SCGhealth Blog


Know the Signs of Physician Burnout

Wednesday, May 09, 2018

By Audrey Landers

During Mental Health month it’s important to think not only of your patients but also yourself. According to Medscape’s 2018 National Physician Burnout & Depression Report, as many as 42% of physicians feel that they are burned out. So often articles on this subject will focus on how burnout affects patient care and practice revenue, anything but the one person it affects the most: the physician.

No one wants to admit that they are under too much stress, physicians especially are often nervous about seeking help because they are afraid that it may reflect poorly on their ability to provide for patients. Because of this, it’s not uncommon for physician burnout to become worse over time. If ignored, physician burnout can be fatal. In fact, the average physician will lose eight colleagues to suicide during their career.

High occurrences of burnout have been recorded in physicians since the 1800s and it’s pretty clear why: Between the grueling hours and stress filled working environments, many physicians don’t have the opportunity to put their work behind them even for a moment.

What is Physician Burnout?
Physician burnout, sometimes called career fatigue, is exhaustion that is caused by extreme prolonged stress. It can penetrate every part of your life, causing physical, emotional and mental exhaustion. It can cause a physician to become depressed and lose all sense of personal accomplishment as well as make it difficult to focus on work.

Recognizing Burnout
Knowing that you are burnt out and need help is the first step. Take the time this month, and every month, to recognize the signs of burnout:

You feel that you are not as engaged with your peers as you once were.
While not many physicians will admit they aren’t as engaged with patients, in Medscape’s survey 42% of physicians with some form of depression acknowledged that they are less engaged with staff and colleagues. You may miss details of what they say, or respond late. You may also be more irritable around them and get frustrated more easily when they make mistakes. 

You don’t have time for yourself
On average, physicians work nearly 60 hours a week, a number that most Americans would find completely unacceptable in the long-term. Once you factor in things like average daily commute (one hour) average time spend cleaning and cooking each day (two hours) and eight hours for sleep, there’s only about four hours of free time left each day. And four hours might sound great until you get around to dividing them up between interactions with friends and family, obligations like pet care, and incidentals like being stuck on the highway an extra 30 minutes because of an accident a few miles down the road. You might begin to realize that you don’t actually have as much time for yourself as you thought.

You don’t have enough time for your patients
More than 50% of physicians agree that their work is often bogged down with bureaucratic tasks, regulations, and increased computerization of their workplace. These tasks don’t feel important when you have patients you need to see and every paper, every chart, and every button click only gets in the way of you doing your job.

You could describe yourself as depressed
This may seem obvious but that makes it no less true. Whether you feel you could be clinically depressed or only depressed in the colloquial sense, this feeling is a sign of burnout. Especially if you feel the depression is mainly caused by work and would go away if you were to enter another career.

If you feel that these signs describe you, you are not alone. Over half a million physicians in the US alone suffer from some form of burnout.



Screen for Depression During Mental Health Awareness Month

Wednesday, May 02, 2018

By Audrey Landers

Depression is an often misunderstood and underestimated mental illness. Many consider it to be a simple sadness that can be powered through, but that could not be further from the truth. Sadness is a normal human emotion, and one that can often help to make a person stronger by learning to deal with it. It is caused by difficult, upsetting and hurtful events. With sadness, there is a resolution to work towards or a lesson to learn that can help one overcome it. Depression is another beast entirely. Depression is not triggered by any particular event and causes those who suffer from it to feel worthless, hopeless, and unmotivated in every situation. Depression can change a person’s personality, make them have thoughts of death or suicide and make them lose interest in things they once loved. Unlike sadness, depression is long-lasting, with symptoms lasting more than two weeks and occurring chronically.

It is estimated that more than 300 million people worldwide suffer from depression, with approximately 16 million American adults having suffered at least one depressive episode in the last year. 

Screen for Depression and Report MIPS Measures
Throughout the year you can do your part to bring awareness to depression by screening for it, which coincidentally will allow you to report the Merit-based Incentive Payment System (MIPS) Measure 134: Preventive Care and Screenings: Screening for Depression and Follow-up Plan. The measure should be reported at least once for each patient age 12 and older seen during the performance period. If the screening is positive, there must be a documented follow-up.

The accepted exceptions for this measure are patient refusal, an urgent situation, and decreased functional capacity seen in the patient.

