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According to Michael S. Wolf, Director for Applied Research on Aging at Northwestern University, the lack of health literacy in the United States has been amplified due to COVID-19 and the accompanying misinformation about the virus. He estimates that one in five people struggle with health information, especially individuals who don’t understand the right questions to ask their healthcare providers.

This issue has become especially pressing as skilled nursing facilities (SNFs) continue to utilize and implement programs and practices to deal with COVID-19 and its effects. Although it is crucial to proceed with these efforts to improve patient outcomes and increase safety, the issue of health literacy must be addressed, or the programs and services provided will not be as effective.

What is heath literacy?

The US Department of Health and Human Services (HHS) defines health literacy as, “The degree to which an individual has the capacity to understand basic information and services needed to make appropriate health decisions."

Why is it important to assess someone’s health literacy and identify SDoH ICD-10 codes?

  • Assessing an individual’s health literacy is important for effective care planning and discharge planning
  • Important for care coordination
  • Improves safety of the individual
  • Supports successful transition back to the community
  • Prevents future rehospitalizations

The drastic need for greater understanding of health literacy is further highlighted in these statistics:

  • 9 out of 10 adults lack skills needed to manage the health and prevent disease
  • 18% of adults have below-basic literacy
  • 12% of adults have proficient health literacy

Poor health literacy can result in:

  • Higher medical costs
  • Increased ER visits/hospital admissions
  • A decline in the use of preventative services
  • Poorer management of chronic conditions
  • Poor outcomes
  • Missed appointments
  • Non-adherence with medications
  • Inability to name medications/dosage or purpose
  • Lack of follow-through on diagnostic tests/referrals
  • Fewer questions asked

There are 5 categories that make up health literacy:

  1. Economic Stability
  2. Education
  3. Health and Health Care
  4. Neighborhood and Built Environment
  5. Social and Community Context

SNF Prospective Payment Systems (PPS) Fiscal Year 2020 Final Rule

One item that was supposed to be added to MDS, but was postponed due to public health emergency (PHE), was health literacy.

  • B1300 Health Literacy à How often do you require assistance when you read instructions, pamphlets or other written materials from your doctor and pharmacy?

Social Determinants of Health and ICD-10 Coding

Social Determinants of Health are defined as: “Conditions in the environments in which people are born, live, learn, work, play, worship and age that affect health, functioning and quality-of-life outcomes and risks."

New ICD-10 coding guidelines took effect on October 1, 2020 – and one of the areas with new coding guidelines is for Social Determinants of Health (SDoH). In the new coding guidelines (1.B.14) there is new guidance for documentation by clinicians other than the Patient’s provider. These guidelines state for Social Determinants of Health:

  • “Patient self-reported documentation may also be used to assign codes for social determinants of health, as long as the patient self-reported information is signed off by and incorporated into the health record by either a clinician or provider.”
  • ICD-10 codes related to SDoH include:
    • Z55 problems related to education and literacy
    • Z56 problems related to employment and unemployment
    • Z59 problems related to housing and economic circumstances
    • Z60 problems related to social environment

Now more than ever, health literacy is a crucial part of a patient's care journey, helping to ensure both the patient and the family fully understands a facility’s care methods. For more information on how your facility can maximize patient outcomes by overcoming health literacy obstacles, read our blog.


By RehabCare