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AOBOG OCC Osteopathic Continuous Certification

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1 AOBOG OCC Osteopathic Continuous Certification
Presented by Carolyn W. Quist, DO, FACOOG (dist.) Vice Chair, AOBOG

2 Learning objectives To learn what Osteopathic Continuous Certification (OCC) means To review the 5 components of Osteopathic Continuous Certification To review the start date of OCC To review the newest component of OCC: Part 4-Practice Performance Assessment To review what loss of certification means

3 What is OCC? Osteopathic Continuous Certification
A Process for Board certified DOs to demonstrate and maintain competency in knowledge and skills in their specialty area An assessment tool to enhance the quality of health care A way for the public to have a “quality standard” for their personal physician Mandated by the AOA’s Bureau of Osteopathic Specialists (BOS) and in the works since 2009 The Board sets the standards and uses evidence-based medicine to back it up. Is a 6-year re-occurring certification process

4 5 Components of OCC Part 1 Professional standing; Unrestricted license in 1:50 states; adhere to AOA Code of Ethics Part 2 Std 120 hours CME requirements- every years; 50 CME hrs. in specialty Part 3 Cognitive assessment: psychometrically valid formal proctored exam (FPE) - once every 6 years (anytime in last 2 years of 6-year cycle) Part 4 Practice Performance Assessment and Improvement modules, includes Communications Module (Pt surveys (CAHPS)) Part 5 Continuous AOA membership Part 4 is the only new requirement to maintenance of Certification

5 we want you! To look at your certificate expiration date!
If you have a time-limited certificate (with an expiration date), then you are required to enter OCC. If you have a non time-limited certificate, you are highly encouraged to enter the OCC process.

6 Who is required to do OCC?
Anyone with a Time-limited certificate, i.e., has an expiration or anniversary date on it! Time-limited certificates started July 2002 for AOBOG. The anniversary date is established by the date of the initial certification. The formal written proctored exam (component 3 of OCC) may be taken no earlier than 2 years prior to the anniversary date of your certification.

7 When does OCC go into effect?
January 1st, 2013 Anyone with a time-limited certificate must go to the AOBOG.org website to create a user profile and then register for OCC. You will be given instructions on how to complete the assignments once registered. There will be an initial entry plan for those physicians whose time-limited certificates end prior to a full 6-year OCC cycle. OCC is Voluntary for physicians with non time-limited or “non-expiring” certificates at this time but strongly encouraged! Non time-limited certificate holders must maintain their certification by remaining a member of the AOA and keeping CME up-to-date, otherwise they will lose the original certification.

