News & Updates

ModernHealthcare Source Article | Comments Courtesy of Matt Zavadsky

Interesting that there has been some movement on this issue – although it does appear there is still some discussions ongoing inside the beltway.

 

Some states already have this type of provision…

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Senate, House negotiators announce bipartisan surprise billing deal

December 08, 2019

 

https://www.modernhealthcare.com/politics-policy/senate-house-negotiators-announce-bipartisan-surprise-billing-deal

 

Three key lawmakers in the U.S. Senate and House of Representatives on Sunday announced a bipartisan deal on legislation to address surprise billing including an arbitration process, though one Democratic senator directly involved in the negotiations was not included in a press release announcing the deal.

 

Details remain sparse, but the lawmakers said they hope the legislation can be included in an end-of-the-year spending deal.

 

Senate health committee Chair Lamar Alexander (R-Tenn.), House Energy & Commerce Chair Frank Pallone (D-N.J.), and Energy & Commerce Ranking Republican Greg Walden (Ore.) announced the agreement.

 

Under the surprise billing provision, providers would be paid for out-of-network care based on a benchmark of the median in-network rate in the area. Providers could appeal some large claims to arbitration, but the threshold for arbitration and which factors an arbiter would be directed to weigh are still unclear. The legislation is similar to a bill that passed the House Energy & Commerce Committee in July. The bill outline was first reported by The New York Times.

 

Air ambulances are also included in the surprise billing provision. Moody's Investor Service warned in late November that the air ambulance industry's business model could be threatened if legislation similar to a provision in the Senate health committee's bill passed.

 

Sens. Bill Cassidy (R-La.), Maggie Hassan (D-N.H.) and Michael Bennet (D-Colo.), who advocated for a provider-friendly surprise billing fix, said they were glad a "simple arbitration safety valve" was included in the legislation, but indicated that discussions may be ongoing.

 

"As our discussions continue around the final details, we are encouraged that we're one step closer to giving patients these vital protections," Cassidy, Hassan and Bennet said in a statement.

 

Previously, hospitals have been mixed in their support of arbitration. The American Hospital Association testified before Congress in May that any legislation should have "baseball-style" arbitration and allow the request for arbitration with the provider or health insurer, not the patient.

 

Many important details of the legislation remain unclear, including the threshold for the arbitration process and whether payment benchmarks would be indexed to inflation.

 

The White House has signaled it would be open to supporting surprise billing legislation including an arbitration backstop.

 

However, Senate health committee Ranking Democrat Patty Murray (Wash.) was not included in a press release announcing the agreement. A spokesperson for Murray said she is still working with Democrats who have concerns about the legislation.

 

"She didn't want to sign onto a press release until those were worked through," the spokesperson said.

 

The Senate health committee's version of surprise billing legislation did not include an arbitration backstop, but the House Energy & Commerce bill did.

 

Pallone, Alexander and Walden said the surprise billing fix would save the government nearly $20 billion. The deal also includes five years of funding for community health centers, a bill that would increase the purchasing age for tobacco to 21, and measures to increase transparency and competition in the prescription drug market. The lawmakers did not specify whether reforms to hospital and insurer contracts were included in the deal.

 

It is unclear whether leadership is supportive of the deal.

 

Senate Majority Leader Mitch McConnell (R-Ky.) said he was glad to see progress on solutions to the teen vaping crisis, including his and Sen. Tim Kaine's (D-Va.) bill to raise the tobacco purchasing age, but did not take a position on the surprise billing provision.

 

"I look forward to reviewing the details on this and the other policies included in the package announced today," McConnell said in a statement.

 

A spokesperson for House Speaker Nancy Pelosi (D-Calif.) did not respond to an inquiry by press time.

An example of why accurate cost & revenue reporting is so important to the ambulance industry…  Many of the things highlighted in the MedPAC report could similarly be surmised by MedPAC about the ambulance industry…

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MedPAC says ambulatory surgical centers don't need a pay raise

MICHAEL BRADY 

December 05, 2019

https://www.modernhealthcare.com/medicare/medpac-says-ambulatory-surgical-centers-dont-need-pay-raise

The Medicare Payment Advisory Commission is expected to vote against a pay increase for ambulatory surgical centers next month because they don't provide cost data.

