May 27, 2016
Volume 60, Issue 21


U.S. House Ways & Means Committee Amends Hospital Package
Adjusts targeted HOPD fix

On May 24, the U.S. House Ways & Means Committee amended legislation it introduced last week, the Helping Hospitals Improve Patient Care Act/HR 5273, to provide more flexibility for certain hospital outpatient department (HOPD) projects caught up in a prohibition enacted last year under the Bipartisan Budget Act of 2015 (BBA 2015).

The BBA 2015 banned new off-campus provider-based HOPDs from using Medicareís Outpatient Prospective Payment System (OPPS) beginning in 2017. The law was enacted so quickly that projects across the country well under construction but not yet able to bill under the OPPS were no longer able to use this entire Medicare reimbursement system. Congress has been working since that time to craft a targeted fix to address these "mid-build" situations.

One of the original exemption pathways under HR 5273 included a multi-part process for an HOPD to fulfill. One of the requirements under that process was for the HOPD to attest by July 1, 2016 in order to be exempted. The amended legislation extended that attestation deadline to December 31, 2016 or 60 days after the legislationís enactment. In order to pay for this legislation, prospective payment system hospitals will see an additional, small reduction to the coding offset increase they were to have received in their Fiscal Year 2018 market-basket.

In addition to this HOPD fix, the legislation contains other provisions of interest. Among those are changes to the hospital readmission reduction program in order to address socioeconomic status. This provision would initially require the Centers for Medicare & Medicaid Services (CMS) to make an adjustment based on the proportion of a hospitalís dually-eligible Medicare and Medicaid patients. CMS may modify risk adjustments in the future. Another provision in this legislation is Speaker Paul Ryanís bill requiring CMS to study and report on how the inpatient and outpatient hospital codes for similar services can be cross-walked. The basis of this provision was Ryanís original bill, HR 3291.

If you have questions, contact Jenny Boese, WHA vice president, federal affairs & advocacy, at 608-268-1816 or jboese@wha.org.

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WHA Information Center Adds "Quick Reports" to KAAVIO

A few weeks ago, the WHA Information Center (WHAIC) launched a new tool designed to help WHA hospitals and health systems gain crucial insights into areas such as population health, utilization, patient access, geographic distribution and market share.

The tool, called "Kaavio," allows WHA hospital and health system users to analyze and visualize Wisconsin discharge data. With Kaavio, users can easily interact with the Wisconsin discharge data applying filters, refining parameters and adding criteria. The changes are instantly reflected in the data. Kaavio presents the data in meaningful graphics that allow users to detect patterns, trends, outliers and relationships that can help users make important decisions.

One feature now available is "Quick Reports." Quick Reports are dashboards that, with just a few clicks, can answer specific questions.

Quick Reports can show:

Kaavio is available to WHA hospitals and health systems that purchase data at the relational data set level for no additional fee through 2016. Kaavio can also be enhanced with the purchase of the "Other Hospital Outpatient Data" (ancillary services information).

Within Kaavio, users can analyze the data for hospitals and free-standing ambulatory surgery centers and compare them to other facilities. They can create custom dashboards with filters for categories such as primary diagnosis category, principal procedure category, MS-DRG, primary payer, patient ZIP code and facility.

To learn more about Kaavio and how to access the new tool, go to the WHA Information Center website, www.whainfocenter.com, or contact Brian Competente at bcompetente@wha.org.

WHAIC is dedicated to collecting, analyzing and disseminating complete, accurate and timely data and reports about charges, utilization, quality and efficiency provided by Wisconsin hospitals, ambulatory surgery centers and other health care providers.

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Wisconsin Hospitals State PAC & Conduit Campaign Tops $120,000
See who is on the first contributor listing of 2016

As of May 26, the 2016 Wisconsin Hospitals State PAC & Conduit topped the $120,000 mark with contributions from almost 130 individuals.

"The Wisconsin Hospitals State PAC & Conduit campaign is off to a great start," said WHA 2016 Advocacy Committee Chair Therese Pandl. "We want to reach our goal of raising $300,000 so together we can help support candidates of both parties who value hospitals and health systems in Wisconsin. I am asking everyone who cares about health care in our state to support our industry in this important way."