Quality Data Code  Performance  Service Provided 
 G8431  Performance Met

Screening for depression is documented as positive
AND
a follow-up plan is documented

 G8510  Performance Met
Screening for depression is documented as negative

 G8433  Denominator Exception

Screening for depression not completed
AND
reason documented

 G8432  Performance Not Met
Depression screening not documented

 G8511  Performance Not Met

Screening for depression is documented as positive
AND
no reason documented


In addition to this MIPS measure, SCG Health has also licensed the Qualified Clinical Data Registery (QCDR) Measure MSSIC1: Pre-Surgical Screening for Depression. This measure, created by the Michigan Spine Surgery Improvement Collaborative, is similar to MIPS 134 but is only performed before a surgical procedure.

May is National Mental Health Awareness Month. Mental Health America first started the awareness campaign in 1948, this year the theme is Fitness #4Mind4Body. MHA hopes this theme will help bring awareness to the connection between mental health and fitness. The organization will be distributing information on topics like nutrition, exercise and sleep throughout the month to encourage people across the country to do what they can to better both their physical and mental health.


Balancing Environmentalism and Hygiene in Your Bathroom.

Monday, April 30, 2018

By Audrey Landers

Sometimes, keeping clean is dirty business. Walk into just about any public bathroom and you’re likely to find at least one industrial sized trash bin filled with hundreds of paper towels. Maybe there will also be a few ancient air-dryers ineffectively blowing lukewarm air. After you wash your hands you’ll try the air-dryer (it’s more hygienic, right?) but you’ll probably just end up grabbing three or four too-thin paper towels anyway, as one study found that air-dryers are woefully slow and inefficient at getting rid of excess water. There’s more than one problem with this picture.

Image from pexels.com

Let’s tackle the myth that air-dryers are the more hygienic option first. Recently, a study published in the Journal of Applied and Environmental Microbiology found that air-dryers actually spread bacteria. “Well sure,” you might think, “not everyone is as diligent at washing as I am.” But I’m afraid that’s wrong too. Air-dryers don’t only spread the bacteria left on your hands after washing, they also spread all the other nasty bacteria in the bathroom. This is not the first study to suggest this. In 2015 a similar study was performed by a team of microbiologists from the University of Westminster and they found that air-dryers can blow bacteria up to three feet off the ground.

The University of Westminster study concluded that paper towels were the most hygienic way to dry your hands, though they aren’t as environmentally conscious. If you’re looking to keep your office green, then air-dryers are still the way to go. But let’s be honest here, if you’re already willing to ignore how unhygienic an air-dryer is, you may as well throw caution to the wind and wipe your hands on your pants rather than waste electricity. You can be a bit more environmentally conscious by using recycled paper towels, the production of which uses 31% less energy than the production of virgin paper towels. With recycled paper towels however, you could be sacrificing hygiene. Research has suggested that bacteria can thrive in recycled paper towels because of the starches that are used as binding.

If, like SCG Health, you work in a small office with few visitors or if you have a staff-only restroom, there is another option that may work for you. Using non-disposable hand towels is a way to keep your hand-drying hygienic and green. We keep a basket of small hand towels that are used once. At the end of the day we collect the basket of used towels and wash them. The cloth towels dry your hand quickly and effectively and allow SCG Health to cut down on unnecessary paper waste. It is important to have multiple towels, because having only one towel that is used over and over throughout the day can allow bacteria to collect

Which option is right for you?

Unfortunately, you’ll have to answer that for yourself. However, I can give you a few suggestions:

  • For small offices: reusable cloth towels are effective, clean, and can add a little bit of luxury to your office.

  • For large offices: opt for paper towels, you might feel bad about the waste, but don’t worry. It only takes about two weeks for a paper towel to decompose.

  • In emergencies: if you have absolutely no other options, then fine, dry your hands on your pants. Just don’t try to shake hands with me after.


