As ob-gyns, we got into the field of obstetrics and gynecology because we’re passionate about women’s health. We’re naturally curious people who love that this great specialty covers everything from surgery to bringing new life into the world. As the health care landscape changes with new technology and new business models, it’s critical that we understand how payment models are decided and the ways in which ACOG and you are involved in the process.
In 1992, Congress transitioned to a physician payment system
based on a resource-based relative value scale, which mandated that payment for
services be based upon the resources required to perform a service and the
related practice expense. The AMA subsequently formed the Relative Value Scale
Update Committee (RUC), which advises the Centers for Medicare & Medicaid
Services on the relative value units (RVUs) that should be assigned to new or
revised codes in the Current Procedural Terminology codebook. Although the RUC
provides the work RVU recommendations, CMS makes the final decision on the
RVUs, even for services they don’t cover. Today, you may know the RUC as the
group responsible for the often murky process of reimbursement for procedures
and services. But do you know ACOG’s role in the RUC?
The RUC is primarily comprised of representatives for specialties
that accept payment through Medicare. Membership was initially determined by
the amount of Medicare expenditure in certain specialties. Though ob-gyns and
pediatric physicians make up a smaller portion of Medicare expenditure, they also
have RUC seats because their services are essential. ACOG has a permanent seat on
the RUC. This means that when the RUC decides on recommendations for RVUs,
which determine reimbursement rates, ACOG is right there at the table,
advocating for ob-gyns and women’s health care physicians. Barbara Levy, MD,
ACOG’s vice president of health policy, served as RUC chair for six years and
recently appeared in a three-episode
series of ACOG’s CHEC Your Practice podcast to explain RVUs and the
RUC in depth.
So, how is reimbursement determined? The process begins when
the RUC sends out a randomized survey that gauges how much time physicians
spend on certain procedures and services, including preservice and postservice
time. Based on the survey results, the RUC presents analyzed, aggregated survey
data in the form of RVU recommendations to CMS, which then takes those recommendations
into account when determining a code’s final RVUs. From there, the CMS
contributes additional data, such as data from their personal database on the
length of hospital stays, which brings in a different perspective.
Have you noticed changes to reimbursements for certain
procedures? A large part of this may be due to technological advances that make
procedures quicker and easier. For example, laparoscopies, which used to
include two days of hospital stay on top of the time it took to do the
procedure itself, are now usually outpatient procedures. In past code reviews,
a significant amount of RVUs were assigned to the amount of time spent in the
hospital. Now, because the CMS records shorter hospital stays for
laparoscopies, reimbursement payments are lower.
Even though you may not feel represented in the
reimbursement process as an individual physician, you and your peers can make
an impact on RVU valuation by participating in the RUC survey whenever you
receive one. Filling out the RUC survey as thoughtfully as possible helps the
RUC get a better understanding of the resources required to perform certain
services. Providing the most accurate responses to the survey is extremely important;
for example, Dr. Levy notes that surgeons tend to think of themselves as “fast
and efficient” and may not consider the amount of time a service takes to
complete. In the end, says Dr. Levy, the “determination of RVUs . . . what we
as ACOG can present to the RUC is only as good as the survey data we get from
ACOG members.” Let’s do this!
Today, at the 2019 ACOG Annual Meeting in my hometown of
Nashville, TN, I had the unique opportunity to stand before our peers as ACOG’s
newly inaugurated 70th president. I’m honored and humbled to be able
to serve as ACOG president and enjoyed seeing some of you at the Meeting. And,
as I think about my time as ACOG president and what I’d like to accomplish, I can’t
help but keep coming back to the common theme of refining and advancing our
profession in times of change.
Obstetrics and gynecology is an ever-evolving profession. As
the premier women’s health care association, ACOG has always been on the front
lines of women’s health care as we develop new guidance, bring new
perspectives, and advocate for our patients and our profession in the halls of
Congress. But as obstetrics and gynecology continues to advance in leaps and
bounds, we as physicians can’t just keep up with that progress …we have to get
in front of it.
My presidential initiatives will focus on reenvisioning the
system of delivery of surgical care to optimize patient safety and outcomes and
supporting more research in women’s health care. So as I begin my year of presidency, I’d like to
challenge us all to consider three questions:
What is the best way to deliver the best care to
What is the best way to prepare today’s trainees
to deliver the highest-quality care in the future that maximizes safety and
How do we ensure the highest-quality health care
for women for generations to come?
