BSMH EHR vendor Epic is currently placing patients in the DEN for SDOH reporting if a patient's had a status of IP anytime during their 23 hour hospital stay even though at the time of discharge the patient was in fact an observation (<23 hour stay) and billed as an observation.  However,  based on the Epic (vendors) logic because the patient switched from IP to AO to IP and back to AO before discharged they are being included in the SDOH report.   

Epic (vendor) asked that we get CMS feedback and we opened a ticket with IQR to get clarification on the below three scenarios and received a response included below.  Epic (vendor) stated in order for them to make changes the IQR/CMS response needed to be made public.  So we are asking for the below question/answer to be reviewed and made public so the correct LOGIC for SDOH can be implemented within the Epic (vendor) SDOH reports. 

3 Scenarios sent to IQR/CMS for clarification. 

Scenario 1:

Patient is admitted to the hospital as an Inpatient; however, during their stay their admission status was switched to an observation and discharged before 23 hour mark.  

• Should the patient be included in the SDOH report because they had a status of Inpatient admission any time during their hospital stay; even if their status was switched to observation before discharged? 

 ** Scenario 2:

Patient came through Emergency room and admitted with a status of Inpatient; however, an hour later their status was switched to Observation and the patient was discharged within the 23 hour Observation status window.

• Should the patient be included in the SDOH report because they had a status of Inpatient admission any time during their hospital stay; even if their status was switched to observation before discharged? 

Scenario 3:

Patient came through Emergency room and admitted with as status of observation; however, during their stay they were switched to inpatient and back to observation and discharged within the 23 hour observation status window.

• Should the patient be included in the SDOH report because they had a status of Inpatient admission any time during their hospital stay; even if their status was switched to observation before discharged? 

IQR/CMS response received (Ticket ID CS2220358) response

For the Inpatient Quality Reporting (IQR) Program, only patients who are admitted to a hospital inpatient stay and who are 18 years or older on the date of admission are included in the SDOH measures.

• Whether or not patients are included in the IQR SDOH measures will depend on how the admissions were billed. Patients whose admissions or services were billed as outpatient/observation would not be included. 

Please confirm what should place a patient in the Denominator for SDOH