Norfolk State University Financial Health Management Memorial Hospital Thesis

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o Suppose you are the new Chief Executive Officer (CEO) at Memorial Hospital.  Memorial is a nonprofit hospital with 300 beds and is located in a busy metropolitan area directly adjacent to a large university.  Memorial is the only hospital within a 20-mile radius of campus, but construction on a new, competing hospital has just started within 5 miles.  

? Identify three forecast content items.  How will they be measured?

? What is the expected status of the content items in the future?

? Which forecasting techniques should you use? 

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Chapter 16 Healthcare Reform Trends HSM 331-90, Health Financial Management Norfolk State University Dr. Batrina Martin, PhD, MSM, MPA, MSW(c), QMHP A/C Healthcare Reform Trends Learning Objectives • • • • • • Identify the need for national healthcare reform. Compare and contrast healthcare reform proposals in the past. Discuss the Affordable Care Act of 2010. Explain the need for entitlement reform. Discuss various state proposals for healthcare reform. Consider possible future developments in healthcare reform. National Healthcare Reform National healthcare reform focuses on three problems: • Quality • Access • Cost National Healthcare Reform Quality • To Err is Human - Medical errors kill 46,000–98,000 Americans every year. - An additional 1.2 million Americans suffer an adverse event caused by the hospital that results in extended hospitalization or disability (more than ½ reported preventable). National Healthcare Reform Quality • In 2016, researchers from John Hopkins Medicine estimated that more than 250,000 Americans die each year from medical errors. • Medical errors are the third leading cause of death. National Healthcare Reform Quality • Since 2011, patient safety programs have reduced medical errors. • An estimate of 50,000 lives and $12 billion National Healthcare Reform Quality • In 2013, avoidable hospital readmissions fell by 17.5%, or by 150,000 fewer hospital readmissions for Medicare beneficiaries. • More than 700 ACOs have generated $417 million in savings for Medicare by emphasizing value-based programs National Healthcare Reform Access • 17.2% of Americans, or approximately 55 million people, were without insurance prior to the ACA. • Available programs: - Medicare - Medicaid - State Children’s Health Insurance Program - Temporary Assistance for Needy Families (TANF) National Healthcare Reform Access, through 2015: • With ACA, 10.2 million Americans had achieved access through the Health Insurance Marketplace. • Additional 12.3 million Americans had achieved access through the Medicaid expansion. • 2.3 million young Americans had achieved access using the provision to stay on their parents’ plan until age 26. National Healthcare Reform Cost • Federal government is now the single largest payer of healthcare expenditures, 35% in 2016. • State and local government 6.3% • Professional providers and hospitals are the largest recipients of healthcare dollars (27.7% and 33.5%). • Healthcare expenditures continue to grow at a faster rate than growth in the economy. Latest Projections on Health Care Costs Year Health Expenditures (b) Per Capita ($) Percent GDP 1950 12.7 82 4.4 1960 26.9 146 5.3 1970 73.2 341 7.1 1980 247.3 1,052 8.9 1990 699.5 2,691 12.2 2000 1,310.0 4,617 13.3 2010 2,600.0 8,417 17.4 2011 2,700.7 8,680 17.3 2012 2,806.6 8,948 17.2 2013 2,879.9 9,115.1 17.3 2014 3,031.3 9,523.4 17.5 2015 3,197.2 9,960.2 17.8 2016* 3,350.7 10,345.5 18.1 2019* 3,958.6 11,887.5 18.5 Healthcare Reform National Healthcare Reform Truven Health Analytics(2009) found $700 billion of unnecessary health spending • • • • • • $250 to $325 billion on waste $125 to $175 billion on fraud and abuse $100 to $150 billion on administrative system inefficiencies $75 to $100 billion on provider inefficiency and error $25 to $50 billion on lack of care coordination $25 to $50 billion on preventable conditions and avoidable care National Healthcare Reform ACA is making healthcare more affordable for consumers. • By subsidizing health insurance purchased on the Health Insurance Marketplaces (85% received a health insurance premium tax credit) National Healthcare Reform In 2016: • Price for healthcare to consumers rose at slowest rate in 50 years. • Total healthcare expenditures for the nation continue to increase at a more rapid rate than the economy—4.8 percent in 2016. • The federal portion of Medicaid increased 18.4 percent in 2014 and 14.7 percent in 2015. National Healthcare Reform Early reform • • • • • 1930: National health insurance as part of Social Security Act Prior to 1994: Reactionary 1965: Publicly-financed healthcare for the elderly and the poor 1973: HMO legislation 1983: Ended Medicare cost-based reimbursement for hospitals and initiated a