FDA reform, telehealth top of health IT legislative agenda

From POLITICO PROFDA_reform__telehealth_top_of_health_IT_legislative_agenda_-_David_Pittman_-_POLITICO

The GOP promise, as is well known, is to spend less taxpayer money and unfetter the creativity of business. These goals extend to the party’s 2015 program for health IT, though not everyone believes they will achieve either.

Legislation to restrict FDA action in the health IT sphere is expected to move in the 114th Congress, since all three candidate bills enjoy bipartisan support. Some critics, however, say the bills aren’t really necessary because FDA has already clarified that it won’t regulate low-risk IT.

Another item atop the legislative agenda would expand Medicare payments for telemedicine services — which champions of the technology are confident would lower overall health costs in spite of a battle over congressional cost estimators.

Here is a rundown of the top legislative items, mainly restricted to telemedicine, expected in the coming year:

A staffer for Blackburn called the SOFTWARE Act a “linchpin” of the House Energy and Commerce Committee’s 21st Century Cures bill, which would include items aimed at stimulating development of medical devices and drugs. The committee has been drafting a bill after six months of hearings. A “discussion draft” of the Cures legislation is expected to be circulated in January. But Blackburn said SOFTWARE could move on its own.

The Hatch-Bennet bill could have the upper hand, some say, given the influence of its sponsors and its greater specificity about what products should be regulated. Hatch and Bennet were behind the 2012 FDASIA language, which directed FDA to study how it would regulate health IT.


Telemedicine is sure to be a component of the 21st Century Cures package, the committee and lobbyists say. The question is how much change lawmakers will seek.

Medicare’s restrictions are so tight that the program paid a mere $12 million for telemedicine last year; those who want to free up more money are hampered by the lack of evidence that it will help older Americans while saving Medicare money.

Legislation offered by different lawmakers in the last year would expand the service at different rates.

The Telehealth Enhancement Act, which has backers in the House and Senate, would waive Medicare’s restrictions for home health services, critical access and sole community hospitals, and in some cases, hospice care, home dialysis patients and homebound seniors.

The Medicare Telehealth Parity Act expands coverage of certain services to federally qualified health centers and health clinics in three phases — covering small, medium and larger metropolitan areas.

It remains to be seen which bill will stick. Much depends on the Congressional Budget Office and what it has to say about how much different legislative proposals will cost. Reports that CBO Director Doug Elmendorf could be on his way out, if true, could mean the GOP will find a budget chief more to its liking, but that doesn’t necessarily mean a better score for telemedicine.

Much also depends on how far the House Energy and Commerce Committee wants to go with its 21st Century Cures bill. The bigger the swing, the more money it will cost and harder it will be to pass.

Licensure is another area of potential change. The TELE-MED Act, backed by Reps. Devin Nunes (R-Calif.) and Frank Pallone (D-N.J.), would allow physicians to treat Medicare patients in all 50 states with a single medical license. The measure has 64 co-sponsors, but isn’t guaranteed passage.

Hospitals have asked Congress to create new exceptions in federal anti-kickback laws to allow purchases of telemedicine equipment for doctors’ offices that would otherwise have trouble affording it. Such practices are illegal now because the purchases would theoretically provide hospitals unfair referrals. Similar laws are gray on the area of lending home health and remote monitoring equipment to patients.

Those who have met with Energy and Commerce staff say the committee is open to their requests. But one telemedicine lobbyist said to expect more incremental progress than touchdowns.


Arthur Allen contributed to this report.



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January 3rd, 2015

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Rural Rheumatology Telemedicine Services Satisfy Patients

from HCP Live

MONDAY, Dec. 29, 2014 (HealthDay News) — Patient satisfaction is high with a rural rheumatology telemedicine service, according to a study published online Dec. 20 in the International Journal of Rheumatic Diseases.

Katherine A. Poulsen  and colleagues, from The Townsville Hospital in Australia, examined patient satisfaction with the rheumatology telemedicine service provided in a rural town in Southern Australia.

