The American Hospital Association, founded in 1898, serves nearly 5,000 hospitals, healthcare systems, networks and other care providers. It is led by Richard Pollack, president and CEO. The Blue Cross Blue Shield Association is the parent organization of 35 BCBS companies across the U.S. Hospitals Infographics to provide visualizations for this data. MCI is a characteristic of the hospitals' market environment. Regarding the association between lobbying and stock market returns, prior research finds different results when using distinct market-based measures. American Hospital Association lobbying hard - Healthcare IT News Neonatal intensive care. The results persist. This competition will lead to better services, and patients are more willing to pay due to better services. NICU has potential for providing mechanical ventilation, neonatal surgery, and special care for the sickest infants born in the hospital or transferred from another institution. Does government funding suppress nonprofits' political activity? Millions are stuck in dental deserts, with no access to oral health They will be the ones who reach out to the local physician groups to connect with them, thereby not only helping small physician offices adopt EHRs but aid in health information exchange. Lobbying The results suggest that hospital lobbying lowers uncompensated care costs in NFP and for-profit hospitals, supporting our H2a and H2c. NOTE: Figures on this page are calculations by OpenSecrets based on data from the Senate Office of Public Records. Fast Facts will be updated with FY2019 ICU bed counts in February 2021. Thus, we predict that MCI is negatively correlated with Salary. The mean (median) of ROA is 0.044 (0.037), which is consistent with that in Collum et al. Patients are the major stakeholders for all types of hospitals and are priorities of hospitals regardless of ownership types. We predict that MCI is negatively correlated with Uncomp. Excluded are hospitals not accessible by the general public, such as prison hospitals or college infirmaries. NFP and for-profit hospitals lobby to classify more healthcare services as normal services rather than charity care and lobby to expand reimbursement coverage and Medicaid under the Affordable Care Act to reduce uncompensated care costs (Nikpay, Buchmueller, and Levy 2015, 2016). Some feel that business organizations abuse lobbying for their selfish interests, which leads to corruption, while others think that lobbying is necessary because it prevents potentially harmful policies by providing important information to policymakers (Anderson, Martin, and Lee 2018). We predict that Urban and Network are negatively correlated with Uncomp. Pediatric intensive care. A special interest's lobbying activity may go up or down over time, depending on how much attention the federal government is giving their issues. It includes the number of hospitals, government hospitals, hospitals in each state, hospital beds, ICU beds, admissions, and expenses in the U.S. Fast Facts on U.S. In the NFP and government subsamples, the estimated coefficients 1 on Lobby_dum or Lobby_exp are insignificant. Our study has several limitations that provide openings for future research. Community hospitals include academic medical centers or other teaching hospitals if they are nonfederal short-term hospitals. Because networked hospitals have better financial performance (Nauenberg, Brewer, Basu, Bliss, and Osborne 1999), we predict that Network is positively correlated with Salary. 2013; Bovbjerg et al. 6. 2006) and government contracts (Hansen and Mitchell 2000). We winsorize all continuous variables at the 1st and 99th percentiles to solve the outlier issue. Web41 out of 91 American Hospital Assn lobbyists in 2020 have previously held government jobs. Burn care. Lee and Baik (2010) find that the more business organizations spend on lobbying, the larger the amount of tariff reduction they will receive from U.S. Customs and Border Protection. Unlike NFP and for-profit hospitals, government hospitals have other public funding on hand for subsidizing uncompensated care costs. We predict that Size is negatively correlated with Uncomp. Hospitals 2022 Infographics PDF, Fast Facts: U.S. For example, in 1997, rural hospitals lobbied Capitol Hill to protect their interests by overturning a budget provision that funnels extra Medicare money to large urban hospitals