8 Patient Protection and Affordable Care Act
In The Affordable Care Act charged the Department of HHS with developing a National Quality Strategy SEC NATIONAL STRATEGY. ‘‘PART S—HEALTH CARE QUALITY PROGRAMS ‘PART D—HEALTH CARE QUALITY IMPROVEMENT ‘‘Subpart I—Quality Measure Development Maintenance of Certification Programs have been added pg. 247 of which Practice Assessment is Required In 2010, the Affordable Care Act (ACA) charged the Department of Health and Human Services (HHS) with developing a National Quality Strategy (NQS) to better meet the promise of providing all Americans with access to healthcare that is safe, effective, and affordable. Legislation required the NQS be shaped by input from stakeholders wielding collective national influence to ensure a nationally achievable, impact-oriented strategy. As a result, The National Quality Forum (NQF) convened the multi-stakeholder National Priorities Partnership (NPP), a partnership of 48 public- and private-sector partners, to provide collective input to HHS for consideration as it developed this national body of work. The Affordable Care Act (ACA) created new responsibilities for NQF as the consensus-based entity, including convening a multi-stakeholder group to provide annual input to the Department of Health and Human Services on the development of a National Quality Strategy. To fulfill this role, NQF convened the National Priorities Partnership (NPP) to: Identify national goals that map to the priorities put forth in the National Quality Strategy; Provide input on measures for tracking national progress toward the goals; and Offer guidance on high-leverage strategic opportunities to accelerate improvement. The NPP is a collaborative effort of 51 major national organizations—which brings together public- and private-sector stakeholder groups in a forum that balances the interests of consumers, purchasers, health plans, clinicians, providers, communities, states, and suppliers in achieving the aims of better care, affordable care, and healthy people and communities. There must be a national strategy for data collection, measurement, and reporting that supports performance measurement and improvement efforts of public- and private-sector stakeholders at the national and community level A big goal is to make care safer. Reduce infections, prevent inappropriate or unnecessary care. Monitor infections, readmissions, inappropriate medication use and inappropriate maternity care. Cesarean section rates, preventable emergency department visits, unwarranted surgical procedures. 25% of healthcare costs are related to modifiable health risks and we are going to be watched on how well we incentivize wellness and healthy behaviors. Under the ACA: pg 247, (c) MAINTENANCE OF CERTIFICATION PROGRAMS.— (1) IN GENERAL.—Section 1848(k)(4) of the Social Security Act (42 U.S.C. 1395w–4(k)(4)) is amended by inserting ‘‘or through a Maintenance of Certification program operated by a specialty body of the American Board of Medical Specialties that meets the criteria for such a registry’’ after ‘‘Database)’’. (2) EFFECTIVE DATE.—The amendment made by paragraph (1) shall apply for years after 2010. (d) INTEGRATION OF PHYSICIAN QUALITY REPORTING AND EHR REPORTING.—Section 1848(m) of the Social Security Act (42 U.S.C. 1395w–4(m)) is amended by adding at the end the following new paragraph: ‘‘(7) INTEGRATION OF PHYSICIAN QUALITY REPORTING AND EHR REPORTING.—Not later than January 1, 2012, the Secretary shall develop a plan to integrate reporting on quality measures under this subsection with reporting requirements under subsection (o) relating to the meaningful use of electronic health records. Such integration shall consist of the following: ‘‘(A) The selection of measures, the reporting of which would both demonstrate—‘‘(i) meaningful use of an electronic health record for purposes of subsection (o); and ‘‘(ii) quality of care furnished to an individual. ‘‘(B) Such other activities as specified by the Secretary.’’. (e) FEEDBACK.—Section 1848(m)(5) of the Social Security Act (42 U.S.C. 1395w–4(m)(5)) is amended by adding at the end the following new subparagraph: ‘‘(H) FEEDBACK.—The Secretary shall provide timely feedback to eligible professionals on the performance of the eligible professional with respect to satisfactorily submitting data on quality measures under this subsection.’’

9 CMS Requirements for a Practice Assessment
Initial assessment using evidence-based medicine Survey of patient experience with care Implementation of quality improvement intervention to address identified weakness Reassess performance improvement after intervention

10 AOA versus ABMS What’s the difference between OCC and MOC?
6 year cycles AOBOG ABOG Part 1 Professional standing; unrestricted license; attestation forms Professional standing; unrestricted license; attestation forms; patient surveys Part 2 120 hours CME requirements every 3 years (50 in specialty) Lifelong learning (LLL) articles: complete 120 questions/year Part 3 Formal proctored written exam once every 6 years Cognitive expertise written exam once every 6 years Part 4 PPA modules: 5 required per 6-year cycle (one of which is Communications Module (patient surveys)) PPSA modules: 1 every year x 5, must complete in 12 months Part 5 AOA membership None The main difference between the AOBOG and ABOG is that the ABOG Maintenance of certification (MOC) process has become a yearly recertification process even though they have a 6 year cycle. A physician can lose their certification on a yearly basis and have to re-enter the process if not completed in a timely manner. The AOBOG OCC process is a 6 year cycle that needs to be completely finished by the end of the 6 years but gives you more leeway to finish the components. The AOA OCC process does have a 5th component that the ABMS doesn’t have and that is the requirement for continuous membership in the AOA (part 5). The ABMS lists patient surveys under part 1 but the AOBOG is going to require completion of a communication survey with patient surveys as a component of part 4. The AOBOG requires 50 hours of CME in the specialty for part 2 where as CME requirements are not a part of the ABMS. The ABMS requires physicians to read a certain number of articles and answer questions relating to the articles with a passing grade to complete Part 2. The AOA expects a physician to meet their CME requirements every 3 years or you could lose your certification. PPAI = practice performance assessment and improvement PPSA = practice performance self assessment