Data were collected from 107 rheumatology outpatients (49 seen at local telemedicine clinics, 46 travelled to be seen face-to-face, and 12 seen at an infrequent local face-to-face clinic).

The researchers found that:

  • Satisfaction with themes relating to quality-of-care was high;
  • More than 90% of patients agreed or strongly agreed with these questions.
  • There were no significant differences noted in the rates of those selecting “strongly agree” across questions comparing models of care, except for one question relating to rapport, in which the local face-to-face model was favored (P = 0.018).
  • Sixty-three percent of patients disagreed or strongly disagreed that they would rather travel for a face-to-face appointment than participate in a telemedicine consultation.

“These results suggest that patients are satisfied with a rheumatology telemedicine service, and may prefer this to extensive traveling,” the authors write. “Evaluation in other settings is recommended before generalizing this finding.”


COMMENT: Patients are satisfied and with convenient access plus elimination of time and cost for transportation are very appealing.



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December 30th, 2014

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Will 2015 deliver the promise of telemedicine?


Image Credit: Andrey_Popov / Shutterstock

Venture Beats reports:

The year of 2014 was a big year for telemedicine. The idea of using technology to provide remote health care has been around for years, but it really started to take off this year with the proliferation of wearable devices, and providers starting to embrace seeing patients through video chat.

In July, Dignity Health unveiled telemedicine robots to bring in specialist physicians from remote locations. Then, in October, Google unveiled a new ‘talk with a doctor now’ video chat service. Even pharmacies got into the act, with remote medical kiosks popping up in Walgreens, CVS, and Wal-mart.

There are several indicators that 2015 will be the year that telemedicine really takes off. Read any predictions related to healthcare, and telemedicine is central in those discussions. Here are just some of the indicators:

  • The Global Telemedicine market in 2016 is predicted to be $27 billion, with Virtual Health Services making up $16 billion of that amount (BBC Research and Towers Watson).

  • By 2018, 65 percent of interactions with healthcare organizations will be done via mobile devices, and by 2018 70 percent of them will have apps, offer wearables, do remote health monitoring, and even offer virtual care (IDC).

  • More than one-third of the money Google Ventures invested in 2014 went to healthcare and life-sciences companies.

Telemedicine will certainly deliver significant financial benefits and efficiencies for players in the healthcare space, including providers and insurance companies. For example, virtual health has the potential to reduce all doctor visits by 93 percent at a savings of $103 per visit ($1,067 per emergency room visit). Fifty percent of all doctor visits can be conducted virtually, and 70 percent of all electronic medical record (EMR) visits can be conducted virtually. The big winner in the rise of telemedicine, however, is the patient. With new technology and capabilities, the patient can receive faster, better quality care with superior outcomes.

This all sounds promising, but is telemedicine guaranteed to explode in 2015? Not exactly. The following needs to happen for this growth to occur:

  • Virtual diagnosis and on-the-spot treatment are combined. Many companies offer to connect patients to doctors via video calls. However, the best that most of these companies can do is conduct a virtual diagnosis; the patient still needs to see a doctor in person to get treatment. Mobile-friendly diagnostic devices such as Tyto enable doctors to complete a more thorough diagnosis and provide on-the-spot treatment. As these devices become more accessible (either directly purchased by individuals, provided as a part of a service such as WorldClinic, or incorporated into local health kiosks), patient treatment can begin immediately before the patient even gets off the phone, resulting in better outcomes for the patient and the healthcare. [Disclosure: WorldClinic is one of Highnote Foundry’s current incubator companies.]

  • The best in connected devices are used. The healthcare industry is starting to leverage the data patients already get from personal FitBits, Apple Health, and other consumer health tracking systems. By creating a normalized set of patient and care data and by integrating these connected devices, tele-health providers can both lower the cost of care and improve overall patient outcomes. For example, American Well’s direct-to-consumer app integrates health related data, such as heart rate, blood pressure, and blood glucose levels into its video visits app. Providers should not be reliant on any one technology or system but rather invest in a scalable model that integrates and assesses the data from any wearable or connected device to deliver personalized, remote care that is genuinely preventative.