with more than 100 beds (Weissenstein 1997). Second, stakeholders are different.2 In NFP hospitals, the employees are one of the major stakeholders (Fritz 2020), an important constituency that can be satisfied with successful lobbying efforts, while investors are the core stakeholders in for-profit hospitals. First, in cost management, we only study the effects of hospital lobbying on employee salaries and uncompensated care costs. Thus, if an NFP or government hospital plans to increase its employee salaries and protect their interests, the hospital has to lobby the legislators to raise the standard of reasonable compensation. Pradhan (2020) reports that government and NFP hospitals have been lobbying to protect employees' incomes and interests for a long time. Yangmei Wang, Yuewu Li, Jiao Li; Hospital Lobbying and Performance. We predict that Leverage is positively correlated with Uncomp. Single, freestanding hospitals may be categorized as a system by bringing into membership three or more, and at least 25 percent, of their owned or leased non-hospital pre-acute or post-acute health care organizations. Therefore, we posit our first set of hypotheses as follows: Hospital lobbying increases employee salaries in NFP hospitals. Gapenski, Vogel, and Langland-Orban (1993) find several determinants of hospital performance including patient mix (i.e., Medicare/Medicaid mix) and organizational characters (i.e., size, teaching status, and network). A 501(c)(3) tax-exempt, charitable organization, 1100 13th Street, NW, Suite 800 In addition, 935 hospitals do not continue to invest in lobbying during the period in our sample; i.e., about 55 percent of hospitals spent zero on lobbying in certain year(s). AMA membership dues In this sense, patients make no difference in hospital lobbying efforts. A unit that must be separate from the newborn nursery providing intensive care to all sick infants including those with the very lowest birth weights (less than 1500 grams). Grants, contracts, and interest group lobbying behavior, Do firm's organisational slacks influence the relationship between corporate lobbying and corporate financial performance? Reporting from the frontiers of health and medicine, You've been selected! In this study, we use the most recent hospital financial and lobbying expense data to examine the effects of hospital lobbying on employee salaries, uncompensated care costs, and ROA. Rural Hospitals Infographic, Fast Facts on U.S. Business organizations use lobbying as a vehicle to promote and protect their interests. Hospital costs include salaries (49 percent), supplies (17 percent), uncompensated care (13 percent), and miscellaneous expenses (21 percent) (Patrick 2014). According to the Center for Responsive Politics (2020), total annual lobbying spending has continually surpassed $3 billion since 2008. Lobbying likelihoods are very close in all three groups, suggesting that hospitals in all three groups have similar interests in lobbying. It would be interesting to get the reaction of HHS Secretary Kathleen Sebelius and ONC head David Blumenthal, MD, to this requested change. Something went wrong. MCI is a continuous variable, but it does not change over the sample period. We predict that Teaching is positively correlated with Uncomp. 1987; Scott et al. Because we are unable to access insurance allocations, spending on employee training, and supply cost data, we focus on investigating the effects of lobbying on employee salaries and uncompensated care costs. To test H3, we develop Model (3) as follows: \begin{equation}\tag{3}RO{A_{i,t}} = {\delta _0} + {\delta _1}Lobb{y_{i,t - 1}} + \sum {Controls + Yea{r_t}} + Stat{e_i} + {\varepsilon _{i,t}} \end{equation}, Hospital staffing, organization, and quality of care: Cross-national findings, Quality improvement and hospital financial performance, Measuring rates of return on lobbying expenditures: An empirical case study of tax breaks for multinational corporations, Lobbying as a potent political marketing tool for firm performance: A closer look, Hospital ownership, performance, and outcomes: Assessing the state-of-the-science, Linking for-profit and nonprofit executive compensation: Salary composition and incentive structures in the U.S. hospital industry, The corporate value of (corrupt) lobbying, Lobbying, political connectedness and financial performance in the air transportation industry, An investigation of economic efficiency in California hospitals. 