Archive for Advocacy

An Update on Alabama’s Certificate of Need Program

An Update on Alabama’s Certificate of Need Program

Over the past few months, we have seen some changes and movement when it comes to the certificate of need (“CON”) program in the State of Alabama.

In February, Emily Marsal was appointed as the new Executive Director of the State Health Planning and Development Agency (“SHPDA”), the state agency overseeing the CON program. Emily comes to SHPDA after serving with the Alabama Department of Senior Services.

In addition, we have seen movement towards revising the State Health Plan (“SHP”). The State Health Coordinating Council (“SHCC”) is the regulatory body consisting of both providers and consumers that oversees the SHP. The SHP is used to help determine the need for certain services within the state based on a variety of factors, including data collected by SHPDA. To be approved, a CON application must be consistent with the SHP. Thus, if the SHP does not show a need for a particular service, a CON application for that service cannot be granted. If the SHP shows a need for a particular service, a CON application for that service must be consistent with the need shown in the SHP.

The SHCC is currently in the process of updating several sections of the SHP. For some services (e.g., SCALF beds), once revised, it is anticipated that the SHP will show a need where it has not shown a need in the past, opening the door for CON applications for such services to be filed. For other services (e.g., in-home hospice), it is anticipated that we may see a new, more detailed need methodology where one has not historically been present.

Thus, physicians and other providers who are interested in venturing outside the traditional physician office into other lines of business should pay attention to the proposed revisions to the SHP and the resulting changes in the need methodology for certain services. For those areas opening the door for CON applications to be filed, we expect that a number of applicants will move quickly in attempts to meet such need. Once a CON application is granted by SHPDA to meet the need reflected in the SHP, the need is no longer present in the SHP and future CON applications cannot be approved, absent a regulatory procedure to adjust the need or amend the SHP. Thus, we suspect that, in certain areas for certain services, time will be of the essence once the revised SHP is implemented.

Additional information on the SHCC meetings the SHP revisions is available on the SHPDA website at http://shpda.state.al.us/.

Kelli Fleming is a partner at Burr & Forman LLP practicing in the firm’s Health Care Industry Group. Burr & Forman LLP is an official partner with the Medical Association. 

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Legislation Introduced to Tackle Doctor Shortages

Legislation Introduced to Tackle Doctor Shortages

WASHINGTON, D.C. – U.S. Reps. Terri Sewell (D-AL) and John Katko (R-NY) have introduced legislation that would take critical steps towards reducing nationwide physician shortages by boosting the number of Medicare-supported residency positions. The Resident Physician Shortage Act (H.R. 1763) would support an additional 3,000 positions each year for the next five years, for a total of 15,000 residency positions.

“This week, medical students across the country will celebrate their match into physician residency programs, but many of their peers will be left without a residency due to the gap between students applying and the number of funded positions. At the same time, the United States faces a projected shortage of up to 120,000 physicians by 2030. We need to act now to train more qualified doctors,” Sewell said. “Increasing the number of Medicare-supported residency positions means increasing the number of trained doctors to meet growing demand. It also means giving hospitals and health centers the tools they need to increase access, lower wait times for patients and create a pipeline of qualified medical professionals to serve Americans’ health needs.”

To become a practicing doctor in the U.S., medical school graduates must complete a residency program. However, for the past two decades, an artificial cap on the number of residents funded by Medicare – which is the primary source of payment for residents – has limited the expansion of training programs and the number of trainees.

According to the Association of American Medical Colleges, the United States will face a physician shortage of between 42,600 and 121,300 physicians by 2030. As the American population grows older, the demand for physicians and other medical professionals will increase.

Earlier this year, the Medical Association empaneled the Manpower Shortage Task Force to develop and restore adequate health care manpower in all geographic areas in order to provide quality local health care for all Alabama citizens. Members of the task force have discussed a number of issues including fully funding the Board of Medical Scholarship Awards, scope of practice, physician pipeline programs, education and the possibility of GME expansion, recruitment and retention of physicians through meaningful tax credits and rural community support, and start-up business models.