The 2016 fundraising campaign is based on the calendar year, which means that since the start of this year, more than $5,600 has come in, on average, each week. The 2016 campaign will need to continue at this pace or better to meet the $300,000 goal by yearís end. While $300,000 is an aggressive goal, it is a reachable goal when everyone pitches in. In this pivotal election year, remember that elections matter, and participation is important.

Take a look at the first 2016 contributor list on page 7 to see who is on the list. Make sure your name is not left off of future lists by making your personal contribution today at www.whconduit.com or by contacting WHAís Jenny Boese at 608-268-1816 or jboese@wha.org, or Nora Statsick at 608-239-4535 or nstatsick@wha.org. Be part of the success story by contributing to the Wisconsin Hospitals State PAC and Conduit today.

Contributors ranging from $1 to $499
Bayer, Tom HSHS St. Vincent Hospital
Boese, June Wheaton Franciscan - All Saints
Braddock, Jonathan ISG Advisors, LLC
Carlson, Peter Aurora Psychiatric Hospital
Clementi, Bridget Children's Hospital of Wisconsin
Coffman, Joan HSHS St. Joseph's Hospital
Collins, Sherry Wisconsin Hospital Association
Coopman, Dianne SSM - St. Mary's Janesville Hospital
Davis, Brett Aspirus, Inc.
Dux, Larry Froedtert & MCW Community Memorial Hospital campus
Ewald, Sandra Aurora Health Care
Ferrigno, Sandra SSM - St. Mary's Hospital
Grabow, Peter Mayo Health System -Franciscan Healthcare LaCrosse
Grasmick, Michael Wisconsin Hospital Association
Groskreutz, Kevin HSHS St. Joseph's Hospital
Gustafson, Sara UW Hospitals and Clinics
Hamilton, Mark UW Hospitals and Clinics
Harrington, Kathleen Mayo Health System - Eau Claire
Hartberg, David Gundersen - Boscobel Area Hospital and Clinics
Heaney, Dwight Fort HealthCare
Kaiser, Ann HSHS Sacred Heart Hospital
Kantos, Craig ThedaCare Medical Center - Waupaca
Kirsch, Jennifer Gundersen Health System
Klay, Chris HSHS St. Joseph's Hospital
Kruse, Joe Mayo Health System -Franciscan Healthcare LaCrosse
Lynch, Sue Mayo Health System -Franciscan Healthcare LaCrosse
Meicher, John SSM - St. Mary's Hospital
Nicklaus, Todd Aspirus, Inc.
Pearson, Jane SSM - St. Mary's Janesville Hospital
Prise, Eric Tomah Memorial Hospital
Revnew, Dorothy ProHealth Care - Oconomowoc Memorial Hospital
Roller, Rachel Aurora Health Care
Schaetzl, Ron SSM - St. Clare Hospital & Health Services
Selle, Ginger SSM - St. Clare Hospital & Health Services
Stapelfeldt, Kimberly Aurora Medical Center - Washington County
Statz, Darrell Rural Wisconsin Health Cooperative
Stelzer, Jason SSM - St. Clare Hospital & Health Services
Swanson, Kaitlin HSHS Eastern Wisconsin Division
Thornton, Eric SSM - St. Mary's Janesville Hospital
Walker, Troy SSM - St. Clare Hospital & Health Services
Whitinger, Margaret Agnesian HealthCare
Wysocki, Scott SSM - St. Clare Hospital & Health Services
Contributors ranging from $500 to $999
Behl, Kevin Columbia St. Mary's Hospital - Milwaukee
DeGroot, Dan HSHS St. Clare Memorial Hospital
Dexter, Donn Mayo Health System - Eau Claire
Doeringsfeld, Jean Wisconsin Hospital Association
Fitzgerald, Moira
Jensema, Christine HSHS Eastern Wisconsin Division
King, Steve SSM - St. Mary's Hospital
Lange, George Columbia St. Mary's Hospital - Milwaukee
Larson, Margaret Affinity Health - Mercy Medical Center
Mulder, Doris Beloit Health System
Nelson, James Fort HealthCare