2013). The results of these studies are not warranted when the research generalizes the effects of lobbying across organization ownership types. Early Medicaid expansion in Connecticut stemmed the growth in hospital uncompensated care, Affordable Care Act Medicaid expansion reduced uninsured hospital stays in 2014, The causes and consequences of internal control problems in nonprofit organizations, Firm level performance implications of nonmarket actions, Regulation and the rising cost of hospital care, Hospitals known for nursing excellence associated with better hospital experience for patients, Civic engagement and nonprofit lobbying in California, 19982003, Management strategies and financial performance in rural and urban hospitals, Hospital lobbying blitz starts paying off, This site uses cookies. The data below, from the 2020 AHA Annual Survey, are a sample of what you will find in AHA Hospital Statistics, 2022 edition. Number of Nongovernment Not-for-Profit Community Hospitals, Number of Investor-Owned (For-Profit) Community Hospitals, Number of State and Local Government Community Hospitals, Number of Nonfederal Psychiatric Hospitals, Intensive Care Beds 3 in Community Hospitals (FY2019 data to be updated 2/21), Medical-Surgical Intensive Care 4 Beds in Community Hospitals, Cardiac Intensive Care 5 Beds in Community Hospitals, Neonatal Intensive Care 6 Beds in Community Hospitals, Pediatric Intensive Care 7 Beds in Community Hospitals, Other Intensive Care 9 Beds in Community Hospitals, Number of Community Hospitals in aSystem 10. Government hospitals (e.g., Jackson Health System) are fully funded by a governmental entity (at the federal, state, or local level) in order to serve diverse constituents such as the military, people living in poverty, and the uninsured; for-profit hospitals (e.g., Tenet Healthcare Corporation) are owned by private investors that profit from providing services to paying patients; and NFP hospitals (e.g., University of Pittsburgh Medical Center [UPMC], Mayo Foundation for Medical Education and Research [Mayo Clinic], Ascension), managed by voluntary boards of trustees, are somewhere in the middle and provide care for paying patients and charitable services to people living in poverty (Baker et al. CMS reviews these waivers during the waiver renewal process (Mahan and Callow 2015). Given the fact that most of the studies focus only on one type of organization ownership when investigating the effects of lobbying (e.g., de Figueiredo and Silverman 2006; Lee and Baik 2010), generalizing the effects of lobbying across organization ownership types is not warranted. A crucial stream of research on lobbying studies the direct relationship between lobbying activities and financial performance as measured by accounting-based and market-based outcomes. The coefficient on Lobby_dum is 0.0294 in the for-profit subsample, suggesting that if a for-profit hospital incurs lobbying expenses, the average net income increases by $2.94 million. Table 2 reports the descriptive statistics of the variables used in our empirical analyses. One may argue that when a tax-exempt hospital does not meet the uncompensated care requirements, hospital administrators may choose to spend more on lobbying to protect the hospital's tax-exempt status. https://doi.org/10.2308/JOGNA-2020-009. Specifically, NFP and government hospitals protect the interests of their employees, who are their major stakeholders, while for-profit hospitals maximize their investors' interests (Fritz 2020). When Lobby_dumt3 and Lobby_expt3 are the variables of interest, the significance disappears. Hospitals 2023 Infographics PDF, Fast Facts on U.S. Researchers also find that lobbying business organizations have a better potential of gaining direct help from the government, in the form of bailouts (Faccio et al. 2000). May include myocardial infarction, pulmonary care, and heart transplant units. According to Milyo, Primo, and Groseclose (2000), business organizations spend approximately ten times more on lobbying than on other political expenses. WebAbout the Supply of Nurses Rising Openings and Employment The US Bureau of Labor Statistics projects 194,500 average annual openings for registered nurses between 2020 and 2030, with employment projected to grow 9%. First, we provide a literature review that