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April 8, 2021

COVID, SDoH and National Minority Health

Addressing Mass Immigration, Poverty and the Disproportionate Impact of the COVID-19 Pandemic and Social Determinants of Health (SDoH)


Written by: Compliance Blogger


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Article Summary

In honor of April, National Minority Health Month, this article addresses mass immigration and the disproportionate impact of COVID-19 to such traveling individuals experiencing poverty, and to other ethnic minority communities.  Presenting Proper documentation of the social determinants of health or SDoH in order to mitigate risk and improve reimbursement. 





April 2021 is National Minority Health Month.  The HHS Office of Minority Health (OMH) and federal and non-federal partners are focusing on the impact COVID-19 is having on racial and ethnic minority and American Indian and Alaska Native communities. The impact of the pandemic is further complicated by the massive surge of new immigrants entering the southern border, exceeding our ability to provide safe care.  Migrants have arrived at the U.S.-Mexico border in higher numbers over the past few months. There were over 170,000 people in March alone, the largest single-month total in well over a decade. Many of these people are testing positive for COVID-19.


The intricacies of poverty, limited access to healthcare, and fear of legal repercussions place vulnerable immigrant communities within the U.S. at high risk for acquiring SARS-CoV-2 and developing severe COVID-19, according to PMC Library of Medicine, National Institutes of Health.


Many vulnerable immigrants have no insurance or are underinsured, making them dependent upon our Federally Qualified Health Centers (FQHCs), safety-net public health systems, or free clinics.  These organizations are often underfunded, limiting their ability to provide testing, management, and follow-up services to their patients.


Another contributing factor to the health of these populations is the lack of access to preventive medicine which leads to increased risk of underlying health conditions such as obesity, hypertension, and diabetes-—comorbidities that have been linked to more severe COVID-19 manifestations.


In a national evaluation of health conditions in immigrant populations, nearly a third (27.7%) of those from Mexico, the Caribbean, and Central America had hypertension, 71.5% were obese, and 9.6% had diabetes. This is compared with the age-adjusted prevalence of 45.4%, 42.4%, and 8.2%, respectively, in the U.S. general population, according to the CDC.


It is noted, however, within the U.S. general population, these comorbidities tend to be higher in minority groups compared to whites. For instance, while the prevalence of diabetes in the U.S. general population was 8.2% overall, it was 12.5% for people of Hispanic origin, 11.7% for non-Hispanic Blacks, and 7.5% for non-Hispanic Whites.


According to reports coming from politicians visiting the border and from media news outlets, the undocumented immigrants entering the United States are under emotional, physical and medical stress.  This may be due to stress related to poverty, trauma, and poor social support, which lead to mental health conditions such as post-traumatic stress disorder, depression, and anxiety, as stated in Sociobehavioral Determinants of Compliance with Health and Medical Care Recommendations reported by the National Institutes of Health.


These psychological stressors may be worsened during a pandemic, certainly for those with limited healthcare resources, high risk of job loss, or high risk of SARS-CoV-2 exposure.


What Health Care Providers Can Do

Encourage vaccination. Because the COVID-19 pandemic has disproportionately impacted racial and ethnic minority communities, the need to get these vulnerable communities vaccinated is becoming increasingly important. The COVID-19 vaccination is an important tool to help us get back together with our families, communities, schools, and workplaces by preventing the spread of COVID-19 and bringing an end to the pandemic.


Offer preventive care.  CMS Educational Tool provides information on Prolonged Preventive Services using codes G0513 or G0514. 


Visit the CMS Office of Minority Health.  Chronic diseases pose a significant problem in the United States resulting in substantial morbidity, mortality, disability, and cost. The CMS Office of Minority Health has designed an interactive map, the Mapping Medicare Disparities (MMD) Tool, to identify areas of disparities between subgroups of Medicare beneficiaries (e.g., racial and ethnic groups) in health outcomes, utilization, and spending. It is an excellent starting point to understand and investigate geographic and racial and ethnic differences in health outcomes. Watch the MMD Tool video.


Learn more about how your office can promote documentation improvement to report SDoH, mitigate risk and improve reimbursement. Register today for the outpatient CDI online training and certification program.



References
  • Centers for Medicare & Medicaid Services – Office of Minority Health
  • National Institute on Minority Health and Health Disparities
  • Centers for Disease Control

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