Medicare payments to ambulatory surgical centers are probably high enough, MedPAC's staff said at a meeting on Thursday. They found that beneficiaries have reliable access to care and that quality is improving. In addition, ambulatory surgical centers have plenty of access to capital and have experienced strong growth in Medicare revenue—it grew 7.4% from 2017 to 2018.

Those trends led several MedPAC members to conclude that there's no need to increase the conversion factor for ambulatory surgical centers. The conversion factor is a base payment amount that's used to calculate how much Medicare pays providers. It's currently scheduled to go up by 2.8% for 2021, but it doesn't appear necessary based on the findings.

"For the calendar year 2021, Congress should eliminate the update," said Dan Zabinski, a senior analyst for MedPAC.

Eliminating the increase would produce cost savings for Medicare without hurting access to care or the willingness of ambulatory surgical centers to deliver services to Medicare beneficiaries, according to MedPAC's staff.

But there's no way to know for sure how much money ambulatory surgical centers earn from Medicare services. That's because MedPAC's staff couldn't calculate profit margins for ambulatory surgical centers because they don't report cost data to the CMS.

"If you won't show us your cost reports, we won't show you an update," said David Grabowski, professor of health care policy at Harvard Medical School.

The commission can't recommend an update without access to the data they would need to make an informed decision, said Dr. Francis J. Crosson, MedPAC chairman and founder of the Permanente Federation.

Ambulatory surgical centers should be able to submit cost data because other small providers such as hospices already do it, according to Zabinski.

"We remain concerned that (ambulatory surgical centers) don't submit cost data, even though the commission has recommended doing so since 2009," said he said.

HHS Secretary Alex Azar has the authority to require ambulatory surgical centers to submit cost data to the CMS, but he hasn't exercised that power yet, Zabinksi said.

Some members of the commission were skeptical of the value of ambulatory surgical centers in the absence of data. Ambulatory surgical centers are often physician-owned. That could give them greater financial incentives to perform additional, unnecessary surgeries.

"I'm really struck that we do not know whether (ambulatory surgical centers) have been a good development or not," said Dana Safran, head of measurement for Haven. "Paying a lower price for something you don't need isn't a bargain.

AJC Source Article | Comments Courtesy of Matt Zavadsky

There is A LOT to unpack about this article. 

Yamil used to be a reporter in the MedStar service area, and she knows a fair amount about effective and quality EMS service delivery.  She, and the AJC, have been doing a series of articles about the Atlanta area EMS system.

Many of us in EMS have advocated for quality and performance measures that can be universally applied to EMS agencies and their providers.  Almost every study that has researched the impact of ambulance response times on patient outcome has demonstrated that any response time greater than 5 minutes has virtually no impact on patient outcomes (see references below).  And, only about 2% of EMS calls could benefit from a response time within 5 minutes (e.g. cardiac arrest).

Therefore, it is a logical presumption that response time is not a measure of clinical quality, but it may be a measure of patient experience (which should be measured separate from clinical quality).

This article seems to highlight the need for communities to develop, and hold EMS agencies accountable for, performance measures that truly matter, and represent a quality EMS system.

References:

Paramedic response time: does it affect patient survival?

https://www.ncbi.nlm.nih.gov/pubmed/15995089

Lack of association between prehospital response times and patient outcomes.

https://www.ncbi.nlm.nih.gov/pubmed/19731155

Emergency medical services advanced life support response times: lots of heat, little light.

https://www.ncbi.nlm.nih.gov/pubmed/11927458

Eight minutes or less: does the ambulance response time guideline impact trauma patient outcome?

https://www.ncbi.nlm.nih.gov/pubmed/12217471

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Proposal falls short of needed EMS reforms, critics say

State urged to require that life-threatening emergency calls be a priority

By Yamil Berard, The Atlanta Journal-Constitution

Nov 27, 2019

 

Some of Georgia’s most influential leaders in emergency medical services, as well as patient advocates, are pushing for more dramatic reforms to a state proposal affecting the hiring of ambulance providers.