11 7 core competencies incorporated into OCC Components
Osteopathic Philosophy/Osteopathic Manipulative Medicine Medical Knowledge Patient Care Interpersonal and Communication Skills Professionalism Practice-Based Learning and Improvement Systems-Based Practice See AOA website for more information (www.osteopathic.org/occ) Continuous certification is a process that provides the practicing Ob/ Gyn with the opportunity to constantly evaluate and improve their knowledge base and practice, make sure they are incorporating evidence-based medicine into patient care and include the 7 core competencies into the process. Physicians are expected to: OP/OMM–Demonstrate and apply knowledge of accepted standards in osteopathic manipulative treatment appropriate to their specialty, Remain dedicated to life-long learning and to practice habits in osteopathic philosophy and OMM Medical knowledge--Demonstrate and apply knowledge of accepted standards of clinical medicine in their respective area, Remain current with new developments in medicine, Participate in life-long activities Patient care: Demonstrate the ability to effectively treat patients, Provide medical care that incorporates the osteopathic philosophy, patient empathy, awareness of behavioral issues, the incorporation of preventive medicine and health promotion Interpersonal and Communication Skills: Demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families, and other members of health care teams. Professionalism: Uphold the Osteopathic Oath in the conduct of their professional activities that promotes advocacy of patient welfare, adherence to ethical principles, collaboration with health professionals, lifelong learning, and sensitivity to a diverse patient population, Be cognizant of their own physical and mental health in order to effectively care for patients. Practice-based Learning and Improvement: Demonstrate the ability to critically evaluate their methods of clinical practice, integrate evidence-based medicine into patient care, Show an understanding of research methods, Improve patient care practices. Systems-based Practice: Demonstrate an understanding of health care delivery systems, Provide effective and qualitative patient care within the system, Practice cost effective medicine

12 Why should I participate?
Benefits of participating in OCC include demonstrating: adherence to the AOA Code of Ethics and specialty standards a commitment to lifelong learning continuous quality improvement of practice membership in the osteopathic professional community quality assurance to the public Amount of clinical experience does not necessarily lead to better outcomes or improvement of skills –Choudhry, N.K., R.H. Fletcher, and S.B. Soumerai, Systematic Review: The Relationship between Clinical Experience and Quality of Health Care. Annals of Internal Medicine, (4): p •Fewer than 30% of physicians examine their own performance data –Audet, A.-M.J., et al., Measure, Learn, And Improve: Physicians' Involvement In Quality Improvement. Health Affairs, (3):p •A physician’s ability to independently and accurately self-assess and self-evaluate is poor –Davis, D.A., et al., Accuracy of Physician Self-assessment Compared With Observed Measures of Competence. JAMA: Journal of the American Medical Association, (9): p Source: Lipner, R., and Magallanes, T. (2010). Development of a comprehensive maintenance of certification program for physicians in the 21stCentury.

13 Part 4-Practice Performance Assessment and Improvement
All of us know a lot of about performance measures. From the time you started school you received a report card showing how you performed based on what you learned at least according to the standards set by the teacher. Measurement is the basic tool to help us determine if what we are doing is on track. If we don't measure what we are doing we really don't know if we are doing it right, or well, for that matter. Other industries have performance measures as well. Manufacturing companies adopt quality improvement methods to ensure that what they are producing are of the highest quality and meet the standards set for a particular product. Pilots, pharmaceutical companies, medical device companies etc. all have to meet certain standards. The medical profession is just taking our process to the next level. Performance measures also help us improve faster. We can make corrections earlier in providing care.” “Because healthcare is an industry that everyone counts on and that receives public funding, there should be quality and outcome measurement, public reporting, transparency and accountability,” Examples of patient safety measures you have already been exposed to in the hospital are SCIP protocols. Now we are taking it to the office. Wider adoption of electronic health records (EHRs) can spur measure use enormously. A tremendous boon for patient care and patient experience, EHRs put all the relevant information, including a patient’s medical history, at a provider’s fingertips. EHRs will also make measurement and performance data available on a real-time basis, making healthcare much more responsive to patient needs. Without good data, healthcare systems simply cannot accurately measure and assess performance. When physicians see their numbers, they act to improve them, using their professional pride and competitiveness to find solutions. Performance measures give us a way to assess healthcare against recognized standards. Part 4-Practice Performance Assessment and Improvement “Measures are the only way we can really know if care is safe, efficient, effective and patient-centered. While measures come from many sources, performance measures give us a way to assess healthcare against recognized standards.”

