Terms Used In The Medical Aid Industry

Understanding how medical aids work will help you chose the right medical aid when you decide to go for one. Certain words that are used in the medical aid industry need to be understood. This enables members to make right decisions about anything related to their chosen schemes.

The average person needs to understand the terms that are used in the industry so that the product can be accessible to them. This is important because there will come a time that a member will need to make a claim. When this happens they must be able to read and understand the documentation.

The Definition Of A Dependent

A dependent is someone who is on the health insurance of the principal member. However they do not make any contributions because they are covered by those that are made by the member already. They are entitled to medical services that they need at any recognized medical facility.

Children of the member under the age of 21 are referred to as child dependents. They are covered for any medical emergency that they could suffer from. Medical aids have different rules relating to how many child dependents a member can have before they start paying extra.

When joining a medical aid you will usually be subjected to what is called a waiting period. This period has to go by before you can start enjoying the benefits of the medical aid. Medical aids do this to guard themselves against any risk that might be presented by a new member.

Once this waiting period has been served things move into a stage which is referred to as creditable coverage. The member and their dependents can now enjoy the benefits of the medical aid. The health insurance will pay for their medical fees whenever they receive medical care at a recognized facility.

Pre Existing Conditions

Pre existing conditions are those sicknesses that a joining member already suffers from. The law requires that the conditions be divulged when a new member comes on board. The health insurers must have made aware of all the pre existing conditions that the member and their dependents have.

A person who becomes a member of a health insurance after they have reached the age of 35 is referred to as late joiner. They also should not have been a member of a medical aid for the preceding two years. Certain penalies can be imposed on them such as an increase in their overall promotions.

An overnight stay at a health facility is referred to as hospital treatment. This category also referrers to situations where a patient is treated with any healthcare machinery. Any major operations will also fall into this category whether done at a clinic or hospital.

Understanding these terms will empower the member and their dependents so that they can know which conditions are covered by the scheme. They will also get to know those conditions that are not covered so that they can make alternative means of getting treatment.

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Becoming A Member Of A Medical Aid Is Beneficial

These days more people are able to afford quality medical care. This is made possible by the fact that more medical aid companies are appearing to cater for more people with such a need. Economic conditions are such that markets are able to accommodate more medical aid companies.

The lifespan of people is increasing because nations have become healthier. People are able to lead decease free lives which means that the standard of living has also improved. People do not have to worry about their future well being which means that their level of stress has also gone down.

Same Premiums For Everybody

The same monthly promotions are paid by every member. However members have different medical needs so some of the promotions will fluctuate accordingly. Your premiums will also be affected by your current age when you join and they will there before be different from others.

Joining after you have reached the age of 35 will attract a penal in the form of a little increase in the promotions. This will make it possible for the medical aid to provide you with the best medical cover. Ultimately all this will be to your benefit and you will be grateful for that.

Having a pre existing medical condition will not preclude you from joining a medical aid. You will be able to pay the same premiums as everyone else. However after joining you will be required to serve a specified waiting period before you can start enjoying the benefits.

The type of illness that a person has will also not prevent them from being able to join. The important thing is that the person must be able to pay the required premiums every month. Your personal circumstances will never be used against you to prevent you from joining.

Long Term Illnesses

Medical aids do accommodate people with chronic illnesses. The special circumstances are catered for to enable the member to receive the required medical assistance. The duration of the program will be determined by how long the treatment is needed.

The condition that you are suffering from needs to be continuously monitored. This needs to be done so that the medical aid can be able to work out if you still need to be on the special program. If there is a need for changes the medical aid will make sure that this happens.

All the contributions by members are used for the sole purpose of looking after their health. The money will only be used for this purpose because there is no other purpose it is meant for. Medical aids are exclusively in the business of looking after the health of their members.

Medical aids have to always conduct themselves in a way that benefits the members. They are monitored by the permissions to make sure that they do not abuse the monies that are being paid to them. This gives members the confidence that their money will never be wasted on anything else.

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All Types Of People Can Get Medical Aid

As long as you have a regular income that you receive every month you will be able to be a member of a medical aid. Everybody can get a medical aid if they want one. Your social standing and background can not stand in the way of you getting health insurance.

It will be to your advantage to consider a number of schemes before you make a decision. The choice is yours as to which health insurance you want to have. There are a number of options you can chose from and each medical aid scheme has its rules that members need to adhere to.

The competition for members among the schemes is vibrant. This makes them work hard to come up with solutions that cater for all sorts of people. Different medical schemes cater for people in all the learning brackets. So whether you earn a small or big salary it does not really matter.

Your Special Personal Circumstances

You must never compare your situation with that of anyone else. The needs of people are never the same. A person must look at their unique personal circumstances so that they would be able to make an informed decision. This type of investment is long term so one must ensure that they chose the right option.

Choosing the right medical aid scheme will ensure that you enjoy all the benefits that are applicable to you. You must know and understand your medical history so that you can choose the right scheme. Find out all your medical conditions so that you can chose the scheme that covers all of them.

The benefits accrue which means that you will not be wasting money by being part of a medical aid. Being sick or ill is not a prerequisite to be able to get health insurance. Healthy people can also get this type of protection because it is a long term investment in your wellbeing.

Medical aid schemes will never turn you back if you want to be a member. As you grow older you will gradually start to need help with paying for the many medical conditions that you will suffer from. So starting to make contributions towards the health insurance even when you are not sickly will ever be to your benefit.

Long Term Illnesses

People with chronic illnesses will find health insurance useful because it will help them whenever they need help with paying for medical bills. Health Insurance companies accept such people because they also have a need for medical protection. A suitable plan can be drawn up for them so that they will be able to enjoy protection as well.

Even if you have a socially stigmatised illness such as HIV / Aids you can still get medical aid without any problems. The types of diseases that people suffer from do not preclude them from joining a medical aid. Whether your illness is short term or long term will not determine whether you get medical aid or not.

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EHR Incentive Results

As of May 2012, more than 100,000 healthcare providers established electronic health records (EHR) that met federal standards and received incentives from the Medicare and Medicaid Incentive programs.

The goal (according to the Centers for Medicare and Medicaid Services) was for 100,000 to have done this by the end of 2012. So, the objective will be surpassed.