  • Post-treatment care and compliance are provided. Most discussion of device-based monitoring centers around prevention but stops short of tracking patient responses to ensure that treatments are effective and modifying treatment as necessary. For example, First Opinion is one organization that provides an anonymous service of text-based responses within five minutes from doctors. First Opinion bills itself as being in the “relationship business,” and its doctors are supposed to stay in touch with patients past the initial contact until they are sure the issue is resolved. Prevention and compliance should be the real goals of telemedicine and are the way to truly drive significant reduction in costs. To do this, providers need to understand the patient’s past medical history and also capture all of the new data associated with telemedicine into an electronic record that follows the patient. Finally, integration with the patient’s existing set of healthcare providers, including specialists, pharmacies and even family caregivers will be essential. Together, this will mean opportunities for entirely new healthcare technology platforms.


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December 29th, 2014

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Dr. Rogove to speak on ICU telemedicine at Society of Critical Care conference January, 2015 in Phoenix

All are invited to hear Dr. Herb Rogove, CEO of C3O Telemedicine to speak at annual SCCM symposium in Phoenix on January 18, 2015. While the original topic is incorrect, his topic is looking at the financial aspects of ICU telemedicine including why the issue is both complex and confusing.SCCM 2015 Telemed Lecture


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December 28th, 2014

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Telemedicine clinics make student care easier

A new virtual health initiative is coming to Carencro schools.
LAFAYETTE, La. – Lafayette General Medical Center is making it easier for school nurses to treat students.The Lafayette Parish School System’s telemedicine program is an addition to the district’s school based health system, which is housed at Carencro Middle School.The Lafayette General Medical Center Foundation donated the technology to launch the telemedicine clinic at Ossun Elementary, and it has changed the operations of the school nurse’s office.

“Anything that can be done at a small clinic can be done here,” said Maurdey Durand, Ossun’s school nurse. “I think it is very beneficial because the kids that can stay at school can stay and we do it comfortably.”Now, she can connect with a medical doctor through a TV screen to treat students.

“The idea is to keep them more in their seat, but we’re also offering services to kids who might not otherwise have them available,” said Dr. Donna Jean Wilson, who teleconferences with Durand and students for appointments.

Ossun Elementary is the flagship campus for this cutting edge technology.

“This is very much a service and solution for parents. We have a lot of single parent families, and it’s very difficult, and when you get the phone call your child is sick you have to leave work.”

Each setup costs somewhere in the ballpark of $15,000 to $30,000 dollars–an investment the Lafayette General Health Foundation feels is worth every penny.

“We are the communities non-for-profit hospital system, so the community owns us, and so doing something like this is giving back to the community,” said Cian Robinson, the executive director of the Lafayette General Medical Center Foundation

The program helps eliminate the need for a student to miss class for headaches, toothaches, and other aches and pains that would typically send them home.

Now, they’re in and out in 30 minutes or less.

“It’s important for us in the school system that the students can be treated for minor illnesses and injuries here at their school and return to class,” said Bradley Cruice, the director of health and wellness for the Lafayette Parish School System.

Robinson says new telemedicine clinics will come online in the next 90 days at three other Carencro-area schools.  The clinics will be located at Carencro Heights Elementary, Live Oak Elementary, and Carencro High.


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December 26th, 2014

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A limited role for telemedicine in the Dutch intensive care unit

from PubMed

[Article in Dutch]


The use of telecommunication and information technology has evolved rapidly in many areas. However, it has not kept pace for the organization of medicine. It can be expected that e-Health will revolutionize the landscape of medicine in the coming years. Due to a shortage of intensivists, with the 24/7 availability of an intensivist in less than 30% of ICUs, tele-ICU care has been introduced in the U.S. with proven beneficial effects on patient outcome and economics. This cannot be compared with the Dutch situation where there are short distances between hospitals, ubiquitous, excellent infrastructure for patient transport and a sufficient number of intensivists. Furthermore, an ICU is not only characterized by its own means in terms of human resources and equipment, but also by the 24/7 availability of other (critical) medical specialities in the hospital. The contribution of tele-ICU is therefore limited in the Netherlands but might play a role for second opinions and consultation for highly specialized expertise.