14 The Difference a Good Measure Can Make
Why measure? Drives improvement Inform consumers Influence payment What to measure? Biggest return in a better quality of life Initially: patient and family engagement, care coordination, safety, population health, overuse, and palliative and end-of-life care. Now we are looking at evidence-based initiatives Healthcare professionals work hard to deliver skilled, thoughtful care. But no one person can see across the complexity of the healthcare system to make sure the end result adds up to the best patient care. Measures light the way, showing where systems are breaking down and where they are succeeding to help patients get well and stay well. Teams that measure are able to make adjustments in care, share successes and probe for causes when progress comes up short--- to improve patient outcomes. Many measures are publicly reported and consumers are better able to assess quality for themselves and then use the results to make choices, ask questions and advocate for good healthcare. Some providers now post performance measures on their websites. There are national sources such as Hospital Compare.gov. More and more payers use measures as preconditions for payment or instituting nonpayment for complications associated with NQFs list of serious reportable events.

15 AHRQ # 208 Public Reporting of quality Reviewed 198 articles
Individual clinicians and organizations, responded to public reports by making positive changes in their behavior. Studies found that hospitals were more likely to offer new services, policies were changed, surgeons with worse outcomes left surgical practice, and quality improvement activities increased. Almost all identified studies found no evidence or only weak evidence that public reporting affects the selection of health care providers by patients or their representatives. AHRQ Publication No. 12-E011-EF. Rockville, MD. Agency for Healthcare Research and Quality. July Everyone claims that there is no data that any of this makes a difference. The AHRQ pulled over 1500 articles and summarized the best in a 2012 article. Data shows that when physicians and hospitals are required to report data that is publicly reported, healthcare improves in the right direction. The changes in the recertification process are geared to having physicians start looking at their data and outcomes to effect patient care.

16 Many studies exist that show the length of time a physician is in practice or age is associated with a lower performance for all outcomes.

17 Descriptions of the OCC Components
We will break down the requirements of each of the 5 components of the OCC process in more detail!

18 OCC Part 1 Professional standing Individual must register online
Must attest to having an unrestricted license in at least 1:50 states or Canada - if restricted, must submit letter with explanation and cases will be reviewed individually Adhere to AOA Code of Ethics - if problem exists and not reported, could lose certification. (See RES. NO. B-64 - A/2011) Participate in a CAHPS-C&G-like survey: Consumer Assessment of Healthcare Providers and Systems-this will be one of the required PPA modules under Part 4 There are 19 sections to the AOA Code of Ethics. These are represented in the following web site:

19 Osteopathic Pledge of Commitment
As members of the osteopathic medical profession, in an effort to instill loyalty and strengthen the profession, we recall the tenets on which this profession is founded – the dynamic interaction of mind, body and spirit; the body’s ability to heal itself; the primary role of the musculoskeletal system; and preventive medicine as the key to maintain health. I pledge to: Provide compassionate, quality care to my patients; Partner with them to promote health; Display integrity and professionalism throughout my career; Advance the philosophy, practice and science of osteopathic medicine; Continue life-long learning; Support my profession with loyalty in action, word and deed; and Live each day as an example of what an osteopathic physician should be.

20 CAHPS-C&G Surveys Surveys ask patients about their recent experiences with clinicians and their staff CAHPS-C&G surveys include standardized questionnaires for adults and children. The report will help a physician use the results to identify opportunities for improvement and track progress towards goals. Resources available to inform and support the improvement process include CAHPS Improvement guide, recorded webcasts, presentations and case studies on The AOBOG will accept evidence that you have participated in an outside CAHPS survey if you present information that shows you have surveyed at least 30 patients in the 6 year cycle using the same CAHPs questions with a formal outside company reviewing the data. You must also provide documentation of an improvement plan that was developed and implemented based on the survey results.