Oland, Charisse Rusk County Memorial Hospital
Peterson, Douglas Chippewa Valley Hospital
Reardon, Brian Hospital Sisters Health System
Roesler, Bruce The Richland Hospital
Roundy, Ann Columbus Community Hospital
Rude, Nels The Kammer Group
Selberg, Heidi HSHS Eastern Wisconsin Division
Shabino, Charles Wisconsin Hospital Association
Stuart, Philip Tomah Memorial Hospital
Swanson, Kerry SSM - St. Mary's Janesville Hospital
Van Meeteren, Bob Reedsburg Area Medical Center
Wessels, Bill Aspirus, Inc.
Wolf, Edward Lakeview Medical Center
Worrick, Gerald Ministry - Door County Medical Center
Contributors ranging from $1,000 to $1,499
Anderson, Sandy Ministry Health Care
Brenton, Andrew Wisconsin Hospital Association
Brussow, Julie Marshfield Clinic
Dietsche, James Bellin Hospital
Graebner, David Aurora Sheboygan Memorial Medical Center
Hafeman, Paula HSHS St. Vincent Hospital
Hanus, Andrew Aurora Health Care
Jacobson, Terry St. Mary's Hospital of Superior
Jelle, Laura SSM - St. Clare Hospital & Health Services
Just, Lisa Aurora Health Care - South Region
Levin, Jeremy Rural Wisconsin Health Cooperative
Lindberg, Steve Mayo Health System - Red Cedar
Miller, Kim Beaver Dam Community Hospital
Pollard, Dennis Froedtert & MCW Community Memorial Hospital campus
Punzenberger, Lindsay Children's Hospital of Wisconsin
Rush, Steven Wisconsin Hospital Association
Sanders, Robert Children's Hospital of Wisconsin
Schafer, Michael Spooner Health System
Teigen, Seth SSM Health Care of Wisconsin
White-Jacobs, Mary Beth Black River Memorial Hospital
Contributors ranging from $1,500 to $1,999
Bloch, Jodi Children's Hospital of Wisconsin
Clapp, Nicole Grant Regional Health Center
Court, Kelly Wisconsin Hospital Association
Frank, Jennifer Wisconsin Hospital Association
Grasmick, Mary Kay Wisconsin Hospital Association
Gullingsrud, Tim Hayward Area Memorial Hospital and Nursing Home
Hilt, Monica Ministry Health Care/St. Elizabeth Hospital
Lewis, Gordon Burnett Medical Center
McKevett, Timothy Beloit Health System
Russell, John Columbus Community Hospital
Sheehan, John UW Health American Center
Stanford, Matthew Wisconsin Hospital Association
Schulze, Connie Ministry Health Care
Contributors ranging from $2,000 to $2,999
Alig, Joanne Wisconsin Hospital Association
Boese, Jennifer Wisconsin Hospital Association
Kachelski, Joe Wisconsin Statewide Health Information Network
Lappin, Michael Aurora Health Care
Leitch, Laura Hall Render
Mettner, Michelle Children's Hospital of Wisconsin
Meyer, Daniel Aurora BayCare Medical Center 
Natzke, Ryan Marshfield Clinic
Potter, Brian Wisconsin Hospital Association
Starmann-Harrison, Mary Hospital Sisters Health System
Steines, Sara Children's Hospital of Wisconsin
Wallace, Michael Fort HealthCare
Contributors ranging from $3,000 to $4,999
Boatwright, Damond SSM Health Care of Wisconsin
Jacobson, Catherine Froedtert & The Medical College of Wisconsin
Neufelder, Daniel Ministry Health Care
O'Brien, Kyle Wisconsin Hospital Association
Pandl, Therese HSHS Eastern Wisconsin Division
Standridge, Debra Wheaton Franciscan Healthcare
Turkal, Nick Aurora Health Care
Contributors ranging from $5,000 to $9,999
Borgerding, Eric & Dana Wisconsin Hospital Association
Brenton, Stephen Wisconsin Hospital Association
Kerwin, George Bellin Hospital
Size, Tim Rural Wisconsin Health Cooperative
Troy, Peggy Children's Hospital of Wisconsin
Tyre, Scott Capitol Navigators, Inc.