“Naturally, there are a lot of concerns about health care shortages in rural areas, but our goal with the task force is a long-term solution,” said Medical Association Executive Director Mark Jackson. “The task force and the resolution stand as a reminder that Alabama ranks in the last five of 50 states in health status categories, and while primary care medicine is effective in raising health status, supporting hospitals and improving the economic status of disadvantaged communities, the state’s aging population is causing an escalation in need for primary care physicians. The Association would like to thank Rep. Sewell for introducing the bill and will work closely with her and her staff to help ensure its passage.”

Read the Resident Physician Shortage Act

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Medical Association Signs on to Letter Targeting PA Requirements

Medical Association Signs on to Letter Targeting PA Requirements

The Medical Association recently joined the American Medical Association and 85 other national medical groups and state medical associations in sending a letter to the Centers for Medicare & Medicaid  Services to urge CMS to provide guidance to Medicare Advantage plans on prior authorization processes through its 2020 Call Letter. In the jointly signed letter, the groups call upon CMS to require MA plans to selectively apply PA requirements and provide examples of criteria to be used for programs such as ordering/prescribing patterns that align with evidence-based guidelines and historically high PA approval rates. Citing the CMS Patients Over Paperwork initiative, the letter stresses this new guidance will promote safe, timely and affordable access to care for patients; enhance efficiency; and reduce administrative burden on physician practices.

The letter further explains how the prior authorization process has been found to be burdensome for health care providers, health plans and even patients and that physicians and insurers have agreed that these policy changes to eliminate PAs on those services for which there is low variation in care can promote greater transparency regarding services subject to PAs and protect patients to ensure PAs do not impact the continuity of care.

PA programs can create significant treatment barriers by delaying the start or continuation of necessary treatment, which may in turn adversely affect patient health outcomes. According to a 2018 AMA survey of 1,000 practicing physicians, 91 percent of physicians said PAs can delay a patient’s access to necessary care. These delays may have serious implications for patients and their health, as 75 percent of physicians reported that PA can lead to treatment abandonment, and 91 percent indicated that PA can have a negative impact on patient clinical outcomes. Most alarmingly, 28 percent of physicians indicated that PA has led to a serious adverse event (e.g., death, hospitalization, disability/permanent bodily damage) for a patient in their care.

Read the letter in its entirety

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Montgomery County Hosts AMA President

Montgomery County Hosts AMA President

Feb. 21, 2019 MONTGOMERY ─ The Medical Society of Montgomery County hosted Dr. Barbara L. McAneny, president of the American Medical Association as its keynote speaker for its regular quarterly meeting at the Alabama Department of Archives and History.

During the reception before her lecture, Dr. McAneny had the opportunity to speak one-on-one with many local physicians from a variety of different specialties about their concerns for medicine not only in Alabama, but also on the national stage.

Speaking to a packed house, Dr. McAneny spoke to more than 75 local physicians and guests highlighting some of the AMA’s recent advocacy work and strategic priorities, including issues with physician burnout, access to care, regulatory burdens, increased consolidation, the opioid epidemic, technology and the increasing cost of medical care.

While in Montgomery, MSMC President Stephen Suggs, M.D., and his wife, DeDe, had the opportunity to escort Dr. McAneny to some local landmarks, such as the Equal Justice Initiative’s Legacy Museum and National Memorial for Peace and Justice. Before she left Montgomery, Dr. McAneny also visited with the 42nd Medical Group at Maxwell Air Force Base for a mission briefing and tour of the campus.

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Third Party Task Force Hosts UnitedHealthcare Execs

Third Party Task Force Hosts UnitedHealthcare Execs

Feb. 19, 2019 MONTGOMERY ─ The Association’s Third Party Task Force hosted executives from UnitedHealthcare earlier this week as they made a presentation and answered questions from members of the Board of  Censors and Association staff. Chief Executive Officer, Gulf States Region, Joe Ochipinti, and Vice President of Provider Relations Mike Apple discussed topics ranging from the group’s expansion in Alabama to prior authorization issues and upcoming town hall meetings.

Task Force members questioned the UnitedHealthcare (UHC) representatives about the recent expansion from 300,000 to about 420,000 insureds in Alabama and how this will affect provider relations. UHC will host several town hall meetings across the state to provide educational opportunities for physicians in the area.