Levels of Gynecologic Care will help us answer those
questions. This new concept, loosely modeled after the Levels of Maternal Care
program, is centered on the robust and diverse task force I assembled to
investigate what future practice patterns might best deliver the highest-quality
and most effective gynecologic surgical care in the most efficient and safest
manner. By anticipating the future, we can ensure that we are prepared to adapt
to changing trends, patient needs, and new health care systems and processes.
While these initiatives are incredibly important to improving women’s health, I’m equally excited for the opportunity to get to know you, my colleagues. ACOG’s members are some of the most passionate, dedicated physicians out there and have helped shape the course of women’s health care throughout our history. I’m eager to hear from you about the work you’re doing to ensure health care of the highest possible quality for patients everywhere. Please connect with me on Twitter at @DrTedAnderson.
Almost one year ago to the day, I took the stage in Austin at
the 2018 ACOG Annual Meeting and began my presidency. What a wonderful year it’s
I was so excited to get started on my three presidential initiatives
as I took office. I knew that I would focus on preventing maternal mortality
and I am so happy to say that we made great progress this year.
My first initiative was advocacy on state and federal levels
to establish maternal mortality review committees. ACOG members more than
stepped up to the challenge: In December of 2018, ACOG contributed hugely to
the passing of the Preventing Maternal Deaths Act, which provides
infrastructure and support for maternal mortality review committees at the
state level. Things are moving quickly, and the CDC has already released the
notification of funding opportunity.
My second initiative emphasized strengthening the culture of
patient safety in hospitals by implementing the Alliance for Innovation on
Maternal Health program. We made great progress on this goal when ACOG received
a $2 million grant from the Health Resources and Services Administration that
enabled us to expand the program to 27 states.
My final initiative was updating ACOG’s clinical guidance
for heart disease in pregnancy, which, as the leading cause of maternal
mortality, accounts for nearly 25% of maternal deaths. Read more about ACOG’s
informative new resource on this topic at the end of the blog.
With national attention focused on maternal mortality, we had wonderful opportunities for collaboration. Working with the American College of Cardiology and the American College of Emergency Physicians on my Pregnancy and Heart Disease Task Force and collaborating with the more than 15 organizations, including the American Psychiatric Association, who partnered with us for a summit on maternal mental health really drove home the important role that these partnerships can play in amplifying our voices.
I’ve also had the opportunity to travel to so many District
and Section meetings, where I got to see many old friends and make new ones.
Our ACOG members are doing so many great things to advance our profession and
improve women’s health!
My presidency was unique in that I also took on the role of interim
CEO. Filling in as the interim CEO gave me the opportunity to work in our Washington,
D.C., office with the people who keep ACOG running behind the scenes: our
national staff. It has been a privilege to get to know our incredible team and
see how hard they work every day to help our members. For example, our
facilities team keeps ACOG running smoothly so that everyone can do their jobs,
and our Resource Center, which also houses an obstetrics and gynecology museum,
provides information for anyone who seeks it. Our IT team is partnering with
our Marketing and Communications team to complete the new ACOG website we’ll be
launching later this year. Our Finance team creates budgets, assesses projects,
and processes reimbursements from members like you. The Long-Acting
Reversible Contraceptive and Coding HelpDesks, and the staff that keep them
running, support members and fulfill their day-to-day practice management
needs. From Publications to Development, Membership to District and
Section Activities, ACOG staff work incredibly hard to deliver value to our
members. ACOG’s team is dedicated to
understanding member needs and ensuring that busy clinicians can make the most
of the limited time they have.
Earlier in the blog I hinted at a new resource that will
fulfill my third initiative. I’m proud to announce a new Practice Bulletin on pregnancy
and heart disease, which was published in this month’s Green Journal. This
bulletin addresses screening, diagnosis, and management of cardiovascular
disease in women before, during, and after pregnancy. The bulletin also covers
pregnancy-related complications such as preeclampsia and gestational diabetes
that are associated with increased lifelong cardiovascular risk and provides
recommendations to help us deliver better care to women who need it. While this
guidance is a great step in the right direction, it’s up to us as women’s
health care clinicians to implement these recommendations.