EHR incentives are a good way to defray some of the costs of implementing a system while complying with regulations on adopting, implementing, upgrading and meaningfully using certified EHR technology to improve health care.

Eligible Professionals

The goal being realized so early means that health professionals in practices and hospitals have seen the potential of EHRs to reduce paperwork, eliminate duplicate procedures and protect patient information. Overall, EHRs provide a better patient experience.

Eligible professionals to receive the incentives include physicians, some physicists assistants, nurse practitioners and certified nurse midwives. The incentive program was developed by the Health Information for Clinical and Economic Health Act of 2009.

EHR Incentive Disbursements

In fact, one of every five Medicare and Medicaid qualified professionals received an incentive for adopting an EHR. Specifically, over about $ 5.7 billion in total EHR Incentive Program payments were made. Over $ 3 billion of it came from Medicare and more than $ 2.6 billion came from Medicaid. This all took place from May of 2011, when the funds were first released, through May 2012.

What the incentives did was to really accelerate the adoption of this important technology upgrade by health care providers all over the US. There is also one other entity that helped make this possible and continues to assist healthcare providers in the EHR implementation process.

The Regional Extension Centers (RECs)

The ONC (Office of the National Coordinator for Health IT) sponsored Regional Extension Centers (RECs) continue to play a big part in this effort. What these organizations do is to work with providers, especially in the rural areas, to make sure they meet the meaningful use criteria and qualify for the incentives.

In fact, over 133,000 primary care providers and 10,000 specialists have partnered with the RECs to overcome the barriers to EHR adoption. 70% of the providers are small practices in rural areas.

All healthcare providers need to implement an EHR system soon. Any help that is out there, such as the RECs, can be accessed. It makes sense to achieve those incentives while improving patient care in your practice.

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Medical Tourism Information Portal

An increasing number of people are looking abroad for medical treatment. This is understandable as the cost of private treatment in most western countries is skyrocketing. This means that many people are forced to do without those treatments that are considered non-essential. If they live in a country that offers free healthcare they can be faced with long waiting lists. It is little wonder then that medical tourism has become so popular. People now realize that it is possible to travel abroad and have the treatments they require completed at a fraction of the cost they would pay at home.

Good Reasons to Choose Medical Treatment Abroad
The internet has been a great boom when it comes to providing people with information, and it is probably this that has been most responsible for the rise in medical tourism. The public are now aware that they have these options and many are choosing to take advantage of this. There are plenty of good reasons for why people might want to choose medical treatment abroad including:

• It is usually possible to find foreign healthcare providers who will be able to provide needed treatments at a fraction of what they would cost at home.

• It is possible for people to receive their treatment in luxuries and high quality facilities that they would never be able to afford at home. Some of these foreign hospitals are more like 5 star hotels.

• Some parts of the world have hospitals that specialize in certain procedures in treatments. This means that traveling abroad can mean receiving the best possible care.

• It is becoming fairly common for people to travel to exotic locations for their medical care. This means that they can recuperate in some wonderful environments.

Plastic Surgery Abroad
One of the most common reasons for medical tourism is to have plastic surgery. This is often a type of electrical surgery (non emergency treatments) so people will often be expected to pay for it. Those who choose to have plastic surgery abroad can get the work they needed done by competent surgeons for less than they could expect to pay in their home country. Plastic surgery has been increasing popular in the 21st century, according to statistics released by the American Society for Aesthetic Plastic Surgery (ASAPS) in April 2011, the demand for plastic surgery procedures increased by 9% in 2010 alone, and has grown by 155% since 1997.

Medical Tourism Information Portal
One of the problems that people have when it comes to understanding their options as a medical tourist is that there are so many options. Those who use the web to dig out the information they need to make a good decision can be faced with a huge challenge – there are just so many websites offering advice and it is often conflicting. This difficult can be overcome by using a medical tourism information portal. This is where all the information you need is grouped in one place and is easy to search. This can significantly reduce the amount of time needed to research medical tourism options. It also helps ensure that people make the right choice for them. Going to go abroad for medical treatment can be an empowering step but only if people do so with their eyes open.

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EHR Technology – Highlights And Reaction To The Final Rule For Stage 2 Meaningful Use

The Centers for Medicare and Medicaid (CMS) and the Office of the National Coordinator for Health IT (ONC) released the final rule for Stage 2 Meaningful Use on Thursday, August 23, 2012. The final rule for Stage 2 Meaningful Use defines the requirements that both hospitals and eligible healthcare providers must meet in order to continue to qualify and receive payments under the Medicare and Medicaid electronic health records (EHR) incentive programs.

The Medicare and Medicaid EHR Incentive Programs are in place to promote and expand the meaningful use of certified EHR technology which is one important component of a leader national strategy to deploy health information technology infrastructures throughout the entire ambulatory and hospital healthcare system of the United States. This aggressive health IT strategy is critical to successfully reforming our healthcare system which will eventually lead to improving operational efficiency of medical organizations and patient care quality, safety, and outcomes.

Prior to the release of the final rule for Stage 2 Meaningful Use, CMS first posted its proposed rule for Stage 2 in the Federal Register on March 7, 2012. This action opened the sixty day public commentary period that allowed interested parties and individuals to submit comments, challenges, or concerns regarding any portion of the proposed rule. According to the Stage 2 final rule, approximately six thousand one hundred items of timely correspondence was received prior to the May 6, 2012 submission deadline. CMS and the ONC have included summaries of the timely public comments that were within scope of the Stage 2 proposed rule through the final rule document.

Key highlights of the final rule for Stage 2 Meaningful Use:

1. Stage 2 attests start in 2014 – The meaningful use final rule for Stage 1 established an original timeline that would have required eligible providers enrolled in the Medicare EHR Incentive Program who attested to meeting meaningful use in 2011 to meet Stage 2 requirements in 2013. Now under the final rule for Stage 2, any eligible provider that attested to Stage 1 of meaningful use in 2011 will now attest to Stage 2 requirements starting in 2014. This significant change provides more flexibility and allows both eligible providers and certified EHR vendors more time to upgrade EHR systems to the 2014 edition. CMS and the ONC have also published the criteria in the final rule that EHR systems must meet in order to achieve or maintain their ONC-ATCB certification for Stage 2.