21 OCC Part 2: Continuous Medical Education

22 Usual AOA CME Requirements
30 1-A credits= face-to-face CME conference CAQ Specialty CME credits (as applicable) 50 Specialty CME Credits-any category Minimum of 120 credits of CME during each three-year cycle. Minimum of 50 specialty credits must be in the specialty area of certification. The AOBOG does not have any CAQ (certificates of added qualifications) only CSQ’s (certificates of special qualifications). CSQ’s include the general Ob-Gyn’s, reproductive endocrinology and infertility, maternal-fetal medicine, gynecologic oncology, Female pelvic medicine and reconstructive surgery. The subspecialty becomes the primary certification unless the physician wants to maintain certification in both the CSQ and the basic primary specialty certification. If you practice any general Ob-Gyn activities as a sub-specialist you must maintain both certifications. 120 CME Credit hours total due every 3 years A minimum of 50 specialty credits must be Ob-Gyn related

23 Description Maximum # of Credits/cycle Annual OMED Conference and Exposition Determined annually by each specialty board AIDS Seminars (any osteopathic or allopathic) 5 Risk Management/Patient Safety Ethics AOA Specialty College Conferences & Seminars ALL AOA State Society Seminars 25 Medical Journals/Home Study Courses 20 Scientific Exhibits AMA/PRA courses Specified by Board

24 Specialty CME Description Maximum # of Credits/cycle
Formal Teaching in the Specialty Specified by Board Standardized Life Support Specialty Certifying Board Test Construction 15 Publications Healthcare Facility Meetings Hospital inspections Acute Care Hospital Programs 25 College of Osteopathic Medicine Seminars Osteopathic Foundation Seminars Practice Performance Assessment and Improvement Modules To be Determined

25 Component 3: Secure written exam once every six years

26 Part 3 Cognitive Assessment: Formal Proctored Exam (FPE)
Take and Pass the psychometrically valid formal proctored examination once every 6-year cycle Separate fee Given once a year and can be taken in either of the last 2 years of the 6-year OCC cycle Must pass prior to the expiration of your certificate See AOBOG.org website for specifics Receive category 1-B credits for passing: 15 hours

27 The Right Tools for the Job
Component 4 is the Practice Performance Assessment and Improvement Diplomates must engage in continuous improvement through comparison of their personal practice performance measured against national standards for his or her medical specialty

28 Part 4: PPAs or PIMs Practice Performance Assessment modules or Practice Improvement Modules-many names for the same thing! Requirement: 5 online modules completed per 6-year OCC cycle - Diagnosis specific chart review AOBOG PPA Committee reviews the data against national benchmarks or creates the benchmarks based on collated data received Physician receives a report with recommendations for Improvement if necessary Implement the practice improvement program and then reassess practice in a specified amount of time Charts must be from an individual physician and not a group practice Diplomates must engage in continuous improvement through comparison of personal practice performance measured against national standards for his or her medical specialty. It is designed to give the individual physician an opportunity to engage in a practice improvement process regarding their direct patient care experience.

29 O-CAT is a PIM developed by Meaningful Measurements
AOBOG will be using O-CAT (Osteopathic Continuous Assessment & Training) from Meaningful Measurements as our platform for the PPAs. O-CAT is a tool for physicians to track the pulse of their practice. Benchmark Engage in methods of improvement Benchmark again

30 Part 4-Collecting data Register to start one on the AOBOG website and then will be linked to O-CAT. Stage A: Each module involves a short introduction with 3-4 key points, 2-4 key references, and yes/no questions per chart. A certain # of charts will be pulled per module depending on the topic. Same questions for each chart. (You do not mail charts in but you are subject to potential audit, so keep a list.) Answer attestation information. Data is submitted back to AOBOG for review, and/or compared to pre- determined national benchmarks. The PIM’s will be a Web-based performance measurement program that analyzes data abstracted from patient medical records in order to evaluate clinical practices against evidence-based guidelines. The overarching purpose is to improve patient outcomes and ultimately increase quality of patient care. To provide a structure for the quantitative evaluation of current osteopathic care provided individually and in the aggregate by osteopathic physicians. To identify where quality-of-care improvements can be made in osteopathic physicians’ offices and provide educational interventions. To provide osteopathic physicians with information on how they are treating their populations. The system provides a structured three stage process: STAGE A: Assess Performance Assess current practice using identified performance measures through a self-assessment survey and patient chart reviews Complete a self-assessment survey. Select 20 medical records based on the indicated parameters such as diagnostic criteria, patient inclusion and exclusion criteria and sampling technology. Enter and submit data from patient medical records online for analysis. Receive a performance analysis report comparing your performance with other participants and national benchmarks. Complete an evaluation on the process. STAGE B: Build and Implement Action Plan Select from educational interventions and practice improvements designed for sustained improvement in patient care Identify an improvement goal and build an Action Plan using the interventions and systems tools within the PI module. Complete one educational activity and apply what you have learned in practice for a recommended 90 days (minimum of 30 days). STAGE C: Reassess Performance Enter data from 20 additional charts online for patient visits since you have completed Stage B to generate a comparison report . Compare your Stage A and Stage C survey and performance results . Complete an evaluation on the process . Receive ? credits of AOA Category 1-B Credit . It has been developed to collect no identifiable patient information and meets the HIPAA privacy regulation for “de-identification of protected information” set forth in 45 CFR Sec (b)(2). All physician-specific data is confidential and will only be made available to the physician or their delegate.