competitive environment under prospective payment • 1984: Limited amount employer could deduct from health benefits for employees • 1992: Ended Medicare charge-based reimbursement for physicians and initiated a prospective payment National Healthcare Reform Unsuccessful legislative attempts at reform • • • • • Incremental proposals Single-payer proposals Employer-based proposals Managed competition proposals Clinton Plan National Healthcare Reform HIPAA of 1996 • • • • • Insurance reform Medical savings accounts Administrative simplification Healthcare tax rule changes Medicare/Medicaid fraud and abuse changes National Healthcare Reform Balanced Budget Act of 1997 • • • • Provider-sponsored organizations Kids Care Medicaid managed care Initiated SGR for physicians National Healthcare Reform MMA of 2003 • Increased payments to providers • Prescription drug coverage to Medicare beneficiaries National Healthcare Reform DEFRA of 2005 • Reduced Medicare payments for services provided as a result of certain hospital-acquired infections • Adjusted disproportionate share hospital payments • Hospitals with 100 or fewer beds and a high proportion of Medicare patients receive special payments • Reduced payment to ASCs if payments exceeded hospital outpatient fee schedule National Healthcare Reform Tax Relief and Health Care Act of 2006 • Provisions to prevent a 2007 cut in Medicare physician payments mandated under DEFRA of 2005. National Healthcare Reform Medicare, Medicaid, and SCHIP Extension Act of 2007 • Extended funding for SCHIP through March 2009 • Provided .5% Medicare payment increase for physicians for 6 months • Extended transitional medical assistance eligibility for Medicaid beneficiaries for 6 months National Healthcare Reform American Recovery and Reinvestment Act of 2009 • $244 billion for education and healthcare as well as entitlement programs National Healthcare Reform • Patient Protection and Affordable Care Act, Senate version of healthcare reform, signed into law 3/23/10. • Health Care and Education Reconciliation Act, House version of healthcare reform, signed into law 3/30/10. • Both laws will cost $940 billion over 10 years and provide insurance coverage to an additional 32 million Americans. National Healthcare Reform Affordable Care Act provisions • • • • Expands coverage to 32 million Reduces rates of increase in Medicare and Medicaid spending Adopts several delivery system reforms Provides grants and loans to improve workforce education and training on healthcare issues • Provision to reduce waste, fraud, and abuse in Medicare and Medicaid • Imposes new reporting requirements for tax-exempt hospitals • Significant restriction on physician-owned hospitals and prohibits new facilities National Healthcare Reform Affordable Care Act of 2010 after Supreme Court decision • Individual mandate unconstitutional under commerce clause • Individual mandate constitutional as tax • Medicaid mandate putting all federal funding for Medicaid at risk if states do not expand Medicaid eligibility declared unconstitutional National Healthcare Reform Budget Control Act of 2011 • Reduces discretionary spending by $1.2 over 10 years. • Sequestration, an across-the-board cut in the same amount, would automatically be enforced if the committee could not identify the cuts. • The act continued funding for healthcare fraud and abuse investigations. Copyright Healthcare© 2018 Foundation of the American College of Executives. Not for sale. National Healthcare Reform American Taxpayer Relief Act of 2013 • Delays for two months the budget sequestration • Raised taxes on the wealthy, generating $600 billion over ten years • Suspends for one year planned 26.5% reduction in Medicare payments to physicians • Cut $1.2 trillion in federal spending over ten years (2% cut from Medicare reimbursement to hospital, or about $10 billion over ten years) Copyright Healthcare© 2018 Foundation of the American College of Executives. Not for sale. National Healthcare Reform Bipartisan Budget Act of 2013 • Passed in late 2013, averts a federal government shutdown • Eliminates many automatic spending cuts mandated in sequestration • Delays for three months the pending cut to physician reimbursement Copyright Healthcare© 2018 Foundation of the American College of Executives. Not for sale. National Healthcare Reform Medicare Patient Access and Quality Improvement Bill of 2013 • Had significant bipartisan support, would have replaced the 24.0% cut in physician reimbursement mandated by SGR with a 0.5% increase per year for five years and value-based reimbursement after five years. Copyright Healthcare© 2018 Foundation of the American College of Executives. Not for sale. National Healthcare Reform SGR Repeal and Medicare Provider Modernization Act of 2014 • In early 2014, the Medicare Patient Access and Quality Improvement Act was replaced by the SGR Repeal and Medicare Provider Modernization Act, which