Healthcare

Ask an Attorney: Understanding Medicare’s hospice benefit in cases of terminal illness

Published in The Middletown Press By Robert Scalise
Caring for a loved one during the final stages of life is difficult both physically and emotionally. Thankfully, Medicare can help ease the burden.

Medicare’s hospice benefit covers any care that is reasonable and necessary for easing the course of a terminal illness. It is one of Medicare’s most comprehensive benefits, and can be extremely helpful to both a terminally ill individual and his or her family, but it is little understood and underutilized. Understanding what is offered ahead of time may help Medicare beneficiaries and their families make the difficult decision to choose hospice if the time comes.

The focus of hospice is palliative care, which helps people who are terminally ill and their families maintain their quality of life. Palliative care addresses physical, intellectual, emotional, social and spiritual needs while supporting the terminally ill individual’s independence, access to information, and ability to make choices about health care.

To qualify for Medicare’s hospice benefit, a beneficiary must be entitled to Medicare Part A, and a doctor must certify that the beneficiary has a life expectancy of six months or less. If the beneficiary lives longer than six months, the doctor can continue to certify the patient for hospice care indefinitely.

The beneficiary must agree to give up any treatment to cure his or her illness and elect to receive only palliative care. This can seem overwhelming, but beneficiaries can also change their minds at any time. It’s possible to revoke the benefit and reelect it later, and to do so as often as needed.

Medicare will cover any care that is reasonable and necessary for easing the course of a terminal illness. Hospice nurses and doctors are on call 24 hours a day, seven days a week to give beneficiaries support and care when needed. Services are usually provided in the home. The Medicare hospice benefit offers:
• Physician and nurse practitioner services
• Nursing care
• Medical appliances and supplies
• Drugs for symptom management and pain relief
• Short-term inpatient and respite care
• Homemaker and home health aide services
• Counseling
• Social work services
• Spiritual care
• Volunteer participation
• Bereavement services

Services are considered appropriate if they are aimed at improving the beneficiary’s life and making him or her more comfortable.
Because the beneficiary is electing palliative care over treatment, there are things the hospice benefit will not cover:
• Treatment to cure the beneficiary’s illness
• Prescription drugs, other than those for symptom control or pain relief
• Care from a provider that wasn’t arranged by the hospice team, although the beneficiary can choose to have his or her regular doctor serve as the attending medical professional
• Room and board. If the beneficiary is in a nursing home, hospice will not pay for room and board costs. However, if the hospice team determines that the beneficiary needs short-term in-patient care or respite care services, Medicare will cover a stay in a facility.
• Care from a hospital, either inpatient or outpatient, or ambulance transportation, unless arranged by the hospice team. The beneficiary can use regular Medicare to pay for any treatment not related to the beneficiary’s terminal illness.

Medicare now has a hospice compare site that allows patients or their families to evaluate hospice providers according to several criteria. Visit the site at medicare.gov/hospicecompare.

To download Medicare’s booklet on the hospice benefit, go to medicare.gov.
Robert A. Scalise Jr. is a partner of Ericson, Scalise & Mangan, PC in New Britain. For information, visit esmlaw.com.

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VA launches mobile app to streamline veterans’ access to health records, resources

Published in Becker’s Healthcare by Jackie Drees
Department of Veterans Affairs released a new mobile application that aims to simplify veterans’ and caregivers’ access to healthcare information by storing it on a single platform.
Four things to know:
1. The new app, called Launchpad, organizes more than 20 VA health apps into five categories: health management, healthcare team communication, vital health information sharing, mental health improvement and quality of life improvement.
2. Users will be able to view and share their VA EHR data, schedule VA appointments and refill prescriptions, among other functions, on the app.
3. The app also includes free mental healthcare tools for individuals who are not enrolled in VA healthcare services.
4. Launchpad is available for download on Apple and Google devices.

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National Nurses Week Spotlights Most Trusted Profession

Published in nurse.com by Eileen Williamson, MSN, RN

You are celebrated during National Nurses Week for the many contributions you make to the nursing profession and the healthcare of our nation. The word “excellence,” in fact, is one we hear more than any other during Nurses Week.