31 Part 4- Board will Evaluate Physician Data
Stage B: Receive discussing results and giving a completed status or suggesting improvements if necessary. Incomplete status: Diplomate will review the literature and engage in practice improvement. Select from educational interventions and practice improvements designed for sustained improvement in patient care. Identify an improvement goal and build an Action Plan using the interventions and systems tools within the PPA module. Complete one educational activity and apply what you have learned in practice.

32 Component 4 - Required PPA
Osteopathic Continuous Assessment & Training (O-CAT) Communications Module Focuses on Core Competencies of: Interpersonal & Communication Skills Patient Care Professionalism Osteopathic Philosophy This must be one of the 5 modules you do in your 6-year OCC cycle.

33 Part 4 - Stage C Stage C: 1 to 6 months later, an is sent for follow up instructing the physician to review the module, and submit an attestation on changes that were made in your practice as a result of the module. You will have to pull and document a second series of charts if you did not receive a satisfactory score the first time through. Compare your Stage A and Stage C survey and performance results Receive CME credits of AOA category1-B per module

34 PPA Modules All 5 modules must be completed by September 15th of the 6th year of your OCC cycle.

35 Part 5: Continuous Membership
Membership in the professional osteopathic community provides physicians with online technology, practice management assistance, national advocacy for DOs and the profession, professional publications and CME activity reports and programs.

36 Loss of Certification If a Time-limited diplomate doesn’t complete all OCC components in a 6-year cycle before September 15th of the 6th year… they will no longer be certified. Re-entry into the process varies depending on timing. See FAQs page on AOBOG.org. Non time-limited certificate holders: if you lose your certification for any reason, you must take the formal proctored exam at the next administration and then enter the OCC process.

37 Dual Certifications – AOA/ABMS
The AOA BOS is currently discussing what, if any, aspects of ABMS’ Maintenance of Certification (MOC) program may be applicable to OCC. The AOBOG will post all developments to our website – Right now, please make sure you are registered for OCC through the AOBOG website.

38 Clinically Inactive Physicians
A diplomate will have to provide an attestation through petition that they are not involved in any clinical activity and submit documentation. Will participate in all Parts of the OCC process-but will have to be individualized for this group. Communication survey module required If desire to re-enter clinical practice will be required to take and pass the written proctored exam first if they have been out of practice for two years or more The AOBOG will offer a way for physicians to declare a non-clinical status. The non-clinical physician is defined as a physician who does not see any patients or cover (supervise) any resident, fellow or student clinics. If you see one patient and/or sign off on any charts, you will be required to do the complete OCC process. If declared a non-clinical physician you will need to participate in all OCC components except for part 4 until the AOBOG develops modules for non-clinical physicians. A re-entry process has been developed for those wanting to leave academic non-clinical positions to the active practice of medicine. A physician will first have to take and pass the formal written proctored examination at the next scheduled administration. Following this, you will enter the next 6 year OCC cycle.

39 AOA OCC dashboard

40 AOBOG.org Keeping Informed

41 AOA Division of Certification
Questions / Concerns? Carolyn W. Quist, DO Vice Chair American Osteopathic Board of Obstetrics and Gynecology 142 E. Ontario St., 4th Floor Chicago, IL 60611 , ext or AOA Division of Certification (800) , ext. 8266


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