 

The proposal, expected to take effect Dec. 9, is a first step to EMS reforms that are long overdue, said Bud Owens, chairman of an advisory committee of state EMS leaders that makes recommendations to the state.

 

But he and others also believe the revision is not enough to block potential abuse in the hiring of providers and to ensure the standard of care provided by emergency medical services. They say that the state needs to provide better oversight and develop standards to hold providers accountable.

 

The proposal is the state’s response to concerns by the groups that ambulance providers and their representatives have had undue influence on state regional EMS councils, leading to decisions that were not in the public interest.

 

Under its key provisions, the proposal will require the councils, which evaluate and hire EMS and ambulance providers, to conduct business in public, as stipulated by the Georgia Open Meetings laws. The revision also will require council members to disclose any potential conflicts of interest, and refrain from voting on contracts when those interests could compromise their decisions.

 

“I believe we all have to conduct our business appropriately to make sure we’re making decisions in the best interest of those we serve,” said Owens, who is also a county commissioner in Gordon County, in northwest Georgia. “If we can’t handle the business end of it, I don’t think we should be handling the patient care.”

 

Those changes won’t be enough, though, to ensure that those with life-threatening emergencies receive they care they need, other critics say.

 

Across the state, too often ambulances have been slow to arrive. Because of the delayed response or substandard care, some critically ill Georgians have died, said Elmer Stancil, an Atlanta-based attorney who represents the Georgia Ambulance Transparency Project, a group formed last year to push for reforms in EMS.

 

Those losses “illustrate the profound consequences and real human devastation when the state neglects its duty to ensure quality emergency medical care,’’ Stancil wrote in a Nov. 6 email to a lawmaker and state officials, which was obtained by the Atlanta Journal-Constitution under the Georgia Open Records Act.

 

“That’s really what’s at stake with this rule revision: the lives and welfare of real Georgians,” Stancil wrote.

 

In June, an AJC examination found that state has operated for years with vague standards and weak oversight. In most cases, the Georgia Department of Public Health, which oversees the state’s EMS system and ambulance providers, leaves it up to ambulance company officials to determine the quality of care provided by their medics and to investigate complaints.

 

It also leaves it to regional councils to recommend ambulance providers. But the department does not share with the councils, or the public, the reams of performance data it has on ambulance providers, based on detailed patient care reports and response time. As a result, many hiring decisions are the result of recommendations that have no substantive data to back them.

 

Even EMS leaders say they have tried for years to wrestle data from the state to no avail.

 

“I can’t review anybody if I don’t have the data as to what they’re doing,’’ said Courtney Terwilliger, EMS director in Emanuel County and a member of the state’s EMS advisory council. “The only people who have it is the state office of EMS, and they are notorious for not providing it.”

Continue Reading>

Pro Publica Source Article | Comments Courtesy of Matt Zavadsky

Very interesting article – tip of the hat to EMS legend and healthcare guru Donald Jones for making us aware of this article.

A little long, but an interesting read…

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This Doctors Group Is Owned by a Private Equity Firm and Repeatedly Sued the Poor Until We Called Them

After the Blackstone Group acquired one of the nation’s largest physician staffing firms in 2017, low-income patients faced far more aggressive debt collection lawsuits. They only stopped after ProPublica and MLK50 asked about it.

 

By Wendi C. Thomas, MLK50, with Maya Miller, Beena Raghavendran and Doris Burke, ProPublica

Nov. 27, 2019

https://www.propublica.org/article/this-doctors-group-is-owned-by-a-private-equity-firm-and-repeatedly-sued-the-poor-until-we-called-them

MEMPHIS, Tenn. — After nine visits to the emergency room at Baptist Memorial Hospital in 2016 and 2017, Jennifer Brooks began receiving bills from an entity she’d never heard of, Southeastern Emergency Physicians.

 

Unsure what the bills were for, Brooks, a stay-at-home mother, said she ignored them until they were sent to collections. She made payment arrangements, but when she was late, she said the collection agency demanded $500, which she didn’t have.

 

In December, Southeastern sued her for more than $8,500 in unpaid bills — a third of what her husband makes per year as a cook.