Hospital executives and administrators, board members, physicians and various healthcare professionals join in the celebrations because they know that without you, their patients would not receive the same level of care.

At each event, you are recognized and applauded for your numerous achievements and accomplishments by your fellow nurses and other healthcare professionals who work closely with you and understand firsthand the excellence you bring to all you do.

Newspapers and TV stations run stories on outstanding nurses and nurse heroes who have gone above and beyond in their patient care.

Grateful patients and family members post their gratitude on social media. Even Hallmark sells nurse-themed greeting cards. My memories and recollections of Nurses Week I can’t recall a May during my four decades of nursing that didn’t include a National Nurses Week celebration. Over the years, the week became an important one for nurses across America, and each of them celebrated in some way, for the same types of reasons, at the same time.

I recall the planning that went on in anticipation and the special camaraderie and professional collaboration we all felt because we were working together. There were special gifts and meals, and each event was important. Everyone got involved and took on some type of assignment to make each event meaningful and memorable.

I remember how much it meant to all of us, and how each one of the days of our celebrations had programs to recognize different things. Who was in charge on what day was an important detail.

Celebrations took place on different shifts, and members of hospital administration came in at different times around the clock to visit patient care units and meet, greet and thank the nurses on duty. There were programs at which awards were given for research projects, poster presentations, advances in safety, recognition of special accomplishments in patient care and leadership, and more. Nurses were honored for leading special initiatives, spearheading change and heading up important projects.

I remember, too, that each year the art and science of nursing was recognized in some way. Since the time of our founder — Florence Nightingale — the art and science of nursing have been defined in different ways, and I think many of us have our own definitions.

To me, the art of nursing is the unique and individual piece of self each of us brings to our practice. The knowledge, theory, skill and experience we share with our patients is the science. Celebrations have changed over time, but the recognition of nurses’ scientific achievements and creative accomplishments have remained.

The two always worked beautifully together and were celebrated — together and beautifully as part of each Nurses Week.

Let’s revel in the meaning of Nurses Week together This week there will be many excellence programs and award ceremonies in healthcare facilities across the country, and each one will reinforce that our nursing careers are gifts for us to hold on to, treasure and nurture.
As you reflect on the meaning of this special week, we hope you will read our special National Nurses Week issue as a keepsake.

Read it, share it, refer back to it and take in all it has to offer.

Nurses, always remember to:
• Stay involved, current and abreast of professional research and advancements.
• Participate in your nursing organizations, conferences, conventions and seminars.
• Advance your education and professional certifications.
• Continue to work and learn together.

In the celebration of each Nurses Week over the course of my career, I’ve seen nurses move from rendering care to planning and designing it. In so doing that, nurses have changed the face of our profession and of healthcare. I’ve seen the public come to know us better as they met us in almost every healthcare encounter they had. It’s not just in the emergency room, operating room, delivery room or patient room, but also in physicians’ offices, ambulatory care, urgent care centers, board rooms, courtrooms and more.

I saw that in the end, the people have come to see us as the most trusted and ethical profession of all. And that gives all of us something really big to celebrate this week.

Happy National Nurses Week!

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New Year is a good time for Veterans to review benefits

The New Year is a time for resolutions and fresh starts. For veterans it’s also a good time to review their benefits with a professional to ensure they are receiving the benefits they have earned through their service and sacrifice.

“All veterans should occasionally check with a Veterans Service Officer to see if changes in a veteran’s circumstances or changes to benefit policies may have modified the programs a veteran may be eligible to receive,” said Brian Natali, chief, Division of Veterans Services and Programs with the Pennsylvania Department of Military and Veterans Affairs (DMVA). “Veterans should take these important steps to secure their benefits, and there are numerous accredited Veterans Service Officers and organizations eager to help.”

Natali said safeguarding military paperwork, especially the DD-214, which is used to verify military service, is an important first step.

The easiest way to manage military documents is to make sure they are filed in a safe place immediately upon leaving the military. Veterans often find that filing their documents for free at their county courthouse of record is an easy way to secure them until needed, which can often be decades into the future.