proposed replacing the SGR with a merit-based incentive pay system which combines three existing incentive programs for physicians: - Physician Quality Reporting System - Value-Based Payment Modifier - Meaningful use criteria for medical records Copyright Healthcare© 2018 Foundation of the American College of Executives. Not for sale. National Healthcare Reform SGR Repeal and Medicare Provider Modernization Act of 2014 • Although the SGR Repeal Act had broad bipartisan support, it was never passed due to conflicting ways to account for the $140 billion that physicians had been overpaid under the SGR. Copyright Healthcare© 2018 Foundation of the American College of Executives. Not for sale. National Healthcare Reform Protecting Access to Medicare Act of 2014 • Extended expiring program authorizations and appropriations, including the SGR for physician reimbursement under Medicare • Skilled Nursing Facility Value-Based Purchasing Program, to become effective in 2019 Copyright Healthcare© 2018 Foundation of the American College of Executives. Not for sale. National Healthcare Reform The Medicare Access and CHIPS Reauthorization Act of 2015 (MACRA) • Cutting hospital reimbursement $34 billion, by increasing Medicare Part B and Part D premiums to wealthy Medicare beneficiaries by $34 billion, and by increasing out-of-pocket costs for Part B by $6 billion • Repealed the SGR Copyright Healthcare© 2018 Foundation of the American College of Executives. Not for sale. National Healthcare Reform The Medicare Access and CHIPS Reauthorization Act of 2015 (MACRA) • Merit Incentive Payment System (MIPS) would measure quality, advancing care information (formerly meaningful use criteria), clinical practice improvement, and cost. • APMs were intended to move physicians away from fee-for-service riskassuming methods of payment. Copyright Healthcare© 2018 Foundation of the American College of Executives. Not for sale. State Reform • Massachusetts Plan • California Health Plan State Reform Massachusetts Plan • Passed in 2006 • Includes - Individual mandate—must find coverage or face a fine - Expands Medicaid and SCHIP eligibility to 150% of FPL - “Commonwealth Care” provides subsidies to state plan up to 300% - Employer mandate for employers with 11 or more employees with group rates to state plan - “Commonwealth Choice” state health plan that provides coverage at a group rate to individuals making more than 300% of the poverty level and to small businesses - Waives mandate to families who make less than $114,000 and cannot find insurance State Reform • California Health Plan, proposed by Governor Schwarzenegger, included: – Individual mandate – Employer mandate – Incentives for personal responsibility for health and wellness • Defeated by legislature in 2008 due to risk and cost State Reform • The ACA required the states to expand Medicaid eligibility to citizens making from 100% to 138% of the federal poverty level. • Supreme Court ruled that provision unconstitutional. State Reform The federal government tried to entice states to expand eligibility to 138 percent by: • Promising to pay 100 percent of the expansion costs for the first three years • Promising to pay 90 percent of the expansion costs until 2022 State Reform • As of mid-2016, 31 states and the District of Columbia had expanded Medicaid, and 19 states had not expanded Medicaid. Free-Market Reform • Total healthcare spending increased only 4.4 percent between 1995 and 1996, the smallest percent increase in 37 years. Free-Market Reform Direct Contracting • The practice of large employers contracting directly with integrated delivery systems capable of accepting a financial risk and delivering a full range of healthcare services - Stimulates competition between integrated delivery systems and encourages local control and innovation - Reduces administrative costs, which in turn reduces employer health plan costs Free-Market Reform Accountable care organizations (ACOs) • Authorized by the ACA of 2010 • Addresses need for clinical coordination among physicians and hospitals • Provides high-quality care at least possible cost by exploring new ways to minimize fragmented care, avoid repetitive services, and improve clinical and service performance Free-Market Reform Accountable care organizations (ACOs) • 20 ACOs in the pioneer program and the 333 in the shared savings program reported savings of $411 million in 2014. • Medicare reported that, after bonuses and incentives were paid by Medicare, CMS recorded a $2.6 million loss. • Accounting for the loss, ACO experts cite initial infrastructure costs and slow changes in physician behavior. The Future of Healthcare Three “brutal facts” about healthcare reform: • Healthcare bubble will eventually burst. • Neither ACOs nor first-generation clinical integration models will produce desired results. • Physician autonomy and the organized medical staff will become less relevant. FuHealthcare