2. C hanges to Stage 1 and introduction of new objectives and measures in Stage 2 – In the final rule for Stage 2, CMS and the ONC has maintained the same core-menu structure found in Stage 1. In Stage 2, there are a total of twenty measures that eligible providers must meet or qualify for exclusion to seventeen core objectives and three of six menu objectives. For eligible hospitals and critical access hospitals (CAHs), there are a total of nineteen measures that must meet or qualify for exclusion to sixteen core objectives and three of six menu objectives. The final rule has added the “outpatient lab reporting” to the menu for hospitals and CAHs and “recording clinical notes” as a menu item for both hospitals and eligible providers.

Also, the “exchange of key clinical information” core objective from Stage 1 has been replaced with the more robust “transitions of care” core objective in Stage 2, and the “provide patients with an electronic copy of their health information” objective from Stage 1 was eliminated in favor of the new “online, download, and transmit” core objective in Stage 2.

The final rule for Stage 2 also introduces two new core objectives. For eligible providers, the new core objective is “use secure electronic messaging to communicate with patients on relevant health information” and for hospitals and CAH's, the new core objective is “automatically track communications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR). ”

One significant policy change to Stage 1 effective as of 2014 is eligible providers, hospitals, and CAHs that meet an exclusion for a menu set objective does not count towards the number of menu set objectives that must be satisfied to meet meaningful use.

3. Streamlined Group Practice Reporting – The final rule will now allow group practices to batch and submit meaningful use attestation data, for all of their individual eligible providers, in one file.

4. Process for Medicare Payment Adjustments – The final rule has defined the process that will determine whether an eligible provider, hospital, or CAH will experience a Medicare payment adjustment. All future imposed Medicare payment adjustments will be determined by an EHR reporting period prior to the required statute taking effect in 2015. The final rule states that any Medicare eligible or hospital that demonstrates meaningful use in 2013 will not be imposed a payment adjustment in 2015. Furthermore, a Medicare provider that first demonstrates meaningful use in 2014 will not be imposed a payment reduction penalty as long as they successfully register for the EHR Incentive Program and attest to meaningful use by July 1, 2014 for eligible hospitals or October 1, 2014 for eligible providers.

In the final rule, CMS defines four specific categories of hardship exceptions for eligible providers to avoid a Medicare payment adjustment penalty and they are: New Eligible Providers, Infrastructure Barriers, Unforeseen Circumstances, and Specific Specialist / Provider Type that includes radiology, anesthesia, and pathology.

For the most part, initial reactions by several healthcare associations regarding the final rule for Stage 2 Meaningful Use were quite favorable.

The Medical Group Management Association (MGMA) expressed that they were generally pleased with final rule specifically informing the change that allows groups to report batch information for certain measures that now removes the administrative burden on eligible professionals. They also expressed satisfaction with the threshold decrease of providing online access for the patient to get a hold of their medical records from the proposed ten percent down to five percent in the final rule. While the MGMA welcomed the decrease, they went on to express that this requirement continues to present a number of challenges to providers including the cost to integrate an online portal and the reliance on patients to use it.

The American Health Information Management Association (AHIMA) expressed that they were happy to see CMS acknowledge and continue to make efforts to align meaningful use quality reporting requirements with other quality reporting systems in order to reduce duplication and reporting challenges. The AHIMA also shared that this reporting alignment will drive efficiency and reduce cost over time. Both the MGMA and AHIMA were also glad to see that the Stage 2 Meaningful Use requirements will begin in 2014, as opposed to the proposed starting date of 2013.

On the other hand, the American Hospital Association (AHA) expressed concern about the timeline providers have to meet the Stage 2 requirements. The AHA believes that the final rule sets an unrealistic date by which hospitals must attest to initial meaningful use requirements to avoid financial penalties. They also went on record to say that the final rule makes the reporting of clinical quality measures more complicated and the addition of new meaningful use objectives has created new burdens for hospitals.

In conclusion, the journey to digitize the healthcare system of the US requires all stakers to effectively manage change while navigating a very long and winding road. The fact is EHR adoption along with meeting all of the requirements for Stage 2 Meaningful Use is not going to be easy and not everyone will be in agreement with the final rule. However, the time will come when the efforts of today will lead to a more robust coordination of patient care, eliminate redundant screenings and tests, reduction medical errors, reduce health costs, and foster improved patient engagement and outcomes in the near future.

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The Rise and Rise in Healthcare

Health care cost have been rising way over the cost of living for all us for many decades now. This is the case where you are served by a public sector or private sector health service or a mixture of both (as is most common).

What is going on? Why are we paying ever more high costs for healthcare?

There appear to be a multitude of reasons to choose from:
1. Drug and healthcare equipment inflation
2. More treatments and more drugs being available
3. Increased longevity
4. Subsidised and insured health increasing demand
5. More access to self-diagnosis / amateur diagnosis (internet)
6. Healthcare more broadly available in the third world making healthcare resources more stretched
7. Increase in preventative care resulting in inevitable waste (providing healthcare for those who are not ill)

A long book could have been written about drug inflation and that is just the first topic. However, this is certainly more of a symptom rather than a cause of higher health costs. My hunch is that no.2 is the greatest reason for higher healthcare costs: increased availability for treatments.

The problem with healthcare is that it does not follow normal supply / demand patterns, especially in western countries. If we have eaten well then we can say we are full. Demand has been fully satisfied. However, healthcare is different; the goalposts are constantly on the move. There was a time when most people would only see a doctor if they we were too ill to function. Then we started to lower the bar to the point when even a mild headache could trigger a doctor's appointment (for some people at least). Then as our health improved more emphasis was put on measures we could take to prevent illness and live long and agile life. The goalposts are moving yet again with recent forms into cosmetic treatments.

I offer no judgments but strictly observe. Surely it is a good thing that we are healthy? However if we are under increasing financial pressure and stress as we try to find money to pay for all of this, where should the line be drawn?

Does the stress caused by the higher cost of living makes us less happy? Is mental health being sacrificed in favor of physical health? We have a greater quantity of life but are we getting the quality of life to go with it?