Another key step, says Natali, is for veterans to apply for federal health care and state benefits by visiting their local county director of veterans affairs or area accredited service organizations to take a look at what benefits they may be eligible for and to get help applying for those benefits.

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How to Plan, Prepare, and Realistically Pay for Long-Term Care

Published in caringfromafar.com

When you plan for your future, do you include any plans for long-term care? It’s an aspect of life that too many adults fail to properly plan for, and that can leave seniors and family members struggling to find a solution. So, if you really want to prepare beforehand, you need to make some smart plans to cope with and pay for long-term care.

Focus on Your Long-Term Care Strategy First

Use Medicare to Your Advantage

Before you begin setting aside funds for long-term care, it’s important to have a good idea of what that situation may look like for you or a loved one. For many older adults, this means taking a look at how Medicare will offset any long-term care needs. While Medicare and Medicaid offer little long-term care assistance, the former can offer peace of mind through Medicare Advantage plans. These supplemental plans cover more of your future care, but it’s important to know the enrollment dates so you don’t miss out on this opportunity.

Know What Factors Put You at Risk

Another smart way to plan for long-term care is to examine your family history and lifestyle choices. For example, seniors with Alzheimer’s are likely to need progressive long-term care, and this is a condition which tends to be passed on from one generation to the next. But knowing you have a risk of developing dementia or Alzheimer’s also allows you to make changes in your life to potentially halt the impact of these illnesses. You can exercise more, change your diet, and even use puzzles and games to help decrease your need for long-term care in the near future. Cognitive decline is a major risk factor for long-term care, but serious falls can be a culprit as well. Also, dedicate some time to making your home a safe spot to age in place.

Put Together Your Plan to Pay for Care

Photo by Pixabay

Assess Your Insurance Coverage Options

You know that Medicare Advantage plans can help seniors stay better prepared for the future, but do you know how Medicare or health insurance covers long-term care costs? This may be a shock, but Medicare and Medicaid offer minimal long-term care coverage. In fact, the only aspects most health insurance plans will pay for are actions directly related to your health. So, the more routine care that most long-term care seniors need likely won’t be included in your average healthcare coverage. For many seniors, this is where options like long-term care insurance come in handy. If you plan ahead, this supplemental coverage is not as expensive and can offset some of the financial burdens. Understanding this kind of coverage can be a challenge, so make sure you carefully read through and research policies before you commit.

Research Other Viable Ways to Pay for Care

Medicare may not help, and long-term care insurance is not the perfect option for everyone. So, how can seniors find other ways to make sure they get the long-term help needed? Thankfully, there are some smart solutions to help give seniors and their families financial peace of mind. If you have served in the military, you may be eligible for more comprehensive VA coverage for your future care needs. It’s a benefit many veterans and loved ones forget, but this assistance is priceless for those struggling to find ways to afford long-term care. For adults who are not veterans, there may still be tools to help with costs. Financial assistance is available for seniors and family caregivers, but you can also reduce the expenses of care by carefully researching facilities and care providers. In essence, you can cut down your expenses by planning ahead.

Long-term care doesn’t have to be stressful, expensive, or, most importantly, an afterthought. It’s an essential step most adults will likely face at some point in the future. So, you should plan for long-term care just like you do any other important aspect of life and give yourself and your family some needed peace of mind in the process.

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Hospice month celebrates success of nation’s first coordinated care model

Published in The Hill by Edo Banach, Opinion Contributor

While there’s no shortage of partisan disagreements on Capitol Hill, one hopes the combative environment that’s become the norm in Washington might take a brief pause now that midterm elections are behind us. At a time when unity and common ground are sorely needed in our politics and our policymaking, one health care program stands out as a reminder of how bipartisanship works at its best: the Medicare Hospice Benefit.

This extraordinary policy achievement was made possible by lawmakers who put aside their differences in the interest of the Americans they served. Enacted as a demonstration in 1978 and a Medicare benefit in 1982, hospice programs have served millions of Americans and their families with compassionate care to relieve pain, manage symptoms, supported beneficiaries and their family caregivers, and provided bereavement services for individuals following the death of a loved one. The benefit has been invaluable to patients and lifesaving for families. And it never would have happened without lawmakers who were committed to the concept, and to working together.