Alcohol Awareness and Screening with MIPS Measure 431

Wednesday, April 18, 2018

By Audrey Landers

According to the Centers for Disease Control and Prevention (CDC) one in 10 deaths among adults is related to excessive drinking. With April being Alcohol Awareness Month, this is the perfect time to pay special attention to the Merit-Based Incentive Payment System (MIPS) Measure 431- Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling

While unhealthy alcohol use can have long-term risks such as certain cancers, the short-term risks are far more pressing. It’s common knowledge that drinking impairs your judgement, reaction time and motor skills and can lead to injuries, accidents and violence even in those who do not drink regularly. These issues are only made worse in an alcoholic who will experience the effects of alcohol far more often than the average person, and may be less likely to notice them.

MIPS Measure 431
On average, those who die alcohol-related deaths have their lifespan shortened by 30 years, and by screening for alcohol abuse you may be able to help keep some patients from losing such a large portion of their lives.

MIPS Measure 431 is defined as the percentage of adult patients who were screened for unhealthy alcohol use using a systematic method at least once within a two-year period and received counseling if identified as an unhealthy alcohol user.

The counseling for those who are identified as unhealthy alcohol users can be short, with the minimum requirement being a 5-15 minute conversation including topics like how to identify high-risk situations for drinking, proper coping mechanisms, and strategies for reducing alcohol consumption. 

You will be required to score at least 97.08% in order to get 9 points when reporting this measure for 2018.

Quality
Data
Code
 
Performance  Service Provided 
 G9621  Performance Met
Patient identified as an unhealthy alcohol user when screened for
unhealthy alcohol use using a systematic screening method
AND
received brief counseling

 G9622  Performance Met
Patient not identified as an unhealthy alcohol user when screened for
unhealthy alcohol use using a systematic screening method

 G9623  Exception

Documentation of medical reason(s) for not screening
for unhealthy alcohol use

 G9624  Performance Not Met

Patient not screened for unhealthy alcohol screening using a systematic screening method 
OR 
patient did not receive brief counseling, reason not given


This year the National Council on Alcoholism and Drug Dependence (NCADD), the organization who created Alcohol Awareness Month, has chosen the theme “Changing Attitudes: It’s Not a Rite of Passage.” The intention is to start a conversation about how teenagers and young adults are first introduced to alcohol, and challenge the flippant attitudes surrounding it.


Questions Your Patients Might Not Know They Need to Ask

Monday, April 09, 2018

By: Audrey Landers

A reader from ConsumerSafety.org let us know this interesting fact: 55% of Americans (almost 178 million people!) regularly take at least one prescription. Unfortunately, we know that low health literacy can keep patients from fully understanding their prescriptions. Not only does health illiteracy cause problems in understanding, but it also affects the ability to recognize what information may not be distributed during an appointment. As SCG Health’s founder, Jen Searfoss, likes to say “you don’t know what you don’t know,” meaning that sometimes patients might not know what they need to ask you when given the opportunity.

Image from Pexels.com

Fortunately they have you: a physician who is ready to go above and beyond by thinking ahead and trying to answer every question before they have it. Here are a few questions these patients might have, if they only knew to ask them:

Why am I being prescribed this medicine?
This question may seem like it doesn’t even need to be asked, after all it’s being prescribed for their high blood pressure, or their arthritis, or the flu that they made their appointment for! But some conditions may require a patient to take many different medications, each of which helps with a different aspect of their ailment. Taking the time to explain what each medication does may keep your patients from feeling that certain prescriptions are useless or unnecessary

How and when will I know if the is medication working? What do I do if I think it isn’t?
Patients sometimes expect magical results from their prescriptions. When you prescribe something new, it’s important to emphasize what the medication will do for them. With some medications, the effect will be noticeable, through easing pain, getting rid of stiffness, or helping to clear up an infection. With others, like for high blood pressure or diabetes, the effects may not be noticeable at all unless there are specific signs they know to look for. Let them know of any subtle signs that show their medication is working. If they believe it isn’t working for them, they may stop taking it or even adjust their dosage on their own so be sure to tell them that even if they feel the medicine is not doing anything, they have to speak to a doctor before they change anything.

What if I miss a dose?
Any missed doses will lower the effectiveness of the medication but each medicine will have different steps that must be taken. Should the patient take a dose as soon as they remember? Or do they double-up on their next scheduled dose? Are there potentially dangerous consequences that come from missing a dose? This information is particularly important if a patient has a history of medication noncompliance.

