Philosophical Changes from SDoH to Well-Being Measures

For this fall fashion season, the social determinants of health (SDoH) are out, and nutrition and well-being are in! Yet the parameters are not yet defined.

Arguably the most notable change in the Inpatient Prospective Payment System (IPPS) Final Rule for the 2026 fiscal year (FY) was the Centers for Medicare & Medicaid Services’ (CMS’s) decision to remove health equity as a pay-for-performance domain. This means that beginning at the end of this year, hospitals will no longer be required to conduct or submit data from the standardized five SDoH screening questions covering housing stability, utilities, personal safety, transportation, and food insecurity.

While the removal of federal reporting requirements reduces administrative burden, it simultaneously creates a new ethical dilemma for case management. The data captured through social risk screenings is not simply a regulatory checkbox; it remains essential for ensuring safe and effective care transitions.

For example, identifying unsafe living conditions is not optional; it directly ties to mandated reporting obligations that protect patient safety. Likewise, awareness of barriers such as food insecurity, utility shutoffs, or lack of transportation directly influences discharge planning and elevates the risk of readmission when left unaddressed. Housing instability has been shown to correlate strongly with inappropriate hospitalizations and extended lengths of stay, often driving costs higher while compromising patient outcomes.

In this way, the absence of a federal reporting mandate does not lessen the clinical and ethical responsibility of case managers. Instead, it challenges organizations to determine how they will continue capturing, documenting, and acting on these risk factors. Based on CMS’s responses to public comments, the agency has clarified that hospitals may voluntarily retain these screenings, even though they are no longer tied to federal reporting requirements. Thus, hospitals can choose to reframe these questions and data as internal quality metrics.

By repositioning these screenings as tools to inform care coordination, discharge planning, and readmission prevention, hospitals can continue to capture critical data that directly impacts patient outcomes. Ultimately, this approach could position case management and quality leaders to leverage the screenings for what they were always intended to do: illuminate barriers to safe transitions of care and reduce avoidable hospital utilization.

The Final Rule also included extensive commentary on potential well-being and nutrition measures for hospital reporting. While CMS did not adopt new requirements, they solicited and summarized significant stakeholder feedback.

Many commenters argued that well-being and nutrition measures are better suited for primary care or outpatient settings, not acute inpatient care. There were comments related to concerns from rural and resource-limited hospital leaders worried that such measures would be impractical and hold hospitals accountable for factors outside their control.

Regarding nutrition, many supported wider adoption of the Malnutrition Care Score (MCS) eCQM, with some recommending it be made mandatory. Commenters also highlighted food insecurity, diet quality, and hospital-community partnerships (e.g., medically tailored meals, food pharmacies) as vital to discharge planning and long-term health. Suggestions also pushed for a rephrasing of the conversation to outcome-based measures reflecting improvements in health and quality of life, similar to an alignment with SDoH screening. It’s kind of like a rebrand of SDoH as well-being!

CMS did not issue new mandates in FY 2026, but noted that this feedback will inform future measure development for the Hospital Inpatient Quality Reporting (IQR) Program.