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December 24th, 2014

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Sir Richard Branson Embraces Telemedicine with Mediaplanet’s “The Future of Healthcare” Campaign

From Mediaplanet

>PRWEB.COM Newswire(PRWEB) December 19, 2014 

With the rapidly evolving healthcare landscape, Mediaplanet has joined forces with the American Medical Association, Sir Richard Branson and many more to educate readers on the plethora of groundbreaking innovations that are available in the industry to reclaim their health.

The print component of “The Future of Healthcare” will be distributed within this weekend’s edition of USA Today, in New York, Chicago, Los Angeles, Minneapolis, Washington D.C., Baltimore, and San Francisco, with a total circulation of approximately 450,000 copies and an estimated readership of 1.3 million. The digital component is being distributed nationally through a vast social media strategy and across a network of top news sites and partner outlets. To explore the digital version of the campaign, click here.

Investing mogul and entrepreneur Sir Richard Branson is featured on the cover of both the print and digital editions. In Mediaplanet’s exclusive interview with the icon, we discuss why he believes telemedicine is the future of healthcare. “Being smarter with data and technology will improve healthcare,” said Sir Richard. He goes on to discuss just how beneficial these advancements can be. “Doctors will be able to provide better care and patients can receive faster treatment, all at a lower cost to the industry.”

This campaign was made possible with the support of the American Medical Association, American Telemedicine Association, Kaiser Permanente, Sir Richard Branson, American Nurses Association, G. Duncan Finlay, Dr. Jess Lonner, Konica Minolta, Alive Science, Vidyo, Virtumedix, OnBase by Hyland, and Blue Belt Technologies!

About Mediaplanet
Mediaplanet is the leading independent publisher of content-marketing campaigns covering a variety of topics and industries. We turn consumer interest into action by providing readers with motivational editorial, pairing it with relevant advertisers, and distributing it within top newspapers and online platforms around the world.


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December 19th, 2014

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Just Released: Telemedicine Practice Guidelines for Live, On Demand Primary and Urgent Care

ATA just released the newly approved Practice Guidelines for Live, On Demand Primary and Urgent Care. These guidelines cover the provision of direct-to-patient, primary and urgent care services delivered by licensed healthcare providers using online, real-time videoconferencing and audio technologies. Technologies include mobile devices such smart phones, laptops or tablets where regulatory conditions permit.

These guidelines were developed by a diverse group of industry leaders and individuals including members of the Practice Guidelines Committee, Guidelines Work Group and ATA Staff.  Extensive reviews and comments concerning the guidelines were received from medical societies, health systems, provider groups, healthcare companies, medical boards and government agencies.  Access the Live, On Demand Primary and Urgent Care guidelines here:


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December 16th, 2014

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A major step for quality in telemedicine: ATA announces accreditation process

Today, ATA launched an accreditation program

for online, direct-to-consumer healthcare consultations. The program will accredit U.S. healthcare entities providing real-time, online consultations directly to the patient that meet specific standards.

The Accreditation Program will:

  • help to assure online healthcare consumers they are making good choices when it comes to online healthcare,
  • provide benchmarks for organizations building an online practice,
  • and provide reassurance for payers that the virtual services they are reimbursing follow federal and state laws and regulations, assure patient privacy, are transparent in pricing and operations, use qualified, licensed providers, and follow appropriate clinical practices and guidelines.

From Dec.15, 2014 through Feb. 28, 2015, registration for the Accreditation Program will be open to ATA Institutional Members, Sustaining President’s Circle and President’s Circle members exclusively.