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Guest Column: Keeping Your Organizationís Retirement Plan on Track
By Forrest Ross, Retirement Services Director, ISG Advisors, LLC

An annual review of your hospital or health systemís retirement plan not only helps you set and manage plan expectations, it may also help your plan meet certain nondiscrimination and regulatory standards. Use contribution and participant rates to help analyze how well the plan works and whether any changes might be beneficial.

Review these 10 items to make sure your hospital or health systemís retirement plan stays on track.

  1. Review plan goals; participant satisfaction - Review plan goals annually for relevancy and success. You may find priorities have changed, and a plan design feature that was once important is no longer meaningful. Seek feedback from employees, and work with your planís service provider to understand industry trends and evaluate features.
  2. Service provider fee disclosure - Retirement plan fee disclosure regulations were implemented in 2012, requiring each covered service provider to disclose detailed information to plan sponsors about fees charged and the services provided for those fees. As part of your fiduciary duty to monitor expenses, benchmark your planís fees against national averages and the health care industry to demonstrate the fees are reasonable and documented.
  3. Participant fee disclosure - Part of the fee disclosure regulations require plan administrators to provide participants with a statement disclosing the fees paid through the retirement plan when investments are participant-directed. As a plan sponsor, you are responsible for providing the disclosures. You must also be able to clearly explain the expenses and why they are the best options for your plan participants.
  4. Create and maintain an administrative procedures manual - The plan document is a crucial part of your hospital or health systemís retirement plan; however, many administrative processes and procedures are not spelled out. An administrative procedures manual provides a concise record of the administrative process, including procedures for reconciling plan contributions, the process for funding contributions, information on calculating employer contributions, and more.
  5. Plan document review - If the plan document is not in compliance, the tax-qualified status of the plan is at risk. Take a proactive approach and work with legal counsel and your plan service provider to conduct a document review.
  6. Required plan communications - Plan sponsors are required to provide plan participants with a number of communications, such as safe harbor notices, automatic enrollment notices, fee disclosures, summary annual reports, and the summary plan description. Review the notices annually to ensure the information is accurate and understandable.
  7. Targeted plan communications - Work with your planís service provider to analyze participant behavior, then use a variety of communication strategies to tailor communications based on whether encouragement is needed to start saving, to examine whether they are saving enough, or to make sure they are making appropriate investment choices.
  8. Plan fiduciaries - The functions a person performs for the plan, not job title, determine fiduciary status. Because all fiduciaries are potentially responsible for the actions of their co-fiduciaries, they must receive training to understand their duties and to document how those duties are performed.
  9. Compliance review - Identify issues and administrative gaps with a compliance review, which looks at internal processes to make sure they are aligned with plan documents and current regulations. Reviewing your administrative processes at the same time can help identify potential problems, correct existing problems, and avoid unpleasant surprises during an audit.
  10. Legislative changes - Legislative changes, new regulations, and revised guidance on existing regulations are common in the retirement industry. Staying up to date on regulatory changes will help keep your plan healthy in the eyes of the Department of Labor and the IRS.

Address the compliance, governance, and fiduciary issues of your hospital or health systemís retirement plan proactively so your plan maintains peak condition.

Source: https://www08.wellsfargomedia.com/assets/pdf/commercial/retirement-employee-benefits/perspectives/10-things-to-keep-401k-plans-on-track.pdf

About ISG Advisors

As WHAís Premier Partner, ISG Advisors goes above and beyond to help hospitals balance employee needs with the cost of employee benefits. Through strategic planning, professional services, and technology based solutions, ISG can help reduce benefit costs, increase efficiency, and improve employee satisfactionóbringing your employee benefits program to new heights in quality and performance.

Securities & Investment Advisory Services offered through VSR Financial Services, Inc., a Registered Investment Adviser and Member FINRA and SIPC. ISG Advisors is not owned or controlled by VSR Financial Services, Inc.

Learn more at www.isg-advisors.com/wha.html.

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WHA Thanks WI Delegation for Signing onto Bipartisan Dear Colleague Letters
Letters urge CMS to provide flexibility with implementation of Section 603/HOPDs

Recently Wisconsinís Congressional Delegation signed onto two bipartisan "Dear Colleague" letters sent to the Centers for Medicare & Medicaid Services (CMS). Those letters urge CMS to provide flexibility in implementing a policy related to new off-campus hospital outpatient departments (HOPDs).