Reform ture Trends The Future of Healthcare Reform Healthcare bubble bursting • Kaufman predicted that federal and state governments would reduce payments for fee-for-service reimbursement and would move toward bundled payments and capitated payments to further reduce healthcare costs. The Future of Healthcare Reform Lack of desired results from ACOs and first-generation clinical integration • Generating significant savings on Medicare fee-for-service patients is difficult for integrated medical groups. • When groups receive shared savings payments, the payments are insufficient to cover the increased costs. The Future of Healthcare Reform Reduced autonomy of physicians and reduced relevance of organized medical staff • Hospitals will need to work with medical staffs to - Modify medical staff bylaws to require conformance to patient safety, patient satisfaction, process, and quality metrics as a condition of hospital privileges - Develop a medical staff organization in which medical leaders have authority over cost, quality, and patient satisfaction decisions of physicians. The Future of Healthcare Reform Entitlement reform • Effort to bring about long-term economic recovery dependent on controlling America’s most costly entitlement programs: Medicare and Social Security Healthcare Reform The Future of Healthcare Reform • Entitlement payments are funded through current tax revenues and the hope of future tax revenues. • Much of the economic burden of funding today’s entitlements will fall onto future generations. The Future of Healthcare Reform President Trump’s healthcare plans • Repeal and replace “Obamacare” [the ACA] with health savings accounts (HSAs). • Work with Congress to create a patient-centered healthcare system that promotes choice, quality, and affordability. • Work with states to establish high-risk pools to ensure access to coverage for individuals who have not maintained continuous coverage. • Allow people to purchase insurance across state lines, in all 50 states, creating a dynamic market. • Maximize flexibility for states via block grants so that local leaders can design innovative Medicaid programs that will better serve their lowincome citizens. The Future of Healthcare Reform Empowering Patients First Act contained the following features: • • • • • • Certain insurance protections would be available to consumers who had maintained continuous health insurance coverage. Consumers would be encouraged to purchase health insurance tax credits and health savings accounts. Physicians could enter into private contracts with Medicare beneficiaries to provide care. Physicians could more easily defend themselves from malpractice suits by showing they followed clinical guidelines, and physicians would be exempt from federal antitrust laws during negotiations with insurance plans. Federal health insurance exchanges would be replaced with federal grants to states to subsidize insurance for people who might have difficulty finding insurance coverage on the open market. Tax-free insurance coverage from employers would be limited to $8,000 per individual and $20,000 per family. Key Points • Healthcare reform attempts to improve quality, lower cost, and increase access. • Healthcare reform since the mid-1990s has been incremental in nature, in that it attempted to improve quality or lower cost or increase access. • The Affordable Care Act of 2010 attempted to improve quality, lower costs, and increase access. • The Medicare Access and CHIPS Reauthorization Act of 2015 attempted to moved physician reimbursement from fee-forservice to risk-based models. Key Points • In the absence of meaningful healthcare reform from the federal government before 2010, some states attempted healthcare reform. • The free market has attempted reform through managed care movements and direct contracting. • With the passage of healthcare reform, entitlement reform in order to guarantee the sustainability of the federal government is expected to be a legislative priority. • Healthcare and the nation’s economy will be interdependent in future decades. • President Trump’s campaign promise was to repeal and replace the ACA with free-market reforms. Discussion Questions 1. How would you summarize the history of healthcare reform? 2. What are the key provisions of the Affordable Care Act of 2010? 3. What are the key provisions of Medicare Access and CHIPS Reauthorization Act of 2015? 4. What are the key provisions of the Massachusetts health plan? 5. Why did the California health plan fail to gain legislative support? Discussion Questions 6. What are the two major free-market initiatives, and what is the impact of each on quality, cost, and access? 7. Why is there a need for entitlement reform? What might entitlement reform look like in the future? 8. Why might healthcare reform not work? 9. What are the major healthcare reform ideas proposed by President Trump? 