COVID-19 Update June 10, 2020


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Notes from Governor Cuomo’s Briefing

– Day 102 of the COVID Crisis

– Day 17 of Civil unrest

Reopening:

– Every region in the state is now reopening

– Long Island entered phase two today

– The focus during this phase will be on data, mainly daily testing results

– “We all have a role to play”… our response to COVID has been a social issue depending on people participating in measures to prevent the spread from employers to employees and other individuals

– Closing was the easy part… the states and countries that have reopened have

seen increases in the number of cases

– Governor reiterated the need to be smart and safe when reopening

especially in a place like NYC

– Moving forward we must:

– Monitor the reopening

– Energize the reopening

– Stimulate the economy with large scale development projects that can help drive economic growth

Q&A:

Reopening:

– In response to a question on the reopening of outdoor swimming pools in Phase two

DeRosa stated that guidance will be put out for municipalities in the coming days

– In response to schools reopening in the fall the Governor stated that he is unsure

as he does not know where we will be in terms of COVID

– He continued stating that theoretically, there could be different measures in different regions, but that all depends on COVID


State Medical Associations Ask Washington for More Aid to States
MSSNY and six other state societies have drafted a letter to the U.S. Senate urging them to provide additional funding to the States and the Medicaid program. As you know, the Heroes Act that recently passed the House provided a $1 trillion dollars in funding to assist States, and a 12% increase in federal Medicaid matching funds.

As State CEOs, you understand that state tax revenues have plummeted, forcing Governors and State Legislatures to make difficult state budget decisions that could negatively impact physicians. States and physicians desperately need additional assistance from Congress. The letter also urges the Senate to direct HHS to release Provider Relief Funding to Medicaid-dependent providers immediately.

June 5, 2020

Dear Senators McConnell and Schumer:

The undersigned large state medical associations, representing tens of thousands of physicians across the nation, thank you for supporting physicians and helping us continue to care for patients during the COVID-19 pandemic.  As the Senate considers another vital COVID-19 response package, we ask that you prioritize the stability of our state-federal partnerships that form the foundation of our health care delivery system. Addressing the needs of states and physicians on the frontlines combating the virus will ensure that our health care system and our economy recover from this crisis.

Additional Aid to States and the Medicaid Program

With millions of Americans losing their jobs and employer-sponsored health insurance coverage, Medicaid has become an essential safety net for families and enrollment is rapidly growing. Half of America’s children and people with disabilities were already enrolled in Medicaid prior to COVID-19.  The growth in unemployment has also significantly reduced state tax revenues as states have been forced to commit substantial additional resources to fight the economic and health care impact of COVID-19.  As a result, states are in serious financial trouble and they do not have the same financing options that are readily available to the federal government. Thus, states will be forced to cut health care funding.

Moreover, states have little flexibility and will be forced to impose cuts on physicians and hospitals that are on the frontlines now already reeling financially from the COVID outbreak, and who will be needed during the second surge caused by months of delayed care.  Medicaid physicians have yet to receive any federal assistance and they will not be able to sustain state cuts during the pandemic to remain accessible to patients enrolled in Medicaid and other federal, state, and local health care programs.  Medicaid patients (children, pregnant women, the elderly and disabled) are already among our most vulnerable patients and during the national emergency, more must be done to protect them.  We cannot afford to lose our current health care workforce during this crisis.

While we appreciate the support Congress provided in the Families First Coronavirus Response Act with the temporary 6.2% increase in Medicaid matching funds for states, more help is needed for states and physicians to meet the increasing Medicaid enrollment demands and our patient’s health care needs.

Therefore, we urge Congress to:

Provide additional aid to the states to protect the health care workforce and to prevent irreversible health care cuts.

Increase Medicaid matching funds by 14% consistent with the Heroes Act.

Direct HHS to release Provider Relief Funds to Medicaid physicians immediately.

Additional HHS Emergency Provider Relief Funding and a More Equitable Distribution Formula

We greatly appreciate the funding that Congress provided to physicians through the HHS Provider Relief Fund.  It is