How do I store the medication?
Will a certain medication become less effective if stored in a humid bathroom medicine cabinet? What medicines need to be kept cool in the fridge? People tend to keep all of their medicine in one area so if a prescription has special storage instructions, the patient needs to know before they pick it up.

What do I avoid while taking this medication?
Medications can have all sorts of unpleasant reactions to things that the average consumer would not expect. While many people will avoid alcohol, physical labor, and heavy machinery depending on the medication, other things they need to avoid are not so obvious. A patient will need to know if their prescription will negatively interact with any over-the-counter medications they might use as well as any supplements. Many people think that anything labeled herbal or natural is automatically healthy, and may not take as much caution as they would with cough medicine or ibuprofen.


The Obesity Epidemic and the Issues that Surround It

Wednesday, March 07, 2018

By Makalla Phelps, Intern

We’ve written briefly about obesity in our blog post about MIPS Measure #128, but the condition is more complex than the simple issue of needing to lose weight. Obesity is at the forefront of diseases plaguing The United States. Over a third of Americans suffer from obesity. Due to this high rate, the life-expectancy of obese individuals has dropped to a short 40 years. Even more concerning is the potential for obesity to become a world-wide epidemic. By 2030, it is estimated that almost half of the world’s population will be considered obese if this trend continues. The need for a change is imminent. 

An individual with a Body Mass Index (BMI) of 30 or higher is considered obese. This seemingly arbitrary number is wreaking havoc on the individuals who fall into this category. In addition to decreased quality of life, obesity can cause or exacerbate many serious and difficult to treat ailments including:

  • Poor mental health (such as depression)
  • Hypertension
  • Osteoarthritis
  • Diabetes
  • Some cancers

These ailments are not only costing the individual, but physicians and society as well. Individuals with a body mass index greater than 35 represent only 37% of the obese population but are responsible for 61% of all excess medical costs. This accumulates to approximately $147 billion annually. The Medicare prescription drug cost of this expense is $7 billion dollars alone. Moreover, the cost of the value of lost productivity in the workplace due to obesity comes in at a massive $73.1 billion annually. An individual with a healthy weight and is physically active costs roughly $1,019, annually. The culmination of medical expenses of obese patients amounts to around $1,429 more per individual. Studies suggest that if there were an increase in physical activity among the 88 million inactive adults in America, there would be a $76.6 billion decrease in medical costs. 

There are many different factors that contribute to an individual becoming obese. The most common cause of obesity is an individual’s behavior. These behaviors include dietary patterns, physical activity (or more likely lack thereof), social aspects, and medication use. A very common excuse that obese patients use is that their ailments are caused by genetics. However it is usually a learned behavior from an individual’s parents. In most cases, an individual may have a genetic predisposition to a certain weight range or an increased risk for diabetes, but it is the individual’s lifestyle habits that will truly determine their fate. Interestingly, the popular personal genomics and biotechnology company, 23andMe, has launched a massive study into the genetic basis of weight loss and obesity. The company hopes to provide their clients with information on how to maintain and/or lose weight based on their genome sequence in the future. Another common social factor contributing to the continuation of obesity can be found in the various body positivity movements that have gained popularity. These social movements began with the message to improve an individual’s self-image. However, what was once something positive turned dangerous when individuals began interpreting the movement as a means of condoning unhealthy behaviors and weights.

Obesity is extremely difficult to treat. Even if social and emotional factors were to be removed, the availability of cheap high-calorie foods and an absence of any obligatory need for exercise has resulted in obesity being very difficult to reverse. Thus, it is important that physicians stress the importance of prevention to their patients when possible. Because obesity is such a complex issue, even the most receptive patients may be easily discouraged when trying to change their lifestyle. Most physicians will find they have to try multiple approaches before something clicks with each individual patient.



MIPS Measure #236- Controlling High Blood Pressure

Monday, February 05, 2018

By Audrey Landers

High blood pressure contributes to nearly 1,000 deaths in America every day. This major health risk contributes heavily to heart attacks, strokes, heart failure and kidney disease. High blood pressure has almost no noticeable symptoms, which is why it is important for patients to get screened often. 

But what about once they are screened and first learn they have high blood pressure? The number one priority is to control it. Less than half of people with high blood pressure have it under control, but if they can manage it then their risk of stroke, heart disease, and even death can go down significantly.