The announced town hall meetings include:

March 6-8
MGMA Alabama 2019 Winter Conference
Hyatt Regency Birmingham/The Wynfrey Hotel
Birmingham

March 19
Alabama Hospital Association
Mobile Service Center
Wynlakes Country Club
Montgomery

March 27
UHC Spring 2019 Provider Information Expo
Wynlakes Country Club ─ 9 a.m. – 3 p.m.
Montgomery

March 28
Baptist Montgomery
Link Computer Lab Training
Deboer Building (Brown Springs Road)
Montgomery

April 10
UHC Spring 2019 Provider Information Expo
Embassy Suites ─ 9 a.m. – 3 p.m.
Huntsville

April 24
Russell Medical Center Town Hall
Education Meeting Room
Alexander City

May 7
DCH Town Hall
Druid City Hospital
Willard Auditorium
Tuscaloosa

May 15
Baldwin County Town Hall
Mobile Infirmary
Mobile

May 16
Mobile County Town Hall
Springhill Memorial Hospital
Mobile

The Third-Party Task Force is a subcommittee of the Board of Censors that meets regularly to provide members with assistance in resolving issues and disputes with insurance companies, including Medicaid and Medicare. The Task Force is staffed by the Legal Department and helps members address hassles or other difficulties with policies and procedures of payors.

If you have questions or issues you would like the Association’s Third Party Task Force to address, please email your inquiry to Cheairs Porter.

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STUDY: Prior Authorization Hurdles Have Led to Serious Adverse Events

STUDY: Prior Authorization Hurdles Have Led to Serious Adverse Events

FEB 5, 2019 CHICAGO — More than one-quarter of physicians surveyed, about 28 percent, report the prior authorization process required by health insurers for certain drugs, tests and treatments have led to serious or life-threatening events for their patients, according to new survey results released by the American Medical Association.

Critical physician concerns highlighted in the AMA survey include:

  • More than nine in 10 physicians (91 percent) say that prior authorizations programs have a negative impact on patient clinical outcomes.
  • Nearly two-thirds of physicians (65 percent) report waiting at least one business day for prior authorization decisions from insurers – and more than one-quarter (26 percent) said they wait three business days or longer.
  • More than nine in 10 physicians (91 percent) said that the prior authorization process delays patient access to necessary care, and three-quarters of physicians (75 percent) report that prior authorization can at least sometimes lead to patients abandoning a recommended course of treatment.
  • A significant majority of physicians (86 percent) said the burdens associated with prior authorization were high or extremely high, and a clear majority of physicians (88 percent) believe burdens associated with prior authorization have increased during the past five years.
  • Every week a medical practice completes an average of 31 prior authorization requirements per physician, which take the equivalent of nearly two business days (14.9 hours) of physician and staff time to complete.
  • To keep up with the administrative burden, more than a third of physicians (36 percent) employ staff members who work exclusively on tasks associated with prior authorization.

“The AMA is committed to attacking the dysfunction in health care by removing the obstacles and burdens that interfere with patient care,” said Dr. Resneck. “To make the patient-physician relationship more valued than paperwork, the AMA has taken a leading role by creating collaborative solutions to right-size and streamline prior authorization and help patients access safe, timely, and affordable care, while reducing administrative burdens that pull physicians away from patient care.”

In January 2017, the AMA with 16 other associations urged industry-wide improvements in prior authorization programs to align with a newly created set of 21 principles intended to ensure that patients receive timely and medically necessary care and medications and reduce the administrative burdens. More than 100 other health care organizations have supported those principles.

In January 2018, the AMA joined the American Hospital Association, America’s Health Insurance Plans, American Pharmacists Association, Blue Cross Blue Shield Association and Medical Group Management Association in a Consensus Statement outlining a shared commitment to industry-wide improvements to prior authorization processes and patient-centered care.

The AMA welcomes the opportunity to work collaboratively with health plans and others to create a partnership that lays the foundation for a more transparent, efficient, fair, and appropriately targeted prior authorization process. Please visit the AMA website to learn more about the organization’s ongoing collaborative efforts.