examines the effects of lobbying on organization performance along with hypotheses development in Section II. Under the current prospective payment system, the reimbursement rate for a specific procedure/treatment at the Centers for Medicare and Medicaid Services (CMS) or insurance companies is predetermined, which creates tremendous pressures on hospitals (K. Chang and G. Chang 2017). Healthcare report: How are U.S. healthcare organizations embracing intelligent automation to enhance patient centricity? Regression of Hospital Total Salaries on Lobbying. AHA Hospital Statistics is published annually by Health Forum, an affiliate of the American Hospital Association. To order print copies of AHA Hospital Statistics, call (800) AHA-2626 or visit the AHA online store. An interactive online version is also available. Note that the ICU beds data is not published in AHA Hospital Statistics. Therefore, we posit our second set of hypotheses as follows: Hospital lobbying reduces uncompensated care costs in NFP hospitals. American WebThis report represents a snapshot of the many activities and achievements that occurred throughout the ANA Enterprise in 2019 and as we began 2020. The coefficient on Lobby_exp is 0.1138 in the for-profit subsample, suggesting that $1 of additional lobbying spending increases net income by $1.10 in for-profit hospitals. Lobbying expenses, however, are the highest in for-profit hospitals, and the lowest in government hospitals, because governmental and charity money cannot be used for lobbying (Andrzejewski 2019; Leech 2006). This finding supports our H2b, which is not a surprise because government hospitals have public funding for subsidizing uncompensated care costs. The American Hospital Association is putting pressure on legislators to change one area of the final ruling on the federal incentives for the meaningful use of EHRs. The data below are examples of the types of insights that can be pulled from the AHA Annual Survey. Hospital lobbying reduces uncompensated care costs in for-profit hospitals. Similar to our predictions in Model (1), we predict that the directions of the coefficients on MedicareMix and MedicaidMix are unknown. Get daily news updates from Healthcare IT News. It is not a surprise that Uncomp is higher on average in government hospitals compared to either for-profit or NFP hospitals, because Cram et al. All the above benefits gained from lobbying contribute positively toward business profitability. Our study suggests that lobbying hospitals gain more benefits than their nonlobbying peers and provides insights into how lobbying can affect hospital performance, which could be helpful for hospital administrators' decision making. In the U.S., seven states have Medicaid-funded uncompensated care pools,3 which help hospitals defray the costs of uncompensated care. Modernizing healthcare payments: exploring the opportunities, challenges and solutions, Leverage a data lakehouse to drive incremental value and quick wins, Nurses' clinical decision-making gets boost from predictive modeling. The American Hospital Association conducts an annual survey of hospitals in the United States. The data below, from the 2020 AHA Annual Survey, are a sample of what you will find in AHA Hospital Statistics, 2022 edition. 2018). CHA Publishes Lobbying Percentage of Dues for Medicare Cost Reports - California Hospital Association / CHA News CHA News 28 Oct 2021 CHA Publishes Lobbying Percentage of Dues for Medicare Cost Reports For CFOs, controllers Jennifer Newman Senior Vice President & Chief Financial Officer Sign up for our newsletter to track moneys influence on U.S. elections and public policy. We re-estimate all models with the four independent variables, respectively. Table 3 presents the results from estimating Model (1). To request permission for commercial use, please contactus. Top 20 healthcare lobbyists by 2021 spending through June In addition, through lobbying, NFP and for-profit hospitals can have uncompensated care costs paid, at least partially, by CMS. Besides salaries (49 percent), hospital costs include supplies (17 percent), uncompensated care (13 percent), and miscellaneous expenditures (21 percent) (Patrick 2014). More is not always better, Economic consequences of regulated changes in disclosure: The case of executive compensation, Corporate governance and lobbying strategies, Raising rivals' costs