The new policy was included in the Bipartisan Budget Act of 2015 (BBA) and prohibited use of the Outpatient Prospective Payment System (OPPS) by new HOPDs. However, for HOPDs currently in existence, BBA 2015 included several grandfathering provisions. CMS is now developing regulation implementing this new policy going forward.

The "Dear Colleague" letters by Congress to CMS focus on key issues of interest, such as providing flexibility for currently grandfathered HOPDs so they are able to relocate, rebuild, change services, among various situations, and not be at risk of losing their grandfathered status.

"The Wisconsin Hospital Association thanks Wisconsinís membersóSenators Baldwin and Johnson; and Representatives Duffy, Grothman, Kind, Moore, Pocan, Ribble and Sensenbrennerófor signing onto these letters," said WHA President/CEO Eric Borgerding. "We appreciate our Delegation understanding the importance of crafting implementation policies that do not inhibit access to care or disadvantage Wisconsinís high-value hospitals and health systems."

Fifty-one Senators, including Wisconsin Sens. Tammy Baldwin and Ron Johnson, signed onto the U.S. Senate letter, which was led by Sen. Rob Portman of Ohio and Sen. Chuck Schumer of New York. In the U.S. House, 235 members, including all of Wisconsinís House members (except for Speaker Ryan due to his leadership role), signed onto the U.S. House letter, which was led by Rep. Devin Nunes of California and Rep. Joseph Crowley of New York.

Read the Senate letter at: www.aha.org/advocacy-issues/letter/2016/160519-senate-hopd-dearcolleague.pdf.

Read the House letter at: www.aha.org/content/16/160524-cms-congress-sec603hopd.pdf.

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Chiropractic Associations Spar in Senate Health Committee Informational Hearing
Physician groups testify against "Primary Spinal Care Practitioner" certification legislation

On May 24, the Senate Committee on Health and Human Services held an informational hearing on a proposal, 2015 Senate Bill 762 (SB 762) (see at http://docs.legis.wisconsin.gov/2015/related/proposals/sb762.pdf), to create an additional certification for chiropractors that would, among other things, allow prescribing of medications and administration of anesthesia under the direction of a physician. The new certification, known in the legislation as a Primary Spinal Care Practitioner (PSCP), would allow the PSCPs to practice "spinal medicine" after completing an additional 60 hours of instruction and 500 clinical rotation hours beyond their chiropractic training.

Wisconsinís two professional chiropractic groups, the Wisconsin Chiropractic Association (WCA) and the Chiropractic Society of Wisconsin (CSW), had differing views on the proposal. The WCA said the proposal would be a more "patient-centered" care delivery model by giving a chiropractor trained as a PSCP "all the tools that are necessary to be the primary caregiver for spine care." WCA President Rod Lefler said the proposal would "reduce the seven to nine different providers that are needed and make the referral process more simple" for someone suffering with back pain.

The Chiropractic Society of Wisconsin testified with "100 percent opposition" to the proposal, stating that the majority of chiropractors in Wisconsin oppose the concept of adding prescribing authority and that the educational component included in SB 762 is "grossly inadequate and creates a public safety concern." The CSW stated that their position against the legislation is in alignment with "all recognized and established national and state chiropractic institutions and organizations" who do not support adding prescribing authority for chiropractors.

A group of physicians from the Wisconsin Medical Society, the Wisconsin Academy of Family Physicians and the Wisconsin Society of Anesthesiologists testified in opposition to the bill. The Wisconsin Society of Anesthesiologists stated the bill contained "many very troubling proposals." Donn Dexter, MD, chief medical officer for the Wisconsin Medical Society and neurologist at Mayo Health System in Eau Claire testified against the legislation, saying the billís scope would be "incredibly ambiguous" and indicating that he believed the new certification was a "shortcut to being a physician."

Sen. Leah Vukmir, chair of the Committee, asked representatives from the Wisconsin Chiropractic Association if any other state has similar prescribing authority for chiropractors. Lefler testified that New Mexico and Oklahoma had limited prescribing authority for chiropractors, but he said Wisconsin has a "chance to lead the nation" and is the first state to "come to the table" with this type of proposal.