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Medical Association Announces 2019 State and Federal Agendas

Medical Association Announces 2019 State and Federal Agendas

The Medical Association Board of Censors has met and approved the Association’s 2019 State and Federal Agendas. These agendas were developed with guidance from the House of Delegates and input from individual physicians. As the Alabama Legislature and U.S. Congress begin their work for 2019, additional items affecting physicians, medical practices and patients may be added to this list.

2019 STATE AGENDA

The Medical Association supports:

  • Legislation prohibiting deceptive health care advertising and requiring all health care professionals to clearly identify their type of license to patients
  • Reforming the “certificate of need” process to increase physician ownership of equipment and facilities and expand access to quality, affordable care
    • The recommendations of the Rural Health Taskforce:
    • Increased in funding for the Board of Medical Scholarship Awards (BMSA),
    • Broaden the rural physician tax credit,
    • Promote continued support for the Rural Medical Program and the Rural Medical Scholars Program
    • Expansion of the model Huntsville Rural Premedical Internship program to other medical school campuses
    • Increased funding for the Alabama Area Health Education Center (AHEC) program
  • Medicaid expansion
  • Increasing physician Medicaid payments to Medicare levels for all specialties of medicine
  • Increased funding for the Prescription Drug Monitoring Program to continue transforming it into a useful tool for physician monitoring of patients at risk for drug interactions and overdose potential
  • Requirements for vaccine registry review prior to administration and uploading patient vaccine information into the database
  • Strengthening existing tort reforms and ensuring liability system stability
  • Continued physician compounding, dispensing of drugs
  • The same standards and reimbursements for telehealth and face-to-face visits
  • Reforming the “certificate of need” process to increase physician ownership of equipment and facilities and expand access to quality, affordable care

The Medical Association opposes:

  • Any scope of practice expansion which could lower quality of care for or increase costs for patients including, but not limited to, eliminating the referral requirement for physical therapy; allowing optometrists to perform eye surgery and injections; expanding podiatric surgical allowances; and, abolishing collaborative practice, supervisory agreements and/or supervision requirements between physicians and nurse practitioners, physician assistants and nurse anesthetists.
  • Legislation or other initiatives that could increase lawsuits against physicians
  • Non-physicians setting standards for medical care delivery
  • Tax increases disproportionately affecting physicians
  • Expanding Prescription Drug Monitoring Program access for law enforcement
  • Statutory requirements for mandatory Prescription Drug Monitoring Program checks
  • Expansion of Maintenance of Certification (MOC) requirements
  • Changes to workers’ compensation laws negatively affecting treatment of injured workers and medical practices
  • Biologic substitution legislation containing insufficient quality and notification requirements and which increases administrative burdens on physicians

 

2019 FEDERAL AGENDA 

The Medical Association supports:

  • Meaningful tort reforms that maintain existing state protections
  • Reducing administrative and regulatory burdens on physicians and medical practices
  • Repeal of the Affordable Care Act and replacement with a system that:
    • Includes meaningful tort reforms that maintain existing state protections
    • Preserves employer-based health insurance
    • Protects coverage for patients with pre-existing conditions and for dependents under age 26
    • With proper oversight, allows the sale of health insurance across state lines
    • Allows for deducting individual health insurance expenses on tax returns
    • Increases allowed contributions to health savings accounts
    • Ensures access for vulnerable populations and does not increase uncompensated care
    • Ensures universal, catastrophic coverage
    • Does not require adherence with insurance requirements until insurance reimbursement begins
    • Reduces administrative and regulatory burdens
  • Overhauling federal fraud and abuse programs and reforming the RAC program
  • Prescription drug abuse education, prevention and treatment initiatives
  • Allowing patient private contracting in Medicare and expanding veterans’ access to non-VA physicians
  • Reducing escalating prescription drug costs
  • A patient-centered MACRA framework, including non-punitive and flexible implementation of new MIPS, PQRS and MU requirements
  • Better interstate Prescription Drug Monitoring Program connectivity
  • Eliminating “pain” as the fifth vital sign
  • Requiring all VA facilities, methadone clinics and suboxone clinics to input prescription data into state PDMPs where they are located