 

The case against Brooks is one of more than 4,800 lawsuits Southeastern has filed against patients in Shelby County General Sessions Court since 2017. In the first six months of this year, Southeastern filed more lawsuits than local hospitals Methodist Le Bonheur Healthcare, Baptist and Regional One combined.

 

Lawsuits against poor patients over unpaid medical debts have received widespread media attention over the past few years. In almost all cases, the plaintiff has been a hospital system, often a nonprofit.

 

What sets the practices of Southeastern, and its parent, TeamHealth, apart is that it is a physician staffing firm that contracts with the doctors who treat patients in four of Baptist’s emergency rooms around the region. Physicians historically have avoided suing patients en masse, instead choosing to send unpaid bills to collections or writing them off as bad debt.

 

TeamHealth is owned by the Blackstone Group, a private equity firm. In 2017, Blackstone acquired TeamHealth and its subsidiary Southeastern in a $6.1 billion deal. It was just one in a growing number of large private equity investments in health care in the last decade.

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Indy Channel Source Article | Comments Courtesy of Matt Zavadsky

An excellent example of EMS  (including community paramedics) partnering with innovative health systems in rural communities where medical care is becoming increasingly scarce.

EMS systems in rural America are being called upon to do more in these communities as the healthcare safety net provider. 

Kudos to the EMS folks in Crawfordsville and their healthcare partners for rising to the challenge to fill a gap!

 

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Maternity care deserts endanger mothers and babies in Indiana's rural communities

Nov 20, 2019

 

CRAWFORDSVILLE — Today is the day.

 

While nervous, you feel a sense of comfort, knowing you finally made it safely to and you're surrounded by doctors as you await your baby's arrival.

 

Some might say this is what an ideal delivery looks like. But for some women, who live in rural communities, this might not be their child-birth story. Rather, theirs is filled with anxiety and the possibility of what can go wrong.

 

It's hard because we have to drive clear to Lafayette," Ashley Newkark said.

 

Ashley and her husband Rodney, who live in Crawfordsville, are expecting twins.

 

"It's a good 45 minutes to the hospital that we will be delivering at," Rodney Newkark said. "And that goes the same for a real ultrasound. We have to go there 45 minutes, as well, to get the ultrasound tech."

 

For Katelyn Catterson, who lives just 30 minutes south, in Waveland, it's an even longer drive.

 

"It's an hour and 15 minutes away. I'm going to be in labor on our way to the hospital," Catterson said.

 

Both women have a high-risk pregnancy.

 

"I have pre-diabetes, but I think right now they're watching me to make sure that he doesn't develop gestational diabetes," Catterson said.

 

Both Newkark and Catterson live in Montgomery County, one of the worst counties in the state with access to care. The only hospital there quit delivering babies back in 2011. The nearest OB/GYN to Newkark and Catterson is based in Lafayette in Tippecanoe County.

 

That's where they'll have to travel to deliver their babies.

 

"The ambulances were delivering babies tenfold from where we were when we delivered here," Darren Forman, a community paramedic, said. "When you're living on an income that is not substantial and you have to make a decision between spending your gas money to go to the grocery store or going to an OB appointment, that's a decision."

 

Call 6 Investigates found 33 out of Indiana's 92 counties either have no hospitals or the hospital has no OB services where women can receive medical care before and after pregnancy. Meaning women in more than a 1/3 of our state are living in "maternity deserts."

 

"The OB units are decreasing, the numbers of hospitals that actually provide OB care are decreasing, and then the acuity of our patients is going up. So it's like this perfect storm of worsening, more acute patients with less resources," Lori Hardie, a simulation manager at Franciscan Health, said.

 

Experts say we find ourselves in a statewide crisis. Where Indiana's maternal mortality rate is the third highest in the nation and our state's infant mortality rate is the seventh highest.

 

Getting adequate prenatal care is critical in preventing death.

 

"It is difficult to get good quality providers that want to come here and stay here and be involved in the community and really make a difference," Dr. Joshua Krumenacker said.

 

So why are hospitals closing their doors? Turns out, it all comes down to money.

 

"NICUs are very expensive to staff if you can find enough staff for them, so you have a shortage of neonatologists and the facility is excruciatingly expensive," Forman said.

