’t have access to affordable foods that are prescribed for them as part of their diet,” said Dr. Sarah DeSilvey, a family nurse practitioner who works in Georgia, Vermont.
“Or you can imagine when you’re working with a family… facing eviction, and they’ve moved three times, and you’re trying to describe the situation that represents their condition,” DeSilvey said. “You know in the literature its health risks, you know it leads to maternal anxiety and depression, you know the poor outcomes for young children, but you literally can’t tell they have a home. unstable. There is no term for it.
With new diagnostic codes, doctors across the country can use the language of their field to track food insecurity, housing instability, unsafe drinking water and homelessness, just as they would with the hypertension or hypoglycemia.
She, along with Dr Laura Gottlieb, professor of family and community medicine at the University of California at San Francisco, created the codes through The Gravity project, a national organization of more than 2,000 healthcare professionals creating consensus standards with a mission to improve “the personal and population health of the people we all serve by addressing the social determinants of health,” said DeSilvey .
Although DeSilvey has personally experienced financial and real estate instability, its main driver is “that poverty is an unethical problem that must be resolved”.
Working with Blue Cross and the Vermont Blue Shield, DeSilvey sought out a health insurance plan to support its demand for the new codes.
“(DeSilvey) had gone to school with a woman from our coding department, Chris Denis, and they worked together on the app to actually change the codes,” said Sara Teachout, director of government and media relations for the Blue Cross and Blue Shield. from Vermont.
“It was definitely Sarah’s idea, but we recognized how great it was and how we wanted to support her,” Teachout said.
These ICD-10 codes work as a way for “providers to communicate what is happening to their patients,” she said.
“The codes are very specific for saying if you are having surgery (and) all of the different components of it, but they weren’t if the person was food insecure or had no housing. or was homeless or a host of other social determinants of health.
The Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention approved the codes, which went into effect nationwide on October 1.
With the use of codes, The Gravity Project aims for three specific impacts: a better ability to tell patient stories, to share care between physicians and colleagues and to increase the capacity to do research to improve the quality of care.
The codes will allow health care professionals and community action agencies to create a network of patient care that extends beyond the doctor’s office, because “we identify things in clinical settings, but we identify them. let’s resolve in communities, ”DeSilvey said.
Charolette Tidwell, Founder and Director of Antioch for the youth and the family, a pantry and outreach center in Fort Smith, previously worked for 36 years in nursing and the administration of acute and long-term care. She sees the importance of connecting these resources to improve community health.
With heart disease the leading cause of death in Arkansas in 2017, according to the Centers for Disease Control and Prevention, statistics like these “help me know that I need to feed nutritious foods to eliminate some of these problems.” related to lifestyles. That’s why I’m so focused on nutritious foods, ”Tidwell said.
“We have to move on to the idea of… increasing healthy lifestyles with food,” she said.
Project Gravity continues to develop new codes, some of which are currently under public review. By next year, new codes, especially for transportation insecurity and financial hardship, could be approved and added to a growing list of social determinants terms doctors can use.
These codes will not impact a person’s health insurance costs, Teachout said.
“It’s a way of talking about non-medical issues, of tracking social risks, and then I think as that develops, to offer benefits to patients to help them meet those needs,” said Teachout. “It can be through their health insurance which provides them with meals, but it can also be through care coordinators who try to put them in touch with the social services they need. … This makes it easier and clearer what the needs are.
With rates of food insecurity and housing instability increased during the coronavirus pandemic, these codes create a new way for medical providers to care for patients in distress.
“I get a little emotional when I think about what the moratorium on evictions means and what it means to risk losing your home and the fact that we can say it now,” DeSilvey said.
Catherine Nolte is a member of the body of Report for America, a national service program that places reporters in local newsrooms. She can be contacted at [email protected] Southwest Times Record and Report for America are working to place a new generation of journalists in community news organizations across the country. Are you supporting this effort today?