Thank you for allowing me to serve as your ACOG president
this past year. I can’t wait to see how ACOG’s amazing members continue to advance
women’s health care.
Jeanne Conry, MD, PhD, FACOG is president elect of FIGO, ACOG Past President, and a member of the FIGO executive board. She is chair of the United States Women’s Preventive Services Initiative, a collaborative initiative of health professional organizations and consumer advocates who recommend and guide preventive health services across a woman’s life span; and cochair of the FIGO Working Group on Reproductive and Developmental Environmental Health. Read her guest blog:
As an ob-gyn, I’ve devoted my career to doing right by women, both inside the exam room and out. That means supporting women’s health in the United States and globally through advocacy, research, and education. This International Women’s Day, let’s talk about how we as women’s health care professionals can improve women’s health to build a more equitably balanced world and propel change to improve quality of life for generations to come.
The theme of this year’s International Women’s Day is
Balance for Better. Balance for better means not just supporting more diversity
in the workforce but also working to advance women’s health with equal thought
and care. We see women’s health inequalities every day, whether it’s U.S. taxes
on menstrual products or political debates about which women’s health services
should be covered by insurance. The truth is that a more equitably balanced
world means better access to quality care for all women. Exceptional health care requires the empowerment of women, the
elimination of violence, the rejection of reproductive coercion, and a demand
for dignified, high-quality services.
Last year, when I was became president-elect of the International Federation of Gynecology and
Obstetrics (FIGO), I promised to use the distinguished honor to advocate for
bringing women’s health to the forefront of international issues, support
effective family planning choices for all women, and educate and advocate for
awareness about the effect of the environment on reproductive health. FIGO
is in a position to galvanize support for these objectives by partnering
effectively with regional, national, and global organizations and effectively
integrating and collaborating with its member societies. but all ob-gyns can
play a role supporting women as we work to balance for better.
Ob-gyns are in a unique
position to be a strong and effective voice for access to health care all over
the world, particularly in places where the need for access to obstetric and
gynecologic surgery and preventive services are critical. At ACOG, the Office
of Global Women’s Health (OGWH) seeks to increase women’s access to quality
health care by building provider skills, supporting implementation of high-impact
interventions, and scaling proven solutions to decrease maternal mortality and
morbidity and improve care throughout a woman’s life. OGWH was founded on the
premise that by leveraging ACOG and its members’ unique capabilities, we can
help to improve women’s health everywhere.
In 2018, the OGWH
launched an effective e-learning program in India; provided consultation to the
development of international guidance documents; joined a coalition to improve
maternal, newborn, and child health in Madagascar; launched a new surgery
training curriculum in Uganda; and successfully closed out a multiyear collaboration
with the Ethiopian Society of Obstetricians and Gynecologists. These achievements
advance the well-being of women, ensure women and girls access to better sexual
and reproductive health care services, and improve the delivery of maternal and
women’s health care around the world. You can learn more about OGWH programs
and the work
they are doing to balance for better by visiting their website. I also encourage you to
join their Listserv to learn about new
opportunities and how you can become involved.
As an ACOG member and president-elect of FIGO, I look forward to collaborating with you as we strive for excellence in our clinical practice and women’s wellness worldwide. If you haven’t yet, please take a moment today to support International Women’s Day by posting on social media using #balanceforbetter.
The 2019 Annual Meeting is fast approaching, and I couldn’t
be more excited for the program we have planned for all of you! It will be an action-packed
meeting full of opportunities to learn, network, enhance your practice, and get
inspired to make a difference in your communities.
I’m especially enthusiastic about the President’s Panel, where
I’ve carefully selected outstanding speakers to create a positive, solutions-based
interactive session on maternal mortality. My presidential initiatives have focused
on reducing maternal mortality, and this year’s panel reflects a dynamic group who
will help us make the transition from conversation to implementation.