 

People are coming up with their own solutions, though. Forman decided, if women can't get the care they need, he's going to bring it to them.

 

Forman leads Project Swaddle in Crawfordsville, where every week he drives to patients in rural areas and sees them at their home, at no cost to the families.

 

And it's not just Forman.

 

Franciscan Health nurses based in Indianapolis have created their own training program for when things go wrong and you're an hour away from the nearest hospital.

 

Training paramedics in rural communities, using a breathing, high-tech mannequin to simulate real-life emergencies they'd experience in transit.

"With a pregnant mom, she could deliver in the truck for them, she could have bleeding. I mean there's just all kinds of stuff that they've got to be prepared to manage," Hardie said.

For the people trying to make a difference in these communities, the gaping hole in services for women across the state is not something to sit around and wait to change.

 

 

"This is not a problem that's going to go away," Forman said.

CBS News source | Comments courtesy of Matt Zavadsky

Kudos to Paramedic Ivan of Allina EMS for this innovative idea!

Beckers Source Article | Comments Courtesy of Matt Zavadsky

A couple of years back, a friend of mine who was the CEO of a very well respected EMS agency shared this story – he hired a “Black Hat” to penetration test his agency against cyber-attacks. 

The Black Hat was supposed to start on a Monday morning, but the Black Hat walked into the CEO’s office on the preceding Friday about, placed a thumb drive on the CEO’s desk and said, this jump drive contains the names, dates of birth, driver’s license and social security number of about 400 of your patients from this month.

The CEO was astounded and asked how the Black Hat hacked into the system so quickly, to which the Black Hat replied, ‘through the front door…  10 minutes ago I walked up to the receptionist – told her I was here to see you, she buzzed me in, I found an empty cubicle in billing with the computer locked, I ‘unlocked’ it, found your billing application, and downloaded your claims for the last 3 days – want me to start today, as long as I’m here?’

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Stolen flash drive leaves U of Rochester Medical Center with $3M HIPAA settlement

Mackenzie Garrity

11/6/19

 

The University of Rochester (N.Y.) Medical Center has agreed to pay $3 million to HHS' Office for Civil Rights to settle potential HIPAA violations, according to a Nov. 5 news release.

In 2013 URMC filed a data breach report with the OCR stating that an unencrypted flash drive had been stolen. Following the notice that patients' protected health information could have been exposed, the OCR offered technical assistance to URMC.

Then in 2017, URMC disclosed that an unencrypted laptop had been stolen. An OCR investigation found URMC failed to conduct enterprise-wide risk analysis, implement security measures sufficient to reduce risk and vulnerabilities to a reasonable and appropriate level, utilize device and media controls, and employ a mechanism to encrypt and decrypt electronic protected health information.

"Because theft and loss are constant threats, failing to encrypt mobile devices needlessly puts patient health information at risk," said Roger Severino, OCR director. "When covered entities are warned of their deficiencies, but fail to fix the problem, they will be held fully responsible."

Along with paying the $3 million settlement, URMC will also undergo a corrective action plan, including two years of HIPAA-compliance monitoring.

JEMS Source Article by Cindy Green of REMSA

Facing the threat of a disaster or managing the aftermath of such an incident, either natural or manmade, can be tragic. Natural disasters can be prepared for, but ultimately the outcome of such disasters can leave a community without their main lifelines (water/food, shelter and healthcare). Besides the financial burden of restoring order and structure to a community, immediate needs of the public safety and healthcare infrastructure are often times taxing to both local agencies and mutual aid responders alike. Additionally, the communication between government and non-government agencies, as well as local and national responders, directly relates to the success of mitigation efforts. Effective emergency preparedness plans should cross multiple disciplines and outline response efforts from the start of the incident, until the region is back to a steady state.

Continue Reading in JEMS>

DHealthcare Source Article | Comments Courtesy of Matt Zavadsky

Will Maddox from DHealthcare does an excellent job profiling MedStar’s MIH programs in his article.  Although MedStar was one of the first, EMS agencies across the country are now doing similar programs, with similar results.

This IS EMS’ new value proposition in the transforming value-based healthcare environment!