Democrats, including Sens. John Glenn (Ohio) and Bill Bradley (N.J.), joined with Republican senators like Bob Dole (Kan.) and Chuck Grassley(Iowa) to pass what then-Rep. Leon Panetta (D-Calif.) called a “political miracle.” Sen. John Heinz (R-Pa.) personally collected commitments from 68 senators to pass the Heinz-Dole-Packwood amendment to provide hospice services to terminally ill Medicare patients.

Not only did this bipartisan act show how a diverse group of legislators could come together for the good of the country but the hospice benefit itself has become an example of how our fragmented health care system can – and should – work together for the betterment of patients. As America’s original coordinated care model, hospice brings together a multidisciplinary team of providers to meet all aspects of a dying patient’s physical, spiritual and emotional needs. No other health care sector is required to address all aspects of a patient’s, and their family’s, health and wellbeing.

Those elected to serve in the upcoming Congress should know that hospice is a program that works and a Medicare benefit that matters to their constituents. As seasoned and novice legislators alike consider health policy reforms, they should look to the success of the hospice model as an example of preserving what works, and help expand access to comprehensive, coordinated care and person- and family- centered care to all patients with serious, advanced and life-limiting illness. We should also reinforce the foundation of hospice to ensure access, choice and quality care at the end of life.

Hospice is not only best for patients at the end of life, it is also good for the Medicare program. Study after study show hospice care improves quality of life, delivers on patient and family satisfaction and reduces unnecessary costs for Medicare beneficiaries at the end of life. Thirty-plus years later, hospice is a reminder that there are policy solutions that work for both sides of the aisle and across our nation for all Americans. The fruits of cooperation live on today in a Medicare benefit that serves 1.43 million Americans annually.

It’s sometimes unclear if the dust will ever settle in Washington, and if we’ll ever get back to a place of collegiality and bipartisanship in Congress. If our nation’s remarkable hospice benefit is any indication, great things can certainly happen if it does.

Edo Banach is President and CEO of the National Hospice and Palliative Care Organization (NHPCO).

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Financial planning and Medicare

By Steven Merrell, Financial Planning: Let’s talk Medicare

If you are one of the 44 million Americans currently covered by Medicare, you probably know that Medicare’s annual open enrollment period just started. Between now and Dec. 7, you have the opportunity to make adjustments to your Medicare coverage.

Paying for health care is one of the biggest financial challenges many people face in retirement. If you are 65 or older, Medicare is probably an important part of your financial picture. However, if you are new to Medicare, you may be surprised by Medicare’s complexity and the gaps in your coverage.

You can choose between two general directions for your Medicare coverage: Original Medicare and Medicare Advantage plans. Original Medicare, in turn, is divided into two parts. Part A covers inpatient hospital care, skilled nursing facilities (when medically necessary), hospice care and home health care. Part B covers doctor visits and outpatient care and other medically necessary services like ambulance services, clinical research and durable medical equipment. Optional Part D covers prescription drugs and is purchased from private insurance companies.

Original Medicare does not cover everything. For example, while Part A covers hospitalization and skilled nursing facilities, it only covers acute care. If you need long-term care, also known as custodial care, Medicare will not cover it. Medicare also excludes most dental care, eye exams for prescription glasses, dentures, hearing aids and exams for fitting them, acupuncture and routine foot care. If you want to find out if your particular need is covered by Original Medicare, you can search for your item or service on the Medicare coverage website: www.medicare.gov/coverage.

Most people do not pay a premium for Part A, but they do pay a deductible of $1,340 for each benefit period and coinsurance for hospitalization. Part B premiums start at $134 per month but can be higher depending on your income. In addition, for Part B you will pay a deductible of $183 per year and coinsurance above that amount equal to 20 percent of the Medicare-approved charge for most doctor services, including the services provided by your doctors while you are in the hospital.

In a catastrophic scenario, there is no limit to the amount you can owe under Original Medicare. Consequently, many people purchase a supplemental policy, also known as Medigap insurance. Medigap insurance is issued by private companies, but the policies are standardized by law to comply with Medicare requirements. There are 10 standard Medigap policies available each with different coverage limits.