8:36 PM Tue Nov 9 33% 0 SAMPLE PAPER.doc 000 Individual Assignment 1: Responsibilities of the Chief Financial Officer Your Name Department of Nursing and Allied Health, Norfolk State University HSM 331-90: Health Financial Management Dr. Batrina Martin August 24, 2020 Responsibilities of the Chief Financial Officer In health care organizations, the Chief Financial Officer (CFO) measures and reports on the validity of meeting the business's objectives. The CFO also measures the effectiveness of policies and procedures to attain those objectives (Nowicki, 2018). One of the CFO's primary goals is to protect the assets of the organization and ensure that the hospital systems are running most cost-effectively. To achieve the hospital goals, the characteristics and traits of CFOs will be discussed. Also, the American College of Healthcare Executives (ACHE), conducted a survey in 2015 to identify typical CFO profiles (Nowicki, 2018). Subsequently, the International Journal of Innovation and Research in Educational Sciences published an article that identified healthcare CFO professional development attributes. This paper aims to identify the characteristics, traits, and responsibilities of CFOs and their fiduciary duties in healthcare organizations. Characteristics and Traits of the CFO There are some CFOs that oversee the day-to-day administrative operations of healthcare organizations. They plan and supervise all medical services that include monitoring budgets and updating health records. Nowicki (2018) believes there are six skills that CFOs must have: 1) the ability to communicate clearly, 2) provide day-to-day leadership, 3) manage resources and finances, 4) build coalitions, 5) create a positive organizational culture, and 6) maintain strong physician relationships. ACHE Survey of Typical CFO Profiles The American College of Healthcare Executive (ACHE) conducted a survey that showed CFO compensation trends of middle managers from 2005 to 2015. There were seven CFO job titles that showed a progression of increased salaries. In 2015, the director/manager of managed care's largest salary was $134,000 followed by the director/manager of finance at $127,600 (Nowiski, 2018). Today, the nationwide average CFO hospital annual salary is $152,106 (Zip recruiter, 2020). CFO Professional Development Attributes The International Journal of Innovation and Research in Educational Sciences published an article titled "Identifying Healthcare CFO Professional Development Attributes" written by Rochester, Wilson, Berkshire, & Houlihan (2017). The article identifies the concern of uncontrolled healthcare expenditures in the United States. The authors also identified fourteen important attributes for CFO development and success. The top five attributes respectively ranked: "1) ability to translate financial information into meaningful action, 2) effective communicator, 3) high integrity, 4) ability to translate financial and performance metrics into useful measures for operations people, and 5) ability to execute..." (p. 617). The article focused on the importance of financial leaders having a professional development portfolio. Conclusion This paper aimed to identify the characteristics, traits, and responsibilities of CFOs and their fiduciary duties in healthcare organizations. Research and literature reviews were conducted for the past five years. Research showed that the healthcare industry would be the most prominent industry by 2026, employing more than one-third of all jobs in the country with the projected growth rate exceeding every other sector (BLS, 2016). The characteristics, traits, and responsibilities of CFOs play an essential role in helping the United States reduce healthcare costs by improving the CFO professional development portfolio. References Bureau of Labor and Statistics. (2016). Industry employment and output projections to 2024. Retrieved from https://www.bls.gov/opub/mlr/2015/article/industry-employment-and- output-projections-to-2024.htm. Hospital Chief Financial Officer Salary. (2020). Retrieved from https://www.ziprecruiter.com/Salaries/Hospital-Chief-Financial-Officer-Salary. Nowicki, M. (2018). Introduction to the financial management of healthcare organizations (7th ed.). Chicago, IL: Health Administration Press. Rochester, C., Wilson, A., Berkshire, S., & Houlihan, R. (2017). Identifying healthcare CFO professional development attributes. Retrieved from https://www.ijires.org/administrator/components/com_jresearch/files/publications/IJIRES_1096 FINAL.pdf 8:35 PM Tue Nov 9 33% 0 Individual Assignmemt 4 Rubric_HSM-331-90.docx 000 Individual Assignment 4 (30 Points) – Name Rubric Description 331-90 Health Financial Management, HSM Module 6 Rubric Detail Levels of Achievement Somewhat Criteria Not Acceptable Acceptable Acceptable Highly Acceptable Quality 0 Points 6 Points 8 Points 10 Points Work is not clearly Work is somewhat Work is connected to all Work is exceptional