The Medical Association opposes:

  • Non-physicians setting standards for medical care delivery
  • Publication of Medicare physician payment data
  • National medical licensure that supersedes state licensure
  • Legislation/initiatives increasing lawsuits against physicians

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MOC Study Committee’s Official Statement on “Vision Initiative” Draft Report

MOC Study Committee’s Official Statement on “Vision Initiative” Draft Report

In response to the Medical Association and other state and national medical and physician specialty societies’ grievances with ABMS, its member Boards, and specifically the MOC program, ABMS sought input from a broad range of stakeholders in an effort to envision and craft a board certification system that is responsive and meaningful to physicians. This effort has included professional medical organizations, national specialty and state medical societies, hospitals and health systems and others. The group released its vision for the future of board certification – dubbed the “Vision Initiative.”

The Medical Association has been active on the MOC issue, through both its MOC Study Committee and advocacy at the national and even state levels. Below is the official statement on the “Vision Initiative” from MOC Study Committee Chairman Dr. Greg Ayers:

“The Medical Association of the State of Alabama’s MOC Study Committee supports a voluntary process for board certification in medical specialties and a departure from the sometimes punitive approach toward certification taken by some American Board of Medical Specialties’ specialty boards. This process must maintain high standards for professionalism and encourage lifelong learning that is clinically relevant to patient care within physicians’ individual practices. The MOC Study Committee believes the ABMS various specialty boards should continue efforts to improve upon and ensure inexpensive, accessible options for increasing the breadth and scope of physicians’ skills and knowledge so they may best serve their patients; however, those efforts should never, of themselves, hinder, obstruct nor supersede the actual provision of care. The ABMS Boards should collaborate to pursue implementation of reciprocal, longitudinal pathways for multi-specialty diplomates. The continuing physician specialty certification process of the future should not include the current high-stakes examination and burdensome, duplicative components of Maintenance of Certification. Given physicians’ support for self-regulation, the MOC Study Committee calls upon the ABMS Boards to fulfill its duty to administer specialty board certification in a manner that assists physicians in continuing to improve the quality of care patients receive.”

Greg Ayers, M.D., Chairman, MOC Study Committee

For more information, see also:

MOC UPDATE: Working to Solve Problems with Certification

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Senior Physicians: We Need Your Voices!

Senior Physicians: We Need Your Voices!

Any physician that has reached the age of 65 is considered by the American Medical Association and the Medical Association to be a Senior Physician, even if you are not currently working in a medical practice. That does not mean your voice cannot still work for the House of Medicine.

Did you know the Medical Association has a Senior Physician Section Representation on the Board of Censors? This is an elected office, and even though it is a non-voting position by statute, it is nevertheless an important platform for voicing the issues affecting older physicians in Alabama, such as requesting payment for services, malpractice coverage, new technologies, personal health issues, etc…

The position has benefits, too, such as reimbursement for travel to and from monthly board meetings, which are the second Tuesday and Wednesday of the month, and accommodations and food are also provided during your time in Montgomery. Your transportation, hotel and food expenses are covered for the two annual meetings of the AMA. In 2019, the meetings will be June 8-12 in Chicago and Nov. 16-19 in San Diego.

I have served as the Senior Physician Section Representative for the past year, and I will vacate the office during the next Annual Meeting in April 2019 when a new representative will be elected. I urge all Association senior physicians to attend because we are the ones who elect OUR representative – and practicing physicians can also earn CMEs for attending the conference.

I would recommend choosing someone who is still practicing medicine and would like to serve the Medical Association. This position requires someone that understand the difficulties that face all physicians and especially senior physicians in the current medical environment. If you have questions, please email Executive Director Mark Jackson.

Article contributed by Dr. Jim Alford, Senior Physician Section Representative, 2018-2019.

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Three Simple Steps for Increasing Medicine’s Influence

Three Simple Steps for Increasing Medicine’s Influence

From the outside looking in, the political process likely seems as inviting as a shark tank, as navigable as a corn maze, as predictable as the Kentucky Derby. Intimidating, confusing and frustrating are often used by citizens to describe advocacy-related interactions with government and frankly, this isn’t surprising given most citizens’ level of understanding of the political process.