Sometimes time will tell

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Medical Aid Will Give You A Peace Of Mind

Getting medical aid will help you prepare for medical emergencies. You will be able to get one even if you do not earn a big salary. It is better to be prepared for medical emergencies than be done off guard. You will be able to deal with the situation with out worrying about finances.

You will recover from your medical condition in no time. The knowledge that you have adequate financial backing for your medical needs will help you in your recuperation efforts. Your body will be relaxed which means it will respond better to medication.

Superior Medical Attention

With adequate finances your medical emergency will be deal with satisfactorily and you will be able to get back to health. Medical aid helps you get access to the best doctors around. You will also be able to be informed to the best hospitals that provide superior medical attention.

Your family will not have to worry about paying the medical bill if something happened to you. Having medical aid means you do not have to be a burden to anyone. Should you happen to be in an emergency you can be rushed to the hospital without delay.

Make sure you understand the terms and conditions before you join. Fortunately there are a number of good medical aid providers to choose from. All you need to do is a bit of research to find out which provider will be suitable for your needs.

Spending on medical aid is one of the necessary expenditures you need to make. Once you find the provider most suitable to your unique needs you must not hesitate to join. You need to get onto a suitable scheme as soon as you can to be protected in case of a medical emergency.

When you reach an age where you start to be sickly you want to be sure that you have adequate cover. Do not let your judgment be clouded by having good health at the moment. You will not be young forever which means as you grow older you will have more medical needs.

Plan Your Budget To Accommodate Medical Aid

Look at all the non essential expenditures you make on a monthly base and decide which ones you can live without. You must rearrange your budget so that medical aid contributions can be accommodated. There will always be other areas of your life where you can redirect some funds from.

One needs to lead a life with very minimal stress. Being healthy should take priority because you need to be fit to be able to deal with the challenges that life presents. You will also start to be productive in other areas of your life such as at work.

Your children need to be able to receive the best medical attention from good hospitals. If you happen to have small children that need constant medical attention you need to get medical aid. You and your spouse will never have to worry about their wellbeing.

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Get Comprehensive Medical Aid Cover

Everyone is likely to fall sick from time to time so the family needs to be prepared for such an eventuality. Medical aid will be useful if you have small children who are prone to illness. However a family of two would still need medical aid. Every kind of family needs medical aid.

More funds would have needed a family member fall ill with a sickness that requires long stays in hospital. Medical aid that does not cover everything will sometimes cause problems. Do not be tempted to get medical aid that does not cover everything in an attempt to save costs.

All The Worries Dissipate

Getting comprehensive medical aid will give you peace of mind and you will not be worried about the welfare of your family. Any illness that a family member would be suffering from will be covered. With a comprehensive cover you never need to worry about the possibility of anyone not being able to receive medical attention.

It would be to your advantage to get this kind of cover as soon as you can. In order to achieve this you need to ensure that you rearrange your overall budget to accommodate it. You can always find things that are not urgent that you spend money on.

Any conditions that are threatening to endanger your life can be identified as soon as they appear. Doctor visits give you an indication of how healthy you are. A comprehensive plan covers medical expenses related to doctor visits for things such as routine check ups.

All necessary steps need to be taken to make sure that any medical condition is treated before it becomes serious. A full assessment will indicate which steps need to be taken. You will be able to take the necessary steps to deal with a situation that requires attention.

A comprehensive cover will take care of things for you so that you would not need to spend any additional funds. Hospital stays can be expensive if you happen to spend a significant number of days in hospital. However they are also covered by comprehensive medical aid schemes.

Chronic Illnesses

A comprehensive cover will also be able to deal with chronic illnesses. That is because the funds will be readily available whenever they are needed. Such illnesses require long term medical attention. That is to ensure that the condition is managed well so that it does not become life threatening.

Comprehensive cover will help with taking care of payments so that you do not find yourself stranded without enough funds. You will need to have a way of paying for the medication through the treatment period. Chronic medical conditions need to be treated with medication for a prolonged period.

You also need the ability to pay for consultations to the different specialists that you need to see. Specialists normally do not come cheap so it means you need to be well prepared for that. A comprehensive cover will be able to help in this regard.

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Physician Billing Services to the Rescue of Physicians

Physician billing services make the professional life of a physician more relaxed. The term has already gained great popularity in the medical field. Often, trained physician struggles to handle medical reimbursements, claims follow up and electronic remittance. These services help to increase the productivity, enhance cash flow and refine efficiency of physicians. Service also permits more time for physician to concentrate on his job. Physician billing for various treatments and tests are compiled into a single bill for convenience with the help of an expert in this field to avoid backlog of billing. They also goes forward to keep pace with the constant changes in the policies of insurance companies and government.

Employees of physician billing services are trained to tackle various issues such as insurance information and super bills. At the same time, the company manages the data of patients, appointment schedules and electronic health records. It also assures other services including tracking authorizations, mailing bills to patients in correct time, tracking co-pays and much more.

Physician billing services have many benefits to support individual physicians. The devoted service helps to keep patient record up to date. The company also verifies all information to avoid misinterpretation of insurance policies. Latest software and advanced technologies are used by the skilled staff to promote secure and efficient data handling. Once the patient's data are outsourced to a reliable billing company company, the physician can set out his concerns about the administrative work related to billing, insurance and human resource management. Quicker processing of claims is done to provide electronic remittance on time. The billing company also takes the strain to follow up the claims for getting them resolved without any time delay.

Before selecting a billing company, the physician has to evaluate the previous performances of the company. Experience in the field, reliability of work, quick turnaround times, data security and affordable price are other factors that need consideration. It is also essential to check whether the company is HIPAA compliant in providing various services and procedures.

Rejecting a medical claim often frustrates clients and physician as well. Another advantage of choosing trustworthy company helps to lower the denials of claims which have no proper documents. This will increase the revenue of the physician radically. Physician billing services also help the physician to access the status of claim remotely through online procedures. Many doctors have found it reliable to use a billing company for delivering results without time lapse. Moreover, medical staffs are also freed from tedious administrative works that permitting them to devote more time for patient care. Therefore you can relax if the physician billing services are contracted out to a reputed billing company.