Further information about the program is available here



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December 15th, 2014

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Paying for Telemedicine

Published Onlineajmc: December 12, 2014
Robert S. Rudin, PhD; David Auerbach, PhD; Mikhail Zaydman, BS; and Ateev Mehrotra, MD
Telemedicine has the potential to reduce healthcare costs, increase access to healthcare, and improve health outcomes.1,2 However, despite these prospective advantages, telemedicine has been adopted in only limited circumstances, such as for reading radiology reports and remote phone or video visits for minor health issues.3 To promote adoption, some have advocated for telemedicine services to be reimbursed by health plans and many states have issued “parity laws” that force payers to reimburse some forms of telemedicine services at a level equal to in-person care. In this perspective, we explore why health plans are reluctant to cover most telemedicine services as part of current payment arrangements and explain why newer payment models offer greater potential for its expanded and more effective use.

Telemedicine is the delivery of health-related services via telecommunication technologies, such as phones and the Internet. Although some services involve direct interaction between providers and patients.1 Others involve passively collecting patients’ data from their homes and sending the information to healthcare professionals for monitoring.

A central barrier to the adoption of telemedicine is fee-for-service (FFS), the predominant payment method in the United States. In FFS, providers submit a claim to be reimbursed for each clinical service they perform. Providers are not paid for any service not included in the payer’s fee schedule. In many cases, virtual “visits” via phone or the Internet may be as effective in delivering care as in-person visits and require fewer resources to provide.4 However, most healthcare providers who adopt virtual visits will be financially penalized because many types of visits are not reimbursed or are reimbursed at lesser amounts. The few forms of telemedicine that have been widely adopted, such as remote reading of radiology reports, are exceptions. In those cases, the technology does not jeopardize FFS revenue for the provider adopting the technology.

Proponents argue that payers should add telemedicine as a reimbursable service. Some states have enacted parity laws and Congress is considering legislation to expand FFS reimbursement of telemedicine by Medicare. However, arguments in favor of this approach meet resistance from providers and payers alike. Providers are concerned that offering telemedicine (which, other than services covered under a parity law, is usually considered lower intensity compared with in-person visits and therefore reimbursed at a lower rate) will eat up much of their income because it will reduce the need for in-person visits. Payers have the opposite concern: although telemedicine reimbursement may increase use of actual service, inappropriate use will increase costs.1 This concern regarding inappropriate use is consistent with other coverage decisions. For example, when payers expanded coverage of implantable cardiac defibrillators in the 1990s and 2000s, inappropriate use of the devices grew dramatically.5,6 Telemedicine may be particularly prone to overuse because of its key advantages—convenience and increased access.

Emerging Payment Models

Non-FFS payment models offer alternative ways to pay for telemedicine. Under capitation, the strongest form of these new models, providers receive a fixed payment to provide care for each individual. Thus, any reduction in care costs that results from using a lower-cost technology, such as telemedicine, would accrue entirely to the provider organization.

Because pure capitation involves substantial risks for providers, it is not a common payment arrangement. However, emerging models, such as Accountable Care Organizations (ACOs), involve a form of “global payment” in which providers’ payments partially depend on the total health costs that their patients incur. In ACOs, providers must also meet quality-of-care standards, thereby favoring technologies that both improve quality of patient care and reduce costs.

Evidence from health maintenance organizations (HMOs) in the 1980s and 1990s suggests that the new payment models can stimulate adoption of cost-effective technology. HMOs are similar to newer payment models in that they also typically hold providers accountable for the costs of caring for their patients. One study of HMOs found that hospitals in areas with higher concentrations of HMO patients were more likely to use low-intensity heart attack treatment technologies (eg, medical management techniques) and less likely to use high-cost technologies (eg, cardiac catheterization, angioplasty, or bypass surgery), which evidence suggests are overused.7,8 The HMO experience suggests that new payment models will likely stimulate the adoption of telemedicine, which has advanced considerably in technical capability since the 1990s, and early evidence suggests that this is the case.9,10

By placing incentives for reduced cost and improved quality in the hands of provider organizations rather than insurers, new payment approaches should help foster the efficient use of telemedicine. Under FFS, payers are often faced with blanket coverage/no coverage decisions for all providers in their network, regardless of whether FFS is being used in an appropriate or inappropriate clinical situation.11 Under new payment models, adoption decisions are made by the providers, who have the flexibility to experiment with telemedicine and use the technology in a way that maximizes clinical outcomes and minimizes costs.  We provide 2 examples of how this may happen: videoconferencing for outpatient visits, and home telemonitoring.