If you find this confusing, you are not alone. In fact, this confusion is why Medicare Advantage plans have become so popular in recent years. By law, Medicare Advantage plans are required to provide everything that is covered by Original Medicare. The only exception is hospice care, which continues to be provided by Original Medicare Part A.

Steven C. Merrell is an investment adviser and partner at Monterey Private Wealth Inc. in Monterey, CA. 

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5 advantages of early election of hospice benefits in assisted living and skilled nursing

Published in McKnight’s Senior Living by Rhea Go-Coloma, LMSW

For many, hospice care is associated with care received in the home. When provided early enough for residents in assisted living facilities and nursing homes, however, hospice care can provide important benefits for the resident and facility operator alike.

Hospice care, which is covered by Medicare and most private health insurance plans, eases pain and alleviates discomfort when a resident’s illness no longer is responding to treatment.

In fact, about one-third of assisted living residents receive end-of-life care at the community they have made their home. When residents become terminally ill, however, operators must provide care that may go beyond their capabilities.

When this happens, residents may be better served in a hospital or nursing home setting, but frequently it’s in the best interests of the resident to remain in the assisted living community. This is largely because residents have grown accustomed to the people and environment and feel the most at home.

When an assisted living community resident opts for hospice care, he or she also may be able to remain in the facility during the last months of life. This is best achieved when the assisted living community operator partners with an outside hospice provider. In this situation, it’s important for both organizations to work closely together to provide the best possible care for the resident.

Whether the hospice care is being provided in an assisted living community or nursing home, good communication between the family, staff, hospice staff and caregivers is important. Equally critical for success is early adoption of hospice care.

Early adoption of hospice makes all the difference

When adopted early, hospice care offers significant benefits for residents and families. Significantly, hospice healthcare specialists help residents and their families prioritize wishes and goals, creating a greater sense of ease and comfort.

Team-oriented hospice healthcare specialists work with the staff members of the assisted living community or nursing home to coordinate and plan care. Here’s a look at the five most important advantages of early election of hospice care for residents, families and facilities striving to meet the needs of these individuals:

Family support. Early involvement of an interdisciplinary team of hospice specialists helps families on many fronts: teaching family members how to care for the person who is ill, providing support and counseling to family and friends, offering education about the care process.

The hospice team also is there to help families clarify patient wishes, establish physician and patient relationships and balance family dynamics during this stressful time. Bottom line: hospice provides a way for residents to have a diverse group of committed professionals advocating for their needs.

Care goals. Hospice gives families the time they need to discuss goals of care, including an advance directive, a legal document that spells out end-of-life care ahead of time. The hospice team — including doctors, nurses, therapists, healthcare aides, clergy and social workers — addresses every aspect of a resident’s illness, with emphasis on controlling and reducing pain and discomfort. Team members provide symptom management and pain relief, increase quality of life and relieve patient suffering.

Family counseling. Guidance and support are a crucial feature of hospice, helping families deal with the range of emotions that surround this difficult time, offering guidance from social workers and chaplains. Hospice also offers bereavement and grief counseling after a loved one has passed, and it helps with some of the after-death tasks that need to be completed. Ultimately, choosing hospice care early makes end-of-life a calming and successful experience during a difficult time.

Dignity for the resident. Hospice offers the resident a chance to die with dignity. Hospice patients are not hooked up to loud machines, their vital signs are not constantly checked by medical personnel and they do not undergo invasive procedures to prolong life. It’s about respecting patient wishes.

By making arrangement to provide hospice care, operators of assisted living communities and nursing homes can make it possible for residents and families to focus on spending time with their loved one and not dealing with the red tape and medical procedures associated with hospital care.

 

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Suggestions for adult children caring for aging parents

Published in OA Online By Raylene Weaver, LPC of Centers for Children and Families

The Beatles will always be one of my favorite groups. One of their songs that has hit home with me while thinking about this particular article is, “When I’m Sixty-four”.

People want to be needed and appreciated especially when approaching a time in life when it’s easy to be disregarded or forgotten. The aging process can be stressful, causing some to suffer anxiousness and sadness. Several of my clients and friends have faced or are facing tough decisions that are affecting their parents and themselves. I would like to pass on a few suggestions regarding the physical, emotional, mental and financial aspects of AGING that might alleviate some of the stress that can definitely arise for all concerned.