To learn more about MedStar’s programs, and the EMS Transformation, click the links below:

http://www.medstar911.org/mobile-healthcare-programs

http://www.naemt.org/initiatives/ems-transformation

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How MedStar Saved $25 Million by Avoiding Unnecessary Emergency Services

10/31/2019| by Will Maddox

These days, every aspect of the medical industry is looking to find cost savings, and 9-1-1 service is part of that movement as well. MedStar Mobile Healthcare, a North Texas organization that provides emergency services, has avoided over $25 million in medical costs for residents and payers over the past seven years.

 

The emergency department is one of the most expensive pieces of the medical industry, especially when it is full of problems that don’t belong in an emergency room. And when emergency physicians are operating out-of-network at in-network hospitals, surprise bills are end up with those who thought they were making the responsible decision in a time of emergency. These bills have made headlines and inspired legislation to fight them in past years. Emergency service providers can play an outsized role in avoiding these costs by treating problems upstream and diverting patients from expensive and often unnecessary services.

 

Created in 1986 to serve the Fort Worth area, MedStar is a public authority that provides emergency services, and the organization is governed by an appointed board from the fifteen cities the organization serves in North Texas. But despite the public governance, MedStar is not funded by tax dollars, and receives all of its funding through healthcare payers, just like other medical providers.

 

Because they are only paid when their services are necessary and only at set rates, they are forced to look for efficiencies where they can, and avoid services that won’t be reimbursed. The entity sees itself as a key player in avoiding unnecessary medical costs, which often occur in the emergency room. “We believe that we should have always been part of the solution,” says MedStar Executive Director Doug Hooten.

 

Patients known as high utilizers, who sometimes call 9-1-1 up to 20 times a month, are part of the problem, and MedStar has created initiatives to make sure that only emergencies receive ambulance rides to the emergency room.

 

For some people, navigating where to go with what problem can be daunting, and 9-1-1 offers a simple way to ensure that medical treatment will be received, but it isn’t efficient. MedStar created curriculum to train its staff to recognize whether an emergency transport or emergency room is necessary, and providers also look at medications to make sure several different doctors haven’t prescribed the same medication. The program also looks at social determinants of health to see if housing, food, transportation or other needs can improve conditions in a more appropriate and cost-effective way than calling an ambulance with every issue.

 

Continue Reading>

Modern Healthcare Source Article | Comments Courtesy of Matt Zavadsky

Continued disruptive innovation in healthcare – even mobile healthcare.  Note the Lyft and Uber integration into healthcare system’s EHRs – this is something EMS computer aided dispatch developers should take note of – one future path for EMS is for 9-1-1 centers to implement Nurse Triage programs similar to the programs here at MedStar, Las Vegas, D.C., Niagara and Memphis.  Planned CMS ET3 funding for dispatch centers to implement medical triage systems designed to reduce ambulance responses could potentially accelerate this process.  Ride share options to alternate destinations are a good alternative for low/no acuity 9-1-1 callers.

Also note Lyft and Uber’s shift to addressing social determinants of health – food delivery and free rides to healthy grocery options for people in food deserts.  Could be a good partnership with EMS-based MIH programs looking for those options for enrolled patients.

Lyft, Uber expand reach into healthcare

JESSICA KIM COHEN 

October 28, 2019

The nation's two ride-sharing giants are continuing their push into healthcare, announcing major expansions of their work within days of one another.

Uber on Monday announced its healthcare arm plans to integrate an app into Cerner Corp.'s electronic health record system, which would allow caregivers to schedule rides for patients. Lyft last week said it is now providing covered rides for eligible Medicaid beneficiaries in Georgia, Michigan, Missouri, Tennessee and Virginia.

Healthcare is a massive opportunity for on-demand transportation companies like Lyft and Uber, according to analysts, and the companies—despite two very different announcements this week—are largely tackling the industry with similar strategies, beginning with a focus on providing patients with free or affordable rides to non-emergency medical appointments.

Lyft last year unveiled a collaboration with EHR vendor Allscripts. Uber is also offering rides to Medicaid beneficiaries in some states, including Arizona. Lyft has been working with LogistiCare, and Uber with American Logistics—two companies that manage patient transportation to medical appointments for providers and payers.

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