One panelist is Mary-Ann Etiebet, MD, the lead and executive
director of Merck for Mothers. I met Mary-Ann while doing work for the CDC and
had the amazing opportunity to learn about her work around the globe to reduce
maternal mortality. With Merck for Mothers, Mary-Ann leads the charge on
innovative, outcomes-based maternal health programs and private-sector
partnerships that help create solutions that empower women and provide
resources to health care providers. Her work promotes access to quality care
and helps create the foundation for strong families and communities by keeping
mothers healthy through pregnancy and beyond. If you’re looking to understand
how empowering women can improve their health outcomes, look no further than
Another panelist is Rebekah Gee, MD. As the secretary of the
Louisiana Department of Health (LDOH), Rebekah oversaw the state’s Medicaid
expansion, which allowed more than 470,000 Louisiana residents who previously
didn’t have health insurance to become insured. Before serving as secretary,
Rebekah was the director for the LDOH Birth Outcomes Initiative, which reduced
the infant mortality rate by 25% in Louisiana by improving the quality of care
for mothers and infants and addressing poor pregnancy outcomes for high-risk
mothers. Enhancing access to high-quality care really makes a difference.
Rebekah has been a champion working tirelessly on behalf of women in need.
I hope that Mary-Ann’s and Rebekah’s passion, methods, and
results will inspire every single attendee to think about how they can
implement change in their practices and communities as we all continue working
to end preventable maternal mortality.
Registration is now open for the 2019 ACOG Annual Meeting.
If you haven’t yet, I encourage you to register now. As always, you can connect
with me directly on Twitter at @TXMommyDoc.
Last week on my flight from our nation’s capitol to the Texas capitol, I heard the amazing news! The U.S. Congress took a critical step in combatting the U.S. maternal mortality crisis by passing the Preventing Maternal Deaths Act. The bill is now on its way to the president’s desk for enactment.
This achievement follows nearly a decade of ACOG advocacy and active engagement by ob-gyns, our partner organizations and Members of Congress. We all worked together—consistently and tirelessly—on this bipartisan legislation to ensure that no more mothers die from preventable causes before, during, or after pregnancy. It is an important step but by no means is it the last step that we will take to end preventable maternal deaths.
Why This Bill Matters
The Preventing Maternal Deaths Act will provide federal funding to create or expand maternal mortality review committees (MMRCs) in every state. MMRCs bring together multidisciplinary teams including local ob-gyns, nurses, social workers, and other community stakeholders to review the causes of and find local solutions to prevent maternal deaths.
While we have all heard and read the appalling statistics of rising maternal mortality rates, what drives us all to end this crisis goes beyond the numbers. It is the lived experiences we have with our patients and their families, and with our mothers, aunts, sisters and daughters. This issue touches every one of us.
For me it was early in my career. I witnessed the death of a healthy, new mother who lost consciousness on arriving to labor and delivery. Like so many of these deaths, there is no one person to blame. There is a complex set of contributing factors that cause maternal deaths. MMRCs are a vital step to understanding these causes of maternal mortality and how we can prevent similar cases in the future. Supporting the work of MMRCs has been a key initiative of mine as ACOG president, as is part of a larger ACOG effort to make every facility in the United States a safer place to deliver.
Implementing AIM at the Hospital and State Level
The Preventing Maternal Deaths Act is only one piece of the puzzle. Through the Alliance for Innovation on Maternal Health (AIM), ACOG leads a national partnership of provider, public health and advocacy organizations, dedicated to reducing maternal complications and deaths. With plans to expand to 35 states next year, AIM teaches hospitals how to be ready, recognize, and respond to emergency situations. AIM maternal safety bundles (sets of best practices) support doctors, nurses and hospitals with tools to be fully prepared. The bundles include things such as
Checklists and team training
Risk-screening to identify women who may need additional attention
Processes to recognize potential problems early
Workflows that help team members respond quickly and consistently in circumstances where you might only have a few minutes to save a mother and child
AIM has already seen promising improvements in maternal complication rates from the initial four states that joined the initiative. Its success relies on state teams comprised of state health departments, health associations, perinatal collaboratives, provider groups, and hospitals all working together to implement consistent maternity care practices and gather and report data on outcomes and process measures. The data allows them to measure progress and determine which practices are working.
But There is Still More We Need to Do
While positive steps are being made, real progress requires fundamental changes in women’s health care, not just from hospitals and providers, but from policy makers at every level. ACOG has been working to make our voices heard on this vital issue, but we need your help because our work is far from over.
Stay tuned as we continue our work with the U.S. Congress and in statehouses across the country next year. I look forward to continuing to stand shoulder to shoulder with you – my colleagues and friends – as we work together to improve women’s health and make childbirth safer for all.
Eugene Toy, MD, is the medical director of ACOG’s Texas Levels of Maternal Care (LoMC) Verification Program, vice chair of District XI, and an ob-gyn at the University of Texas Medical School at Houston.