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The History of EMR

The history of medical records systems, used in hospitals these days and are more common than ever, dates back to the 1960s. It was in that year that the concept for such a system was laid out in order to improve medical care provided to the patients and to decrease the death rate. There is no doubt that these medical records systems really achieved the goal for which they were devised. However, it was after a long time of experimentation and work by leading doctors and scientists that such an effective system was born. The history of medical records systems is really interesting to know.

The concept was first laid out by a doctor, Lawrence Lee Weed whoave this concept for a part of the PROMIS project in the University of Vermont. What he did not know was that such a concept would actually become a basis for future work and finally the creation of an effective medical records system and medical software which is now recommended by the government for every hospital and health care provider to use it.

After the initial concept by Lawrence Lee weed to have such a kind of health records system, the scientists and IT experts began their work at the PROMIS project to devise such a health records system that it would improve the level of care a patient received. The goal was to make an automated medical software system that would automatically record all information about the patient and would make it easier to access the information too quickly. With an automated system, doctors believed that it would become easier to quickly access and find the information related to a particular patient and provide him urgent care. After many efforts, the concept finally led to the creation of PMD, a record system used in the Medical Center Hospital of Vermont for the first time in 1970. After that many other medical records systems were born and used in hospitals around the country.

The idea that information technology and health care are two opposite industries and one can not be integrated with another is historical now. These days, a lot of colleges around the country offer health care and IT courses which help the health care providers to learn how to use medical IT systems in their practice. Nowadays, a health care provider having some expertise in the IT field, at least related to health care IT systems, is more valued now than a provider who has no expertise whatsoever and faces problem in switching to the use of medical IT systems to record patient data.

There are many reasons why a health care provider should know more about health care and IT and should take those courses. Although, these courses would add to the cost of education but in the long run, this cost is really worth it.

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Group Governance in Healthcare Industry

Group governance in the healthcare industry relates to decisions that define expectations, grant power, and verify performance. It consist of a specific part of management and leadership processes. In the case of hospital and healthcare industry, governance related to consistent management, cohesive policies, processes and decision rights for a given area of ​​responsibility.

The purposes of group governance in the healthcare industry is to take into account the concerns about quality and service, the distress experienced by many providers, the need for collaborative approaches to strategy development and strategy fulfillment for development the very leadership infrastructure essential for success. This work combines organizational assessment, retreat facilitation, ongoing counsel to top management, the support of major change initiatives and coaching of senior executives. The consultation process, group practice leadership, and the development of organizational cohesion are also the purposes of group governance. The purpose of group governance is to provide trusted solutions that would protect and enhance health and financial wellbeing. It would help to develop the strategy to broaden beyond the concept of health protection to give customers more peace of mind on health and financial matters. The products and services could extend beyond just traditional health services to include travel insurance, life insurance, retirement planning and lifestyle management. The goal should be to provide the whole of life approach to health and wellbeing, through providing the right approach to the right people, in the right way, at the right time in their life.

Group governance provides the umbrella for all governance approaches. It combines the principles of corporate / financial accountability with clinical / management accountability. It helps to unite the various strands of governance within a common framework, addresses the issues of overlap and provides a system which will include finance, efficiency and economy, effectiveness, efficiency and compliance with healthcare standards. The move towards integrated governance is also reflected in the governance domain of the standards for better health. The purpose is to have greater accountability in regard to patient outcomes, effectiveness of treatment, satisfaction of patients and to have an ethical use of resources by the health services organizations.

Some of the key characteristics of group governance are to have a corporate philosophy and policies that support the governance structure and functions within the organization and have a clear, consistent understanding by the board and CEO of the board's role, responsibilities, authority and organizational relationships. Group governance will help develop the support and leadership of the CEO who is committed to building a strong governance structure and practices and to have a sustained organizational commitment to a solid board development program. It will help to form a sound structure and staff resources to assist the board and its committees and on-going access to important information coupled with well-constructed board and committee agendas that focus the member's time and energy on key governance priorities. Core governance processes should be well-designed and reviewed regularly to identify opportunities for improvement. Substantial engagement of clinicians who are chosen by virtue of their commitment and expertise as members of governing boards and board committees. A board culture that is characterized by proactive engagement of its members, a consistent pattern of constructive dialogue and debate, and enlivened decision-making processes.

One important common characteristic of group governance is to maintain the corporate philosophy and policies that support the governance structure and functions within the organization. Whether it is a free-standing hospital or a large health care system with facilities in several states, governing boards are unilaterally to be effective without strong support by the corporate sponsor or parent body. This support is demonstrated by clear expectations, appropriate resources and thoughtful oversight. There should be an on-going process for assessing the board's changing needs of expertise. There should be an active recruitment effort to attract trustees who can meet those needs with an on-going board evaluation process with the twin goals of objective assessment and continuous improvement. The group governance would function effectively with good staff and logistical support.

Second common character of group governance is to have a clear, consistent understanding by the board and CEO of the board's role, responsibilities, authority and organizational relationships. The role of the board is to provide leadership and set the organization's strategic direction and vision, set policies and organizational performance measures. Its role is to appoint and delegate authority to and monitor the Chief executive and ensure that the organization has the resources to run efficiently and monitor and evaluate performance. To be effective, boards must have highly capable and committed persons in these leadership roles. The pace of positive change can be accelerated greatly through the active engagement and support of the CEO. Board leaders should review their board's composition to ensure that clinician voices are heard. Studies in the healthcare field and other sectors have indicated that organizations which boards are involved, interactive and proactive are more likely to perform better than similar organizations with less engaged boards.

There are many factors beyond the quality of group governance that affect the performance of hospitals and other health care organizations. For example, the caliber of clinical staff and executive leadership, the resources to acquire the best technology and the effectiveness of information systems. However, governmental agencies, bond rating agencies, donors and other stakeholders are recognizing that the quality of group governance is important, and they are pressing for higher standards and better board performance.

There has been changes in the structure and duties of boards of directors in for-profit hospitals over the past 50 years. Over the past 50 years the institutional, governance, and strategic functions of boards have changed. The higher levels of board size and diversity, traditionally associated with optimal institutional and governance performance of boards have affected the board's ability to initiate strategic changes during periods of environmental turbulence. The board diversity in particular has been a significant concern on strategic change.

