Daylight-saving time is finally here! I look forward to the day in March that it arrives starting June 21 every year. What’s June 21 you ask? Why, it’s the summer solstice.
The summer solstice is the day in the year when the sun travels the longest path through the sky, and that day therefore has the most daylight. Every day after that, until the winter equinox on December 21, there is progressively less daylight at the end of the day.
But on March 12, that all turns around in dramatic fashion. Since December 21, the winter equinox, there has been progressively more daylight. But daylight-saving time adds another hour and — voila! — it is suddenly light until 7:30 pm. Yessss! Spring forward everyone!
I’m definitely a spring and summer guy, and this change every year is a hopeful time for me. Change can be a good thing. It sure feels like we are experiencing more than our fair share since the COVID-19 PHE took over. Soon, the PHE will end but, on its heels comes MDS 3.0 v1.18.11 and the massive shift it will bring.
One of the significant changes that will come our way when the new MDS takes effect this October is a new focus on social determinants of health (SDOH). According to a growing body of evidence, the long days of COVID-19 have revealed a general lack in healthcare associated with identifying and accommodating health equity and health disparity issues that result from SDOH.
Here are a few definitions that may help orient us.
The World Health Organization defines social determinants of health as the, “… the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.”
The Centers for Disease Control and Prevention defines health equity as, “… the state in which everyone has a fair and just opportunity to attain their highest level of health.” “Achieving this requires focused and ongoing societal efforts to address historical and contemporary injustices; overcome economic, social, and other obstacles to health and healthcare; and eliminate preventable health disparities.”
There is not space enough in this column to enumerate the vast body of research that has been and continues to develop related to this topic. And yet, it is something our industry will have to grapple with in some measure come Oct. 1.
Here are a few examples of what I’m talking about.
The list goes on. The effect that this kind of data will have on our daily operations cannot be ignored.
In FY 2023 SNF PPS the final rule CMS’ health equity request for information (RFI) indicated, “CMS is committed to achieving equity in health care outcomes for our beneficiaries. In this RFI, we provide an update on the equity work that is occurring across CMS. Included are: CMS’ plans to expand quality reporting programs to allow provision of more actionable, comprehensive information on health care disparities; measuring health care disparities through quality measurement and reporting these results to providers; and providing an update on methods and research around measure development and disparity reporting.”
In that same RFI, CMS requested comments on whether they should consider, “… incorporating adjustments into the SNF VBP Program to reflect the varied patient populations that SNFs serve around the country and tie health equity outcomes to SNF payments under the Program.”
Recently, CMS also initiated a health equity web page. There, CMS has stated, “The CMS Office of Minority Health released the CMS Framework for Health Equity to address health disparities as a foundational element across all our work — in every program and across every community. Using five priority areas, CMS will use this framework to design, implement, and operationalize policies and programs to support health for all people served by our programs, eliminating avoidable differences in health outcomes experienced by people who are disadvantaged or underserved, and providing the care and support that our enrollees need to thrive.”
Note the language in the five priorities.
Priority 1: Expand the Collection, Reporting and Analysis of Standardized Data
Priority 2: Assess Causes of Disparities Within CMS Programs, and Address Inequities in Policies and Operations to Close Gaps
Priority 3: Build Capacity of Health Care Organizations and the Workforce to Reduce Health and Health Care Disparities
Priority 4: Advance Language Access, Health Literacy and the Provision of Culturally Tailored Services
Priority 5: Increase All Forms of Accessibility to Health Care Services and Coverage
All this takes us back to where we began, to March, and daylight-saving time, and the changes that will come to us in the revised MDS. You may have noticed in your review of the revised MDS that much of the expansion is due to the addition of Standardized Patient Assessment Data Elements (SPADEs).
Within that group of new MDS items is a set of data elements called Social Determinants of Health. Indeed, we will be collecting data in the revised MDS this fall that will press us to begin to face health equity issues head on, and which CMS has identified as necessary to our providing quality healthcare.
Here are the MDS items that have been added, and or revised, to assess for SDOH: Ethnicity – A1005; Race – A1010; Preferred Language – A1110; Interpreter Services – A1110; Transportation – A1250; Health Literacy – B1300; Social Isolation – D0700.
And so, it begins. Change is in the air. Are you ready for it? I’m an early riser, so I don’t mind one less hour of sleep. It’s a sacrifice I’m willing to make for more daylight at the end of the day.
At the end of the day, the inclusion of SDOH into our consideration of the resident’s unique health profile can be a good thing. How CMS will fold these concepts into the quality reporting programs remains to be seen. I’m hopeful that these efforts will indeed produce better outcomes for our residents, a good goal we can all live with.
Recently I heard someone say, “Yes! It’s daylight-saving time. The clock in my car will finally be correct!” That’s funny because it’s true.
The truth is these concepts will require us to spring forward into somewhat uncharted territory. Rest up. October 1 is just around the corner.
Joel VanEaton, BSN, RN, RAC-CT, RAC-CTA, is a master teacher and the executive vice president of PAC Regulatory Affairs and Education at Broad River Rehabilitation.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