Levels of maternal care play an important role in supporting Dr. Hollier’s signature initiative to reduce preventable maternal mortality. The ACOG/Society for Maternal-Fetal Medicine Levels of Maternal Care (LoMC) Obstetric Care Consensus supports this initiative by proposing uniform designations for levels of maternal care related to hospital capabilities and resources. Through the LoMC Verification Program, ACOG aims to foster collaboration among facilities at varying levels of care so that pregnant women receive care at a facility appropriate for their risk.
ACOG launched the LoMC program in Texas, where Level II, III, and IV facilities that provide maternal care must undergo site surveys to receive the level of care designations that will allow them to receive Medicaid reimbursement. I had the privilege of attending the site visits for each of the 11 surveys the LoMC program completed in 2018. Here are some observations:
Build purposeful partnerships. By using a collaborative and transparent approach, ACOG serves as a resource and mentor as well as a survey organization. This partnership builds trust with hospital leadership.
Quality is key. Maternal quality programs are the key to reducing severe morbidity and mortality. Each hospital has its strengths and excellent initiatives, but can also make improvements, including implementation of consistent triggers for quality reviews, monitoring outcomes or closing the loop, and providing education to staff.
It’s about the team. In many settings, the obstetrical unit is fairly isolated and lacks communication, shared processes and guidelines, joint team training, and joint quality reviews. In our surveys, we bring all key hospital services and leadership to the table over dinner to discuss how each area interfaces to work together for the maternal patient.
Trust but verify. Our approach is to verify that the processes put in place by the maternal leadership are utilized consistently and documented. We do this with chart reviews, hospital tours, and interviews of bedside staff.
Show flexibility. ACOG’s approach has been to be open-minded to how medicine is practiced in different settings, since Texas is so geographically diverse. Ultimately, our top priority is patient care.
I’m happy to report that after six months, our Texas LoMC Verification Program has already made a substantial impact in equipping hospitals, doctors, and nurses to improve care for Texas mothers. If you know someone working in a hospital in Texas, tell them to schedule their survey with ACOG and join our efforts in reducing maternal mortality.
Connie Gayle White, MD, MS, FACOG is an ACOG member and practiced as an OB/GYN physician in Frankfort, Kentucky for over 20 years. She is currently the Senior Deputy Commissioner in the Kentucky Department for Public Health (KDPH) overseeing all the clinical services provided by the Department throughout the state – all chronic disease programs, women’s health services, maternal child health, and overseeing development of new programs. Read her guest blog post below.
I once had a patient who smoked cigarettes. Over the years I treated her, I diligently counseled her on the harmful effects of smoking and gave her resources to help her quit. Yet every visit she returned a smoker. One day, I casually asked why she started smoking. She confided to me that she began smoking at the age of 10 because her father hated the smell of tobacco. She knew if she smelled like smoke he wouldn’t come into her room to assault her at night. She then revealed she had taught her younger 8 year old sister to smoke too. Tearfully, she asked if she was a bad sister. I had of course taught her all about the consequences of smoking and now she worried she had inadvertently put her sister’s health at risk. Instead of helping her, I had retraumatized her each year because I hadn’t known anything about ACEs.
Adverse childhood experiences (ACEs) are stressful traumatic events occurring in childhood — such as physical, emotional, or verbal abuse or neglect against any member within a household, or other forms of violence and household dysfunction — can interrupt healthy social-emotional development in children, and their consequences are more far-reaching than most physicians may realize. The first two years of a child’s life are a critical period wherein the brain is hardwired for social-emotional development. Secure attachment stemming from a nurturing, consistent relationship with a caregiver is the foundation of healthy social-emotional development, which in turn becomes the foundation of an individual’s cognitive development and sense of self-identity.
ACEs lead to an increase in risky and unhealthy behaviors in adolescents and adults. For example, as the number of ACEs a teen has experienced increases, it follows the dose-response curve and the likelihood that that teen will have had sex by age 15, become pregnant as a teen, or impregnate someone as a teen. More ACEs are also correlated with higher risk of attempting suicide at age 18 or below. In Kentucky, which has one of the highest rates of children with three or more ACEs in the country, adults with high ACE scores (three or more ACEs) smoke or binge drink at higher percentages than their low-ACE score counterparts.