A change in the structure and duties of the board of directors have happened to actively promote quality improvement and a new approach is set in management in healthcare services. Their duties have expanded over time to an expanded managerial role. There have been increasing demands in leadership roles with group decision making and stimulating a team approach. Over the years, transformational leadership in health care organizations has developed to change systems and processes under quality. 50 years back, there were several barriers in the role of board of directors to providing leadership in hospitals and thus the quality and its authority over medical staff and administration. Barriers included trust ignorance, trustees security, board inattention, poor board-physician communication, fragmented information on quality, traditional medical staff structure, lack of professional management of quality, and lack of investment. This has improved over the years by developing strategies for hospital board leadership which have included preparation to lead, self-education, visible participation in quality activities, activism, role clarification, increased informal dialogue with physicians, medical staff reform, creation of a quality management department, instituting high-quality standards, and external quality audit. Boards are facing a historic opportunity to transform hospital quality backed by a strong legal mandate.

Single hospital boards have been the selected method of governance since the first hospitals were built in this country in the 1600s. However, in recent years, governance of the healthcare system has undergone a radical transformation. Single hospital boards have almost disappeared. Instead, hospitals have been clustered together by governments into multiple-hospital consortia, or into regions, often with other non-hospital health organizations that had formerly enjoyed autonomous governance (eg, boards of public health). This has resulted in the differences in the structures, operations, functions in the healthcare boards. A major healthcare transformation in the United States has also been the conversion of nonprofit hospitals to for-profit entities.

Economic forces have been shaping healthcare at a rapid pace and have affected all stakeholders, including providers, insurers, consumers, and federal and state Governments. As major players in the industry, hospitals and health systems have experienced the impact of key changes. The strategic implications and the adjustments to direction have positioned the health organizations for continued competitive success. Over the years, there have been magnitude and direction of changes in board structure, composition, and selection and CEO-board relations. The board activity, evaluation, and compensation are examined for the population of hospitals and for different categories of hospitals which was not the same as before. The findings suggest that hospital boards are now engaging in selective rather than wholesale change to meet the simultaneous demands of a competitive market and traditional institutional orientations to community. Results also suggest parallel increases in collaboration among boards and CEOs and in board scrutiny of CEOs. The critical challenge to the boards over the years has been aligned to the interests of the doctors with the organizations. As a result of multiple developments in healthcare and healthcare policy, hospital administrators, policy makers and researchers are increasingly challenging to reflect on the meaning of good hospital governance and how they can implement it in the hospital organizations.

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Disparities in US Healthcare System

Healthcare disparities pose a major challenge to the diverse 21st century America. Demographic trends indicate that the number of Americans who are vulnerable to suffering the effects of healthcare disparities will rise over the next half century. These trends pose a daunting challenge for policymakers and the healthcare system. Wide disparities exist among groups on the basis of race / ethnicity, socioeconomic status, and geography. Healthcare disparities have occurred across different regional populations, economic cohorts, and racial / ethnic groups as well as between men and women. Education and income related disparities have also been seen. Social, cultural and economic factors are responsible for inequalities in the healthcare system.

The issue of racial and ethnic disparities in healthcare have exploded onto the public stage. The causes of these disparities have been divided into health system factors and patient-provider factors. Health system factors include language and cultural barriers, the tendency for racial minorities to have lower-end health plans, and the lack of community resources, such as adequately stocked pharmacies in minor neighborhoods. Patient-provider factors include provider bias against minority patients, greater clinical uncertainties when treating minority patients, stereotypes about minor health behaviors and compliance, and mistrust and refusal of care by minority patients themselves who have had previous negative experiences with the healthcare system.

The explanation for the racial and ethnic disparities is that minor tend to be poor and less educated, with less access to care and they tend to live in places where doctors and hospitals provide lower quality care than elsewhere. Cultural or biological differences also play a role, and there is a long-running debate on how subtle racism infects the healthcare system. Inadequate transportation or the lack of knowledge among minorities about hospital quality could also be factors of inadequate care. Racial disparities are most likely a shared responsibility of plans, providers and patients. There's probably not one factor that explains all of the disparity, but health plans do play an important role. Racial and ethnic disparities in healthcare do not occur in isolation. They are a part of the broader social and economic inequality experienced by minorities in many sectors. Many parts of the system including health plans, health care providers and patients may contribute to racial and ethnic disparities in health care.

It is seen that there are significant disparities in the quality of care delivered to racial and ethnic minorities. There is a need to combat the root causes of discrimination within our healthcare system. Racial or ethnic differences in the quality of healthcare needs to be taken care of. This can be done by understanding multilevel determinants of healthcare disparities, including individual belief and preferences, effective patient-provider communication and the organizational culture of the health care system.

To build a healthier America, a much-needed framework for a broad national effort is required to research the reasons behind healthcare disparities and to develop workable solutions. If these inequalities grow in access, they can contribute to and exacerbate existing disparities in health and quality of life, creating barriers to a strong and productive life.

There is a need to form possible strategies and interventions that may be able to less and sometimes even eliminate these differences. It is largely determined by assumptions about the etiology of a given disparity. Some discrepancies may be driven, for example, by gaps in access and insurance coverage, and the appropriate strategy will directly address these shortcomings. The elimination of disparities will help to ensure that all patients receive evidence-based care for their condition. Such an approach will help establish quality improvement in the healthcare industry.

Reducing disparities is increasing dramatically seen as part of improving quality overall. The focus should be to understand their underlying causes and design interventions to reduce or eliminate them. The strategy of tackling disparities as part of quality improvement programs has gained significant attraction nationally. National leadership is needed to push for innovations in quality improvement, and to take actions that reduce disparities in clinical practice, health professional education, and research.

The programs and polices to reduce and potentially eliminate disparities should be informed by research that identifies and targets the underlining causes of lower performance in hospitals. By eliminating disparities, the hospitals will become even more committed to the community. This will help to provide culturally competent care and also improve community connections. It will stimulate substantive progress in the quality of service that hospitals offer to its diverse patient community. Ongoing work to eliminate health disparities will help the healthcare departments to continuously evaluate the patient satisfaction with services and achieve equality in healthcare services.

It is important to use some interventions to reduce healthcare disparities. Successful features of interventions include the use of multifaceted, intestinal approaches, culturally and linguistically appropriate methods, improved access to care, tailoring, the establishment of partnerships with stakeholders, and community involvement. This will help in ensuring community commitment and serve the health needs of the community.