through political strategy: An extension of resource-based theory, Corporate PAC campaign contributions in perspective, Does the hospital board need a doctor? For example, Richter, Samphantharak, and Timmons (2009) find that a 1 percent increase in lobbying spending will lower effective tax rates by 0.5 to 1.6 percent. Our findings suggest that NFP hospitals lobby to protect employees' interests and for-profit hospitals lobby to maximize investors' interests, while government hospitals are inactive or less interested in the above lobbying activities. Dorn Policy Group, Inc. 101 N. 1st Avenue 20th Floor, Suite 2090 Phoenix, Arizona 85003 Telephone: 602-606-4667 Largest Lobbying Lobbying activities draw researchers' attention because lobbying expenses have grown immensely. Search for other works by this author on: To test our first set of hypotheses, we develop Model (1) as follows: \(\def\upalpha{\unicode[Times]{x3B1}}\)\(\def\upbeta{\unicode[Times]{x3B2}}\)\(\def\upgamma{\unicode[Times]{x3B3}}\)\(\def\updelta{\unicode[Times]{x3B4}}\)\(\def\upvarepsilon{\unicode[Times]{x3B5}}\)\(\def\upzeta{\unicode[Times]{x3B6}}\)\(\def\upeta{\unicode[Times]{x3B7}}\)\(\def\uptheta{\unicode[Times]{x3B8}}\)\(\def\upiota{\unicode[Times]{x3B9}}\)\(\def\upkappa{\unicode[Times]{x3BA}}\)\(\def\uplambda{\unicode[Times]{x3BB}}\)\(\def\upmu{\unicode[Times]{x3BC}}\)\(\def\upnu{\unicode[Times]{x3BD}}\)\(\def\upxi{\unicode[Times]{x3BE}}\)\(\def\upomicron{\unicode[Times]{x3BF}}\)\(\def\uppi{\unicode[Times]{x3C0}}\)\(\def\uprho{\unicode[Times]{x3C1}}\)\(\def\upsigma{\unicode[Times]{x3C3}}\)\(\def\uptau{\unicode[Times]{x3C4}}\)\(\def\upupsilon{\unicode[Times]{x3C5}}\)\(\def\upphi{\unicode[Times]{x3C6}}\)\(\def\upchi{\unicode[Times]{x3C7}}\)\(\def\uppsy{\unicode[Times]{x3C8}}\)\(\def\upomega{\unicode[Times]{x3C9}}\)\(\def\bialpha{\boldsymbol{\alpha}}\)\(\def\bibeta{\boldsymbol{\beta}}\)\(\def\bigamma{\boldsymbol{\gamma}}\)\(\def\bidelta{\boldsymbol{\delta}}\)\(\def\bivarepsilon{\boldsymbol{\varepsilon}}\)\(\def\bizeta{\boldsymbol{\zeta}}\)\(\def\bieta{\boldsymbol{\eta}}\)\(\def\bitheta{\boldsymbol{\theta}}\)\(\def\biiota{\boldsymbol{\iota}}\)\(\def\bikappa{\boldsymbol{\kappa}}\)\(\def\bilambda{\boldsymbol{\lambda}}\)\(\def\bimu{\boldsymbol{\mu}}\)\(\def\binu{\boldsymbol{\nu}}\)\(\def\bixi{\boldsymbol{\xi}}\)\(\def\biomicron{\boldsymbol{\micron}}\)\(\def\bipi{\boldsymbol{\pi}}\)\(\def\birho{\boldsymbol{\rho}}\)\(\def\bisigma{\boldsymbol{\sigma}}\)\(\def\bitau{\boldsymbol{\tau}}\)\(\def\biupsilon{\boldsymbol{\upsilon}}\)\(\def\biphi{\boldsymbol{\phi}}\)\(\def\bichi{\boldsymbol{\chi}}\)\(\def\bipsy{\boldsymbol{\psy}}\)\(\def\biomega{\boldsymbol{\omega}}\)\(\def\bupalpha{\bf{\alpha}}\)\(\def\bupbeta{\bf{\beta}}\)\(\def\bupgamma{\bf{\gamma}}\)\(\def\bupdelta{\bf{\delta}}\)\(\def\bupvarepsilon{\bf{\varepsilon}}\)\(\def\bupzeta{\bf{\zeta}}\)\(\def\bupeta{\bf{\eta}}\)\(\def\buptheta{\bf{\theta}}\)\(\def\bupiota{\bf{\iota}}\)\(\def\bupkappa{\bf{\kappa}}\)\(\def\buplambda{\bf{\lambda}}\)\(\def\bupmu{\bf{\mu}}\)\(\def\bupnu{\bf{\nu}}\)\(\def\bupxi{\bf{\xi}}\)\(\def\bupomicron{\bf{\micron}}\)\(\def\buppi{\bf{\pi}}\)\(\def\buprho{\bf{\rho}}\)\(\def\bupsigma{\bf{\sigma}}\)\(\def\buptau{\bf{\tau}}\)\(\def\bupupsilon{\bf{\upsilon}}\)\(\def\bupphi{\bf{\phi}}\)\(\def\bupchi{\bf{\chi}}\)\(\def\buppsy{\bf{\psy}}\)\(\def\bupomega{\bf{\omega}}\)\(\def\bGamma{\bf{\Gamma}}\)\(\def\bDelta{\bf{\Delta}}\)\(\def\bTheta{\bf{\Theta}}\)\(\def\bLambda{\bf{\Lambda}}\)\(\def\bXi{\bf{\Xi}}\)\(\def\bPi{\bf{\Pi}}\)\(\def\bSigma{\bf{\Sigma}}\)\(\def\bPhi{\bf{\Phi}}\)\(\def\bPsi{\bf{\Psi}}\)\(\def\bOmega{\bf{\Omega}}\)\begin{equation}\tag{1}Salar{y_{i,t}} = {\beta _0} + {\beta _1}Lobb{y_{i,t - 1}} + {\beta _2}MC{I_{i,t}} + {\beta _3}MedicareMi{x_{i,t}} + {\beta _4}MedicaidMi{x_{i,t}} + {\beta _5}Siz{e_{i,t}} + {\beta _6}Leverag{e_{i,t}} + {\beta _7}Teachin{g_{i,t}} + {\beta _8}Urba{n_{i,t}} + {\beta _9}Networ{k_{i,t}} + Yea{r_t} + Stat{e_i} + {\varepsilon _{i,t}} \end{equation}. Plenty of studies find that firms' abnormal returns are positively associated with lobbying (see Lo 2003; Hochberg, Sapienza, and Vissing-Jrgensen 2009; Hill, Kelly, Lockhart, and Van Ness 2013; Mathur, Singh, Thompson, and Nejadmalayeri 2013; Borisov, Goldman, and Gupta 2016). Our paper provides evidence to understand that the effects of lobbying vary based on distinct hospital ownership types. Another goal of lobbying is cost (excluding employee