In his Gettysburg Address, President Abraham Lincoln famously opined our nation’s form of government – “of the people, by the people, for the people” – would long endure. Unlike the direct democracy of 5th century Athens, Americans live in a representative democracy, electing individuals from city councilmen to the President to make decisions for them.

Representative democracy eliminates the need for the citizenry to be involved in the minutiae of modern governance. The downside, however, can be a culture of complacency on the part of the electorate. Outcomes are typically directed by those choosing to engage government on issues important to them, and so government becomes “of the people, by the people, for the people [who choose to participate].” The citizenry is ultimately still responsible for holding government accountable, through either direct engagement with lawmakers or the electoral process (or both), though few understand how to do so.

By following the three simple steps below, physicians can increase their influence on issues important to them and the patients they serve.

Step 1: Join, join, join

A significant portion of success is simply showing up, but most physicians don’t have the time to spend flying back and forth to Washington or driving to Montgomery for Congressional or legislative meetings, hearings and sessions. Laws and or regulations are constantly under consideration in either the nation’s or state’s capitol directly affecting medical care. A practicing physician can’t possibly make all the scheduled meetings and still see patients, much less attend to the very necessary continual monitoring of legislative and regulatory bodies that is required of successful modern-day advocacy operations.

But when like-minded people pool their resources good things can happen. Advocacy organizations concerned with ensuring delivery of quality care and a positive practice and liability environment – from individual state and national specialty societies to the Medical Association of the State of Alabama – all deserve your support and membership.

They are all working for you and joining them gives these organizations the resources to hire qualified personnel to represent physicians and their patients before legislative and regulatory bodies.

Step 2: Get to know a few key people

Physicians are responsible for a lot, and in today’s world especially, it’s easy to get in a routine and leave the job of representing the profession to someone else. After all, isn’t that what membership dues are for? Yes and no. While membership in organizations advocating for physicians helps fund advocacy operations, paying membership dues alone is not enough, not in the era of social media, 24-hour news and increased engagement by those on the other side of issues from organized medicine.

Perhaps surprisingly, getting to know a few key people is not difficult, even if only by phone or email. While those paid to represent physicians will know the members of the Legislature and Congress and try to convince them of medicine’s position, in lawmakers’ minds, there is no contact more important than one from a constituent.

Physicians should start locally, getting to know their State Representative and State Senator first, gradually working up to establishing relationships with their member of Congress and U.S. Senators. If they are doing their job well as an elected representative, these legislators and their staff will be glad to hear from a constituent and get his/her perspective. At the same time, don’t overlook the importance of encouraging fellow physicians to engage their local elected officials in meaningful dialogue as well so overall efforts will be amplified.

For more information on how to interact and communicate with lawmakers, check out the Medical Association’s ABCs of VIP.

Step 3: Put your money where your mouth is

Medical and specialty society membership dollars cannot be legally used for elections purposes, and so separate political action committees or PACs must be established and funds raised each year to help elect candidates physicians can work with on important issues. Not surprisingly, numerous entities whose objectives are at odds with medical liability reform, meaningful health system reform and with ensuring the highest standards for medical care are eager to get their allies elected to office.

Just like their parent organizations, the PACs of specialty societies and the official political committee of the Medical Association of the State of Alabama (ALAPAC) are all worthy of your support. When it comes to PAC contributions, never underestimate the impact of even a small donation.

Choosing not to participate in the political process – when it’s known the decisions of lawmakers directly affect medicine – is akin to getting sued, consciously sitting out voir dire and letting the plaintiff’s lawyer pick the jury.

Summary

The future of medical care, in Alabama and the nation, rests not with elected lawmakers and appointed bureaucrats but with the men and women actually caring for patients every day. A representative democracy functions best when the electorate holds those elected to office accountable. Increasing medicine’s ability to successfully advocate for physicians and the patients they serve will require increased participation in the political process. It is incumbent upon physicians to join the organizations fighting for them, to get to know their elected officials and to contribute to PACs whose goals align with their own.

By Niko Corley
Director, Legislative Affairs
Deputy Director, Alabama Medical PAC (ALAPAC)

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