and connected to the required connected to some of the the required elements in the ideology was clearly elements in the required elements in the the assignment. Thesis connected to all the assignment. Thesis assignment. Thesis statement is clear, logical required elements in the statement is not clear, statement is somewhat and sets up the focus of assignment. logical and sets up the clear, logical and sets up the paper. The Research The elements of the focus of the paper. The the focus of the paper. questions are clearly Thesis Statement are Research questions are The Research questions stated and capture the clear, logical, and sets up not clearly stated and are somewhat clearly full scope of the research the focus of the paper. capture the full scope of stated and capture the effort. The Research questions the research effort. full scope of the research are clearly stated and effort. capture the full scope of the research effort. Critical Thinking Grammar and Spelling 0 Points 6 Points 8 Points 10 Points Work did not Work included some Work included Work exceeded successfully include coherence, clarity, and coherence, clarity, and expectations including coherence, clarity, and critical thinking skills. critical thinking skills. coherence, clarity, and critical thinking skills. Metacognition is Metacognition is critical thinking skills. Metacognition is not somewhat connected to connected to the required Metacognition is clearly connected to the the required elements. elements. connected to the required required elements. elements. 0 Points 3 Points 4 Points 5 Points Work contained Work contained some Work is largely free of Work is free of numerous grammatical, grammatical, spelling, grammatical, spelling, grammatical, spelling, spelling, and punctuation and punctuation errors. and punctuation errors. and punctuation errors. errors. 0 Points 3 Points 4 Points 5 Points Work did not include Work somewhat Work included Work reflects stellar references or in-text included references or references or in-text research efforts. Work citations, according to in-text citations, citations according to shows in-text citations, APA format. References according to APA format APA format. References according to APA are not peer-reviewed, and/or references are not are peer-reviewed and format. References are and they are greater than peer-reviewed, and they are less than 10 years peer-reviewed, they are are greater than 10 years old. less than 10 years old, old. and met the requirements. References Used to Support Rationale 10 years old 8:35 PM Tue Nov 9 33% 0 Individual Assignment 4_HSM-331-90.docx 000 Health Financial Management, HSM 331-90 Individual Assignment 4 (30 Points) Module 6 Assignment • Review and study Chapter 14 in the textbook (Nowicki, 2018). • Review and study the PowerPoints posted in Blackboard. . Use critical thinking and metacognition when you read the Mini-Case Study (Nowicki, 2018, p. 321): o Suppose you are the new Chief Executive Officer (CEO) at Memorial Hospital. Memorial is a nonprofit hospital with 300 beds and is located in a busy metropolitan area directly adjacent to a large university. Memorial is the only hospital within a 20- mile radius of campus, but construction on a new, competing hospital has just started within 5 miles. • Identify three forecast content items. How will they be measured? . What is the expected status of the content items in the future? • Which forecasting techniques should you use? • Write a 2-3-page paper in APA (2020) format, create a thesis statement relative to health financial management, and answer the research questions listed above in the Mini-Case Study. Include a cover page, a reference page, three peer- reviewed references, and use the textbook. should follow the SESC format of state, explain, support, and conclude, see the Sample Paper. The paper • Review the Rubric to maximize points.
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Financial Health Management

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Financial Health Management
As a CEO at Memorial Hospital, a 300-bed nonprofit hospital, the construction of the
new hospital just 5 miles from our hospital will pose stiff competition for the clients and patients.
However, on the other hand, it will play a significant role in providing quality health care.
Furthermore, it plays an essential role in national healthcare reform. National healthcare reform
aims at quality care, adequate access, and cost affordability (Angerer-Fuenzalida, 2018).
Therefore, combining the newly constructed hospital and the Memorial hospital will significantly
benefit the community regarding health care provision. This paper aims to identify three forecast
content items concerning the construction of the new hospital and how they will be measured,
the expected status of the content items in the future, and fin...


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