When helping a patient control their blood pressure, you also have the opportunity to report the Merit-Based Incentive Payment System (MIPS) measure #236: Controlling High Blood Pressure.

MIPS measure #236 is a high-priority outcomes measure, meaning you can get bonus points for reporting it. The measure is defined as the percentage of patients between the ages of 18-85 whose high blood pressure was controlled during the measurement period. It should be reported at least once during the 12 month performance period for patients with high blood pressure.

It is important to note that only blood pressure reading taken by a clinician in your office will be accepted. You may not use patient reported readings, readings taken for diagnostic testing purposes, or readings taken the same day as a major surgical procedure. If you do not record a blood pressure reading then it will be assumed that the patient’s blood pressure is not under control.

This measure has a very high benchmark, requiring a minimum of 91.07% to get ten points when reporting through a QCDR.

Quality Data Code  Performance  Service Provided 
G8752
Performance Met 

Most recent systolic blood pressure
<140 mmHG 

G8753

AND

G8754
    Performance Not Met    
 
AND

Performance Met

Most recent systolic blood pressure
≥140 mmHg

AND

Most recent diastolic blood pressure
<90 mmHg 

G8755 Performance Not Met 

Most recent diastolic blood pressure 
≥90 mmHg 

G8756 Performance Not Met

   
   No documentation of blood pressure measurement    
no reason given 


For more information, you can view the entire measure here. This measure can also be reported through electronic clinical quality measures (eCQM) using CMS measure CMS165v5.


What You Can do to Go Red for Women

Wednesday, January 24, 2018

By Audrey Landers

It’s a long-standing myth that cardiovascular disease is an illness affecting only old men. In reality, approximately one in four women will die from heart disease. To combat this myth and spread awareness of heart health in women, the American Heart Association (AHA) started the “Go Red For Women” campaign in 2004. Wear Red Day takes place on the first Friday in February, meaning that this year it will take place on February 2, 2018. Here’s what you can do to participate in the campaign:

Raise Awareness in Your Practice
Physicians should already know the symptoms of a heart attack, but that doesn’t mean your patients will. Teach your at-risk female patients what they may experience when having a heart attack. It’s important that they know the typical “Hollywood Heart Attack” they see on TV may not be what they experience. While both men and women can experience the tell-tale chest pains, women are slightly more likely to experience jaw pain, nausea and shortness of breath. In fact, more than 70% of women reported having flu-like symptoms in the weeks leading up to a heart attack presenting with chest pain.

Help your patients create a plan for what to do if they have a heart attack. You can include the signs of a heart attack, instructions for what to do, and the address and phone numbers of nearby hospitals with heart surgery centers, as well as any specialists you recommend. By educating your patients, you are putting them in the best possible position to survive.

Donate
The AHA uses funds raised from Go Red for Women activities to support awareness, research and education programs. Since 2004, more than $60 million has been raised. There are a few different ways you can contribute to this growing number, the first being through a donation to the Go Red For Women fund. You can give either a one-time donation or a monthly gift. You can also create a FUNraiser for larger donations. If you prefer to shop instead of donate, AHA has plenty of Go Red merchandise, from apparel to office supplies.

Show Your Support
The most obvious way to support Go Red For Women is to, well, wear red on Wear Red Day. You can purchase pins and shirts at AHA’s store, wear your own clothes or even buy something new (Macy’s is a sponsor this year). While you and your office are decked out in red, be sure to post a picture to you social media accounts and use the hashtags #goredforwomen and #WearRedDay!


Health Literacy -Do Your Patients Understand You?

Wednesday, January 10, 2018

By Audrey Landers

Health literacy is the combination of basic reading and numerical skills that enables someone to understand the health information and services needed for healthy decision making. 

99% of adults in the United States are literate, while only 12% are considered to be proficiently health literate with 14% being considered below basic. What causes this enormous gap? One cause is that the reading level which is required to considered to be literate and health literate are vastly different. In order to be literate a person must be able to read at some level, with no qualifying benchmark for how well they must be able to do so.

The majority of adults read at an eight grade level, with 20% reading at a fifth grade level or below. Meanwhile, most medical documents are written at a tenth grade level. This difference means that even well-educated adults can have difficulty comprehending healthcare and reality is even more grim for those who only have basic literacy skills. 