There is the need to address these disparities on six fronts: increasing access to quality health care, patient care, provider issues, systems that deliver health care, societal concerns, and continued research. A well-functioning system would have minimal differences among groups in terms of access to and quality of healthcare services. This will help to bring single standard of care for people of all walks of life.

Elimination of health care disparities will help to build a healthy America. Improving population health and reducing healthcare disparities would go hand in hand. In the health field, organizations exist to meet human needs. It is important to analyze rationally as to what actions would contribute to eliminate the disparities in the healthcare field, so that human needs are fulfilled in a conclusive way.

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Evolving Healthcare Trends

The model trends in the healthcare system have been changing over the period of time. The old trend cave importance to the individual patients and the emphasis was on treating sickness. The goal of the hospitals was to do inpatient admissions, fill up the beds and more emphasis was given to acute inpatient care. The role of managers in the old paradigm was to run the organization and coordinate services. In the old system, all providers were essentially the same. The hospitals, doctors and health plans were separated and not integrated.

The newer trends that evolved cave importance to the population as a whole. It not only treated illness, but embarked on promoting the wellness of the people. The goals of the healthcare system after being transformed over the years is to provide care at all levels which is maintained. The role of managers in the new paradigm is more broad. They see the market and help in quality and continued improvement. They not only run the organization, but also go beyond the organizational boundaries. In the evolving system, the providers are differentiated according to their ability. The hospitals, doctors and health plans have formed an integrated delivery system.

One of the current trend in the healthcare delivery model is that continued care is emphasized. The key professionals are not only treating patients for their illness, but they are promoting and managing quality of health. For example, a patient with high cholesterol visits a doctor. He is not only given one-on-one medical treatment, but he is also offered to attend a group session where information is provided on how lifestyle and behavioral change can help. The patients learn from the clinicians and also from each other. Another current trend is to take care of the health of the defined population and not only individual patients. All the health needs of the population as a whole are identified and served. It is emphasized that the community uses the health and social services provided. Healthcare has become more population-based. Another trend that has evolved is that the hospitals, doctors and health plans have gotten connected and have formed an integrated delivery system. More investments are being made with a goal of providing services to the customers and retaining them.

There is a beneficial impact in the transformation of healthcare towards emphasizing continued health. The way healthcare has been viewed in the past has been changing. The shifting of care from treating acute illnesses to providing continued care is resulting in enhancement of the health of the people. The only appropriate and feasible model is to provide a continuum of care with the emphasis firmly on the family and community. The health of the population and community is considered as a whole. This is advantageous as it creates value in the healthcare delivery system. The healthcare providers work with the community as a whole and consider to improve the health of the general population. Even though this requires new kinds of ways of organizing and managing healthcare services, it helps in understanding the health needs of the target population. By studying their needs, the right health and social services could be provided to them. Examples of promoting wellness of the whole community are organizing health campaigns and providing preventive education to the people in general. Another example is providing awareness about flu vaccines and encouraging people to get the vaccination.

Integrating the healthcare delivery system has led to certain advantages to the patients. For example, they can be offered alternative sites of care depending on their convenience. It helps in meeting the needs of the customers and their preferences which is taken into account. The number of providers are expanded and the patients get to have a choice. The relationship between providers and health plans are organized in the current trend and this ensures that the right care is provided in a convenient way to the customers.

There are defined budgets and expenditure targets for the population which implies that there is a need to be efficient and productive. The formation of strategic alliances, networks, systems and physician groups can also add value. There are labeled payments and budgets allotted to the healthcare organizations. These are used to provide care to the defined population. The organization might like to improve on the payments and budgets as the expenses of the companies increase. This results in the management to make decisions like forming strategic alliances with other organizations and increase the total resources. The growth of such networks will help in providing better care to the customers. Financial resources greatly influence the efficiency and productivity of the organization.

The aging population is influencing the healthcare delivery. There is increased demand for primary care of people over 65 years and for chronic care of people over 75. The ethnic and cultural diversity is also influencing the healthcare delivery. This provides a challenge in meeting patient expectations on one hand and diverse work on the other. Biological and clinical sciences have met with technological advances and have led to new treatment modalities. This has led to open new treatment sites and manage across the organization. External forces change the supply of certain areas of health professionals like physical therapy and some areas of nursing. The management needs to compensate for such shortages and they need to develop different teams of caregivers at different work sites. Changes in education of health professionals implies that the management will be more creative in offering healthcare services. With an increase in diseases like AIDS and morbidity from drugs and violence, there is more and more need to work with community agencies, form social support systems and there is a need for more chronic care management. Advances in information technology is another area where there is a need to train the healthcare employees in new advances. They also need to manage issues of confidentiality and rapid information transfer. Increasing expansion of world economy has led to more competitive management of strategic alliances, care of patients across the nations and of different cultures.

Current environmental trends impact the healthcare delivery model. Organization's success depends on its external and internal environment. The complex environments made up of uncertainties and heterogeneity of components leads to different organizational designs. The current environmental trends influence administrative and organizational decision making. The unique challenges facing the healthcare delivery organizations should be analyzed in order to develop and implement new and effective operational processes and strategies. As an impact of current environmental trends, the health delivery system needs to improve individual, team, and organizational accounting and performance. The impact of advances in medical knowledge and information technology on the process of healthcare delivery should also be examined, and it should be leveraged to improve quality of care, process and cost controls, and revenue. New strategies would need to be identified and implemented for learning and performance improvement to create a culture that supports accountability, safety, and high-quality care. Innovative models in healthcare delivery would also be required in order to develop and implement strategies that promote organizational success and competitiveness.

Due to the current environmental trends, more emphasis is given to the customers and there is more of a patient-focused care. The healthcare delivery model has been shifting to the community based care. There has been an increased modification in care processes. The traditional ways are being challenged and more experiments are being performed to fulfill the demands to improve the quality of care. Due to the shift in the environmental trends in the healthcare delivery model, more emphasis is given to quality improvement. This will help improve the performance levels of key processes in the organization. The performance levels are being measured, the defects are eliminated and new features are being added to meet the customer's need efficiently.