Videoconferencing for Outpatient Visits

Real-time video communication between patient and provider allows for many of the same benefits as an inperson visit, without requiring the patient or provider to travel. This form of telemedicine has been evaluated in research studies for decades, and several studies have shown positive effects on patient outcomes even when low-bandwidth, telephone-based Internet connections reduced the quality of the video image.12 Videoconferencing in the form of visits for new acute problems is often covered by health plans, but use of videoconferencing is uncommon, particularly for chronic illness care, where it may have the most benefit. However, provider systems that have non-FFS payment models are already making extensive use of videoconferencing. In the Veterans Health Administration (VHA), videoconferencing is used routinely to deliver mental health services.13 Kaiser, a capitated system that is providing 2.5 million “phone visits”each year, is testing videoconferencing for more general use,14 and has made more than 350 after-hours video visits to patients who claim they would have otherwise gone to the emergency department.

As more providers adopt new payment models, they will likely also begin to use videoconferencing. As an early example, the Alternative Quality Contract from Blue Cross Blue Shield uses global payments, and providers under that contract have begun piloting a telemedicine platform that enables videoconferencing visits.9 Because of global payments, the pilot practices will be motivated to prevent overuse, perhaps by triaging patient requests for videoconferences, using some form of co-pay, or making the virtual visit available only to patients for whom a physician believes it would be most beneficial.

Home Telemonitoring

Many technologies are available that measure health indicators of patients in their homes and transmit the data to an overseeing provider. The provider, who might be a physician, nurse, social worker, or even a non-clinical staff member, can filter patient questions and report to a clinical team when necessary. Several studies show the potential benefit. In a cardiac study at Partners Healthcare, 3000 congestive health failure patients received in-home monitoring of weight, blood pressure, heart rate, and pulse oximetry. Decision support software helped identify high-risk patients. As a result, readmissions dropped by 44%, saving the health plan $10 million in 6 years.15 The VHA also implemented a home telemedicine program in which the more than 17,000 patient participants had a 25% reduction in the number of bed days of care and a 20% reduction in the number of hospital admissions compared with usual care.16

As new payment models that reward cost savings spread, providers will have incentives to adopt these home monitoring technologies as part of routine care. Early reports suggest that providers are responding to these incentives: ACOs are planning to use home monitoring to prevent more costly hospital visits or emergency care.10 As with virtual visits, the new payment models will encourage telemonitoring to be used only for patients who will likely benefit from the service.


Telemedicine technologies have the potential to benefit patients by increasing access to care, promoting convenience, enhancing quality of healthcare, and reducing costs.1 However, payers and providers are unlikely to support adding telemedicine as a reimbursed service because of its uncertain effect on provider payments and its potential for overuse. Direct reimbursement might still be needed for certain telemedicine services, but such payments will likely be the exception, not the rule. Emerging payment models offer the greatest hope that telemedicine will be widely adopted and used in a way that will make it worth the cost.

Take-Away Points

  • Telemedicine offers the potential for better care, lower costs, and increased convenience.
  • Expanding existing fee-for-service payment models to include telemedicine may lead to its overuse. Already there are many skeptics among payers and providers regarding this method of payment.
  • The greatest potential for effective and efficient use of telemedicine services lies in the use of emerging payment models.
Author Affiliations: From RAND Corporation, Boston, MA (RSR, DA, AM), and Santa Monica, CA (MZ).

Source of Funding: Some of this work was funded by a generous gift from Teletracking, Inc.

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December 12th, 2014

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