A…ASK parents specific questions concerning their health. Do family members know their medical history, names of their doctors, any medications they might be taking or appointments they are scheduled on a regular basis? If on Medicaid or Medicare, do they also carry supplemental insurance? Are all financial papers, investments, bank account information, bill payment procedures, updated will, computer passwords and any other important documents or information easily accessible? Do they have a bereavement plan?

G…GUILTY feelings about wanting to be prepared by creating a plan for a parent’s future? Questions concerning the private aspects of their lives might seem like prying but this can hopefully be of some consolation for parents, knowing that they will be taken care of “when the time comes”. The objective for the children is to be “in the know” not to be “nosey”.

I…INDEPENDENT lifestyle is what one wants for aging parents. Parents hope to be independent for as long as possible. They want to continue to travel, take care of their own bills, shop, visit friends and attend worship services. Children sometimes become too “helpful” when parents are capable of handling chores and projects and making decisions for their future. Parents do need family members visiting and checking in on them, showing care and concern, just not insisting on control.

N…NECESSARY intervention will be inevitable for many parents. Knowing when to step in and offer the appropriate type of care and assistance can be stressful. Emotions will surface that might not have been seen or experienced before. When going thru matters for instance, pertaining to insisting a parent not drive any longer, taking over their physical and financial aspects of daily life or ultimately moving them into a facility for mental or physical issues or children becoming caretakers of parents in their own homes, professional agencies might be considered. Seeking assistance from those in the medical field, state/local agencies and counseling professionals might become necessary. But until this time arises…

G…GIVE the gift of respect, love and kindness to parents. They are experiencing and living life to the best of their abilities like their children. One article I came across by Evan H Farr, “What Aging Parents Really Want from Their Adult Children”, stated that adult children should: 1) make suggestions instead of giving orders, 2) pick your battles about what parents can and cannot do, 3) reframe, don’t blame and 4) stop and think how you would want to be treated.

So I guess that brings me back to the Beatles. A couple of the lines from Paul and John’s song says, “Will you still need me, will you still feed, me when I’m sixty-four?” Can I just ask…when I’m 74, 84, 94?

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How AI can improve end-of-life care

Published in Stanford Medicine’s SCOPE by Amy Jeter Hansen

It’s hard to wrap your brain around. It’s hard to even type these words, but here they are: it’s useful for physicians to be able to predict when a patient will die.

Photo by Edward Caldwell

Don’t misunderstand. It’s not about playing God or acting nefarious. It’s about doctors being able to help patients die on their own terms, as comfortably as possible, having received the best, most appropriate care.

In the new issue of Stanford Medicine magazine, writer Kris Newby describes a Stanford pilot program that marries technology and compassion, artificial intelligence and palliative care, with the aim of helping doctors better understand which patients could benefit from end-of-life conversations while there is still time.

In the article, palliative care physician Stephanie Harman, MD, tells Newby:

Ideally with this AI model, we’re identifying patients who are sicker than we realize… And it gives us an excuse to say, ‘It’d be great if we could talk about advanced care planning.’ Or, ‘Have you had a discussion with your regular doctor about what matters most to you if and when you get sicker?’ I think the twist is that we’re using machine learning to add more to a patient’s care without taking anything away.

Developed by Nigam Shah, MBBS, PhD, the model uses an algorithm to calculate the probability that a patient will die within the next 12 months, based on comparisons of the past year of the patient’s medical history with records of millions of other patients. Many factors are considered, including the number of hospital admissions, disease classification codes and prescription codes.

The tool provides Harman with a daily report of newly-admitted hospital patients who have a 90 percent or higher probability of dying in three to 12 months. Harman reviews the medical records to decide if the patients have palliative care needs. “She’s found the list to be helpful,” the article explains, “and she sees how it can improve hospital care and enable her to spend more time with the most critical patients.”

This is important because, as the article notes, less than half of admitted hospital patients who need palliative care actually receive it. And many more people would want to die at home than actually do.

Hopefully, tools like this will help.

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