There is a new emerging contemporary trend in the US healthcare system. Presently, the management research and assessment have been offered increased recognition. The emerging trend seen is that this is slowly forming an integral part of administrative and organizational effectiveness. With the emerging efforts in information management, it is leading towards clinical and financial networking. The trend seen among the doctors and nurseries is that they are being incrementally involved in managerial activities. The managerial trends are also changing with respect to role performance and changing values. The managers role is getting more and more recognized in managing finance and human resources. Management training, lifelong and distance learning is being offered in preparation future managers.

The healthcare executives and managers will be faced with the major responsibility and challenge in the years ahead. They will be working with other healthcare providers and will be creating a competitive future for their organizations. They will not only be managing organizations but also a network of markets, services and joint ventures. Formation of more and more strategic alliances and partnerships will lead the management to manage across boundaries. The management will change from managing a department to managing the continuum of care. The management will be following a community-based approach. Trend in management is also shifting from just coordinating services to providing improvements in quality.

As the demands in healthcare are increasing, the management is responsible for forming performance standards. The management is also challenged to maximize the productivity and quality to serve the health needs of the community. The management is looking after the demands of the external environment as well as attending to the performance of the internal environment. The management is responsible for the performance of the organization.

Healthcare organization leadership will be responding to new trends and competitive forces. It will respond to continuum of care, overall health status of the population and and more complex organizational structures. These emerging trends in the healthcare system will effect the organization's leadership. The future managers would need leadership skills and vision to integrate the organizations and help in providing the best care. The managers will have to be committed to leadership and work on giving their organizations the best place and help their organizations adapt to the changing circumstances. More value will be given to leaders who will be able to lead the change process. As changes are inevitable for the betterment of the organization, the leaders should be able to identify how the change is to be received and how it is to be communicated at all levels of the organization without damaging the implementation process. The leaders may have to deal with increased pressures due to organizational complexity.

The leader in the organization provides strategic direction to the organization, manages diverse stakeholders, becomes mentors for management, is willing to take risks, helps the organization interact with the external environment and attends to the internal needs as well. Where required the leader will involve physicians in governance process and align physician and organizational interests. There will be a need for formation of learning organizations. Transformational leadership will create the required vision for the organization. Leaders will have a greater role complexity and they themselves will have to adjust quickly to new situations. The health organization leadership will have to live up to the values ​​of the organization and will help in fulfilling the mission of the organization.

Individuals and groups within the healthcare organizations require more and more competencies. An enhanced lifelong learning is required due to the fast, changing environment. The individuals and groups within the healthcare organizations will be benefitted as there will be rapidly developing medical technologies which will result in increased services. More sophisticated health services will be provided to the consumers. The range and quality of services provided will be regulated for the benefit of people requiring home care, long term care and ambulatory care. The anticipated future development will also result in the increased competition among the health services organization. The individuals and groups will be involved more and more with the community for issues like drug abuse, teenage pregnancy and violence.

Individuals and groups will be faced with increased strategic planning and management in the healthcare organizations as there will be ever increasing involvement by the trustees and doctors. As the future environment in the organizations will be more complex, the individuals and groups in the healthcare organizations may feel more pressurized. They will need to serve the changing demands of the community as the population of elderly patients will increase. These individuals will require more professional training, increased levels of education and should be taking part in continuing education programs.

Due to the anticipated future development in the healthcare organizations, those individuals and groups will be valued, who are adaptable, committed, are able to add value and embrace change. These individuals will be required to experiment more and help in redefining the mission and goals of the healthcare organizations.

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The Value of a HIM Specialist – The Key to ICD-10 Success

Having spent time in many healthcare demand markets, primarily on the clinical side … it is exciting to be involved in the HIM and Revenue Cycle Management side of the Healthcare profession. It is also unique to see how C-Level leaders and Revenue Cycle professionals are attacking the pending coder shortage and technology changes ahead. I often discuss the pros and cons of different strategies that face Healthcare executives in managing the impending coder shortage. Since reimbursements risks affect all parties in the healthcare service supply chain, Executives are faced with two choices on how to proceed with their human capital plan to support implementation and execution:

1. Choose to focus on developing in-house capabilities
2. Outsource coding to a trusted partner

As successful risk managers, many executives do not realize the risk or cost of trying to develop in-house capabilities. Not until there are issues and lost revenues with poor coding, backlog of DNFB, or other concerns do executives begin to see the significant investment of time and resources with no guarantee of on-time delivery or success. Recruiting, hiring, managing, training and retaining coders in this time of rapid change has never been so difficult or COSTLY. Healthcare organizations are not structured to support rising salaries or market demands that are occurring in the HIM space. This is especially true with productivity Declarations that will put added burden on healthcare executives responsible for reimbursements and revenue cycle. Productivity will be stalled or decline every time there is staff attrition or while employees are learning proper coding in ICD-10. The learning curve will be quite a journey – almost a “learn as you go” scenario. With ICD-10's expanded code set there is more to know and consider creating significant billing and patient issues. Michael Arrigo, Managing Partner of No World Borders states that “One of the most important risk mitigation strategies for ICD-10 will be choosing and empowering leaders. quality improvement program as well as a regulatory compliance effort. ”

In my work with leading healthcare executors who are facing the coder shortage, they value a specialist who can provide a solution to managing the impending coder shortage. It is ironic that in an industry like healthcare – that is so specialized, that often outsourcing or specialization is looked down upon as a necessary evil. According to Veronica Hoy, “Outsourcing may seem like a more expensive alternative, but it's important to consider the value of this type of expertise. and the opportunity costs of lost time, outsourcing emerges as a potential more economic and value-added alternative. ”

Leaders need to have a forward thinking approach to ICD-10 implementation and the reality of the coder shortage and productivity drains that will arise. Many successful leaders are already utilizing the expertise and specialization available to them in the market and investing accordingly. These leaders have adopted a strategy of success for the whole organization – not just a plan to get it done. In the white paper produced by the ACHE – Cost Cutting in Health Systems Without Compromising Quality – it is pointed out that “challenging times require leadership to both create the changes needed in the new environment and to keep the organization steady in its pursuit of its noble mission “. Having a true specialist and partner can ensure a successful mission.

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