Can you address sdoh and disparities for $15?
What can you buy for $15?
Recently we have been busy doing quite a bit of shopping. Two of our kids have birthdays around Thanksgiving, and it feels like the holidays are immediately upon us as soon as the birthday presents are unwrapped. This time of year we need gifts for all sorts of people in our lives, from teachers to postal workers, not to mention the kids’ school gift exchanges and white elephant games.
So what can you buy for $15? Or maybe a better question is, can you buy better health for $15? I’m inclined to believe you can. Which is why the Office of the Inspector General’s guidance around nominal gifts is so important. OIG initially offered guidelines around nominal gifts for Medicare and Medicaid beneficiaries in 2002. The guidelines clarified that providers could supply gifts of nominal value to patients as long as they met certain standards:
Gifts could not be cash or cash equivalents (e.g., money orders or gift cards to “big-box retailers”
Each gift could be valued at no more than $10
Each patient could receive no more than $50 worth of gifts per year
In 2016, OIG updated their guidance. While cash and cash equivalents are still not allowed, providers can now supply gifts valued at up to $15 each and patients may receive up to $75 worth of gifts per year. And that is definitely enough to impact patients’ health, especially when the gifts are focused on addressing health disparities and social determinants of health (SDOH).
Which means providers have to be smart about the nominal gifts they provide. While grocery or gas gift cards may be useful, do they benefit patients who live in a food desert or who don’t have access to a vehicle? To make nominal gifts meaningful and impactful, the gift should be personalized and address the root causes of patient health and outcomes.
Your patient with depression and anxiety may find that a few months of a paid subscription to an app like HeadSpace that can provide targeted meditation and mood tracking, to be helpful in managing their mental health.
Your patient with COPD or other chronic respiratory illness may benefit from receiving monthly air filters, especially in seasons or areas where air quality is poor.
How many patients with chronic disease would benefit from a senior citizen membership to a gym like Planet Fitness?
Each of these can be provided within the $15/$75 nominal gift limits. Or how about:
Grocery and pharmacy home delivery using a service like Walmart+ to help patients who live in a food desert or who lack transportation
A set of low weight dumbbells or resistance bands to help build muscle mass in elderly patients without access to safe exercise spaces
A pill organizer that holds a month of medications (especially if the pharmacist or clinic nurse fills it) for patients who struggle with complex medication regimens
A water filter or water filter pitcher for patients living in areas where water supply may be prone to contamination
A few sets of reading glasses (you may have heard them called “cheaters”) to help patients who have trouble reading instructions or drawing up insulin
Health disparities are a systemic problem that need a systemic solution. But the patients who are experiencing those disparities are individuals who need personalized care. Nominal gifts can’t solve everything, but they are an underutilized tool in the pursuit of equitable care.