The Wisconsin Hospital Association has registered against SB 762.

The Legislature is adjourned for the 2015-16 legislation session, therefore SB 762 will not move forward this year.

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Patient Safety Expert to Lead WHA Fall Prevention Practices Workshop, Aug. 17

On August 17, WHA is offering the workshop "Re-Energizing Fall and Injury Prevention Practices," which will focus on the state of science specific to fall and injury prevention, shifts in regulatory guidelines, and best practice approaches to fall risk and injury reduction. Registration is now open at https://events.SignUp4.net/FallsInjuryPrevent0817.

This one-day workshop will be led by Patricia Quigley, PhD, nationally-renowned expert in clinical practice innovations in patient safety, nursing and rehabilitation designed to promote independence and safety. Quigley has a legacy of leadership in health care outcomes related to functional improvement, rehabilitation outcomes and continuum of care. She serves as the patient safety expert for fall and injury reduction to the Hospital Engagement Networks. Her leadership in falls risk and injury prevention research has resulted in redesign measurement of patient safety indicators for falls and fall injuries that link organizational, unit and patient-level variables that are relevant and evidence-based.

Quality and patient safety leaders, managers, front-line nursing staff and nursing leaders from hospitals and health systems will benefit most from participating in this workshop. Hospital staff are encouraged to attend as a team, as attendees will engage in group discussions of changes that can be made quickly and those that require added infrastructure and capacity. In addition, post-acute providers who partner with hospitals, including staff from assisted-living facilities, skilled nursing facilities and home health providers should consider attending this important event as well.

The workshop is scheduled August 17 at Glacier Canyon Lodge at The Wilderness Resort in Wisconsin Dells. There is a minimal registration fee to attend this workshop, thanks to funding provided by the Wisconsin Office of Rural Health. For questions about the workshopís content, contact Beth Dibbert at bdibbert@wha.org or at 608-274-1820.

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WHA Hosts Symposium for Patient and Family Centered Care

On May 20, more than 125 hospital leaders, caregivers and patients came together to attend the WHA Symposium for Patient and Family Centered Care. The Symposium featured The Institute for Patient and Family Centered Care (IPFCC). The IPFCC is globally recognized as a leader in advancing the understanding and adoption of patient and family centric cultures. Throughout the day, participants learned topics ranging from how to get started with partnering with patients and families, to engaging patients and families in clinical interactions, to investigating the role that leaders play in developing a patient and family-centric culture. Attendees left with short and long-term goals to take back and implement at their local hospitals.

Patient and Family Care and Engagement has been a foundational initiative through the WHA Partners for Patients collaborative. The aim of the initiative has been to pool the existing resources within the state of Wisconsin to develop a strategy and structure for facilitating the spread of Patient and Family Centered Care and Engagement through education, consultation, collaboration, training and dedication. The results have been impressive. In two short years the number of Patient and Family Advisory Councils (PFAC) at member hospitals has more than tripled. A Patient and Family Advisory Council (PFAC) is an organized structured committee with the purpose of partnering patients and families with members of the health care team to provide guidance on how to improve the patient and family experience.

"PFACs are essential in helping guide hospitals to approach improvements with the patients and their families in mind. By engaging the patients and family members through advisory councils, hospitals have been able to improve quality and safety as well as increase efficiencies and reduce costs," according to Kelly Court, WHA chief quality officer.

To learn more about how WHA can support patient and family-centered care improvement efforts for member hospitals, contact Court at kcourt@wha.org.

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WCHQ Statewide Quality Improvement Event

The Wisconsin Collaborative for Healthcare Quality (WCHQ) is partnering with the Wisconsin Department of Health Services to host the third annual Statewide Quality Improvement Event focused on improving the quality of care and patient outcomes in Wisconsin. This event is designed for clinical, operational, quality, and executive leaders and staff from health systems, medical groups, hospitals and clinics. Other health care stakeholders are welcome to attend.

Additional information and registration are available at: http://onlinecommunity.wchq.org/event/SQIE2016.

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