Those who suffer the most from low health literacy are often those with other disadvantages. Elderly patients who may have trouble with their memory or with understanding new concepts, non-native English speakers and those from low-income families are most vulnerable to the problems that low health literacy creates. Those who are health illiterate are more likely to have difficulty understanding (and taking) medications, less likely to participate in activities that promote wellness and are hospitalized more often.

What can you do to help?

While increasing health literacy may seem like David vs Goliath to most physicians, there are a few things you can do in your own practice to help give patients the opportunity to understand more about their health.

First, by learning how to identify those who may have extremely low health literacy, you can personalize the care you give them to their needs. Here are a few signs to look for:

  • The patient needs help to fill out forms
  • The patient puts off decision making and instruction reading
  • The patient is a chronic no-show
  • The patient has difficulty complying with medication and recommended lifestyle changes

Be aware of your language. Health literacy also refers to a patient’s ability to understand spoken language in medical settings. To make yourself understood in the exam room you should be aware that some words can have very different meanings and implications in “medicalese” verses common English. One example is the word “diet” which to a physician may just mean what food someone eats but to a patient it means going on a diet like atkins or paleo.

Be specific. How many times have you told a patient to “come back if you get worse?” What does “get worse” mean exactly? This question is disastrous when combined with a new prescription that could have side effects that would confuse a patient. Instead, give patients specific symptoms and signs to look for whenever possible.

Use the “teach back” method. After giving a patient instructions on how to perform a task or take medication, instead of asking if they understood you, ask them to explain it back to you. By using this method, you can gauge what the patient understands and will know what exactly they have trouble with if they aren’t getting something.

Make it easy. One common piece of advice for educating patients is to give them a printed handout with the information and instructions they need on it. As mentioned above, most healthcare documents are written at a tenth grade level, meaning that even if you give your patient information to take home they may not be able to fully understand it. To combat this, it is recommended that any patient education material should be written at the sixth grade level or lower. You should also include easy-to-understand pictures and graphics when possible. The US National Library of Medicine has a great guide for writing easy-to-read heath materials.

To give you a general idea of what grade-level writing looks like, I put this blog post through a readability checker and found that it is written at about the eleventh grade level.


MIPS Measure#128- Help Your Patients Achieve Their New Year’s Resolutions

Wednesday, January 03, 2018

By Audrey Landers

Every Year in January people make New Year’s resolutions and every year the goal at the top of everyone’s list is to lose weight (It may even be your own resolution, I know it’s mine). It’s so common that this year media outlets have made a point of publishing lists of resolutions that have nothing to do with weight loss! The only thing more predictable than having weight loss as your New Year’s resolution is not sticking to it and forgetting about it by February, only for the whole cycle to start over again the next time you change calendars.

Photo from Pexels.com

Obesity is a national epidemic, and while no one wants to be told they have to lose weight, patients may be more receptive to your help during this time of the year. If you aren’t already, it’s also the perfect time to be reporting Merit-based Incentive Payment system (MIPS) measure #128: Preventive Care Screening- Body Mass Index (BMI) Screening and Follow-Up Plan.

MIPS measure #128 is the percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous six months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the current encounter. Those with a higher than normal BMI and those with a lower than normal BMI would both be considered outside of normal parameters. You can get 9 points for this measure by reporting 50-68.89%.

This measure does allow for exceptions, which can include elderly patients for whom weight change would complicate other health conditions or patients in an urgent medical situation where treatment cannot be delayed.

 

Quality
Data
Code
 
Performance  Service Provided 
 G8420 Performance Met 

BMI is documented within normal parameters 
and 
no follow-up plan is required 

 G8417 Performance Met

BMI is documented above normal parameters 
and
a follow-up plan is documented 

 G8418 Performance Met 

BMI is documented below normal parameters 
and 
a follow-up plan is documented 

 G9716 Exception 

BMI is documented as being outside of normal limits
and
a follow-up plan is not completed for documented reasons
 
 G8421 Performance Not Met 

BMI not documented 
and 
no reason is given
 
 G8419 Performance Not Met 

BMI documented outside of normal parameters 
and
no follow-up plan is documented, no reason given 


For more information, you can view the entire measure here. This measure can also be reported through electronic clinical quality measures (eCQM) using CMS measure CMS69v5.





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