However, risky behaviors are not the only way ACEs manifest later in life. Chronic toxic stress resulting from conditions producing high ACEs starting at birth and beyond increases serum cortisol levels over prolonged periods Arthritis, asthma, chronic obstructive pulmonary disease, and depression are more prevalent in adults age 18 and over with low ACE scores than in adults without, and even more prevalent still in adults with high ACE scores. Astonishingly, you’re more at risk for lung cancer if your ACE score is high than you are if you are a smoker. ACEs aren’t just a matter of psychology or emotion — they’re based in science, and knowledge of them can be a powerful tool for treating patients.
I’ve seen firsthand the serious and long-lasting effects of ACEs on women’s health, and now I realize that compassionate, trauma-informed treatment is a crucial skill for ob-gyns to learn so that we can not only effectively treat our patients but also avoid retraumatizing them without realizing it. Patients with ACEs are not just bringing themselves into our exam rooms — they’re bringing their experiences, too. By learning about ACEs, ob-gyns and their staff can treat patients with compassion and find real, effective solutions to issues that neither the ob-gyn nor the patient could solve otherwise. Start by watching this TED Talk: How childhood trauma affects health across a lifetime | Nadine Burke Harris and learn how to use ACEs when evaluating patient care options.
Flu season is upon us again! As we enter the time of year when many of us are at increased risk for sickness, it’s important for ob-gyns and providers to take stock of what we can do to protect ourselves, our patients, and our patients’ families. Now is the time to understand the importance of preventing and treating the flu and learn how best to treat your patients.
It’s always crucial that we protect our patients however possible — but during this time of year, it’s especially important that we protect our pregnant patients, who are at increased risk of severe disease, complications, and hospitalization related to the flu. Those risks are especially compounded for pregnant women with any underlying conditions. As ob-gyns, we’re in a unique position to help drive home the importance of flu vaccinations — and to provide crucial assessment and treatment when need be. In order to best serve our patients during this flu season, we need to be ready to address the issue of the flu from all angles.
So what can ob-gyns do to make sure we’re prepared to protect our patients?
Recommend — and, when feasible, offer — flu vaccination to all patients, particularly those who are pregnant. The flu vaccine is recommended for everyone six months and older.
Lead by example and get vaccinated ourselves
Encourage our colleagues and staff to get vaccinated
Be prepared to assess and treat pregnant patients who present to us with suspected or confirmed influenza
As providers, we’re responsible for not only doing our best to prevent the risk of contracting the flu but also recognizing flu symptoms, assessing their severity, and prescribing safe and effective antiviral therapy for pregnant women with the flu. With ACOG’s flu resources, providers can make sure they’re prepared to defend against the flu on all fronts. Protect women and their families this flu season by encouraging your patients and staff to get vaccinated against the flu and doing so yourself.
This summer, I had the opportunity to participate on a panel moderated by The Hill, a Washington, D.C., newspaper and website, where we addressed equity in maternal and infant health (watch a recording of the session). The session reminded me of how important it is for us as ob-gyns to consider social determinants of health when caring for our patients.
Social determinants of health are conditions in a person’s environment that can affect a wide range of health, functioning, and quality-of-life outcomes and risks. We may not think of social determinants as influential factors when it comes to health, but the environments in which our patients are born, live, work, and spend their time all impact their health outcomes. Availability of resources to meet daily needs such as safe housing and local food markets; access to educational, economic, and job opportunities; access to health care services; and social norms and attitudes such as discrimination, racism, and distrust of government — these are all determinants that affect conditions we see in our patients every day.
Social determinants also affect pregnancy outcomes. Disparities in maternal mortality and morbidity rates between women of different races, ages, geographic locations, and more can be linked to different social determinants of health. Because social determinants vary so widely, their effects manifest differently for different groups of women.
So why am I telling you all of this? As providers, we can benefit immensely from understanding how our patients’ environments affect their health and allowing that understanding to inform our practice. If we want to secure better health for all mothers, we must take social determinants as seriously as we would any other pre-, peri-, or postnatal condition. Once we understand how environments can affect health outcomes, we can treat our patients more holistically. We can not only address those influences but also help create and maintain healthy environments that promote better health outcomes. Read through ACOG’s Social Determinants of Health resource overview, which offers resources that may be helpful for you and your patients related to social determinants of health.