salaries) saving (Frankenfield 2020). WebAMA estimates that 65% of your membership dues are allocable to lobbying activities of the AMA, and therefore are not deductible for income tax purposes. Photo by Freedom to Marry courtesy of Creative Commons license. After merging data from the two data sources, we exclude observations that lack valid data needed to calculate the variables in our analyses. (2016). In the United States, lobbying is practiced primarily by business organizations using either external lobbyists or in-house professionals. First, patients are different. HOA Statistics [2023]: Average HOA Fees + Number of HOAs Panel B of Table 2 presents the descriptive statistics of the variables under the different types of hospital ownership. Similarly, by examining publicly traded firms, Chen et al. AHA Center for Health Innovation Market Scan, Updates and Resources on Novel Coronavirus (COVID-19), Institute for Diversity and Health Equity, Rural Health and Critical Access Hospitals, National Uniform Billing Committee (NUBC), AHA Rural Health Care Leadership Conference, Individual Membership Organization Events, Map of Community Hospitals in the United States, View the Fast Facts: U.S. We use the r and cluster options of the regress function in Stata to ensure that standard errors are robust and clustered at the hospital level. (2018). As we discussed previously, however, uncompensated care costs are one part of hospital costs. Follow the money on gun rights and gun control groups. Provides care to severely burned patients. de Figueiredo and Silverman (2006) find that lobbying by public universities increases the amount of federal funding they can receive for academic research. Dues-paying members are eligible to receive a print copy of JAMA , the Journal of the American Medical Association. The unit is staffed with specially trained nursing personnel and contains monitoring and specialized support or treatment equipment for patients who, because of heart seizure, open-heart surgery, or other life-threatening conditions, require intensified, comprehensive observation and care. Prior research only focuses on one type of organization ownership, i.e., either not-for-profit (NFP), government, or for-profit, to study the effects of lobbying. Hospital lobbying does not increase employee salaries in for-profit hospitals. In the for-profit subsample, the estimated coefficients are positive (0.0294 and 0.1138, respectively) and significant (p = 0.078, and p = 0.016, respectively), suggesting that lobbying increases ROA only in for-profit hospitals. Except for the Revolving Door section, content on this site is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 United States License by OpenSecrets.org. System affiliation does not preclude network participation. Another stream of the literature examines the benefits of lobbying for NFP organizations. The According to the extant literature, one goal of hospital lobbying is to protect employees' incomes (Landers and Sehgal 2004; Pradhan 2020). In addition, lobbyists actively communicate with government officials so that lobbying hospitals or groups can influence or shape policies in order to protect their own interests and increase their competitive advantage (Chen et al. How to Become A Lobbyist - Dorn Policy Group, Inc. Table 8 presents the results, which are consistent with those in our main analyses in Table 4. National Education Assn We replace the continuous variables in Models (1)(3) with the changes in these variables.6 For example, _Uncomp is the difference between Uncomp in year t1 and year t, and _Lobby_exp is the difference between Lobby_exp in year t2 and year t1. We also find that the effects of lobbying on employee salaries, uncompensated care costs, and ROA are not significant in government hospitals. In fact, no other sector of the U.S. economy spends more on lobbying than the healthcare sector does, according to OpenSecrets. In 2020, the healthcare sector spent more than $623 million on lobbying, and from January through June 2021, it spent upward of $331 million on lobbying. Feel free to distribute or cite this material, but please credit OpenSecrets. We further conduct a supplementary change analysis to show that reverse causality does not drive the association between hospital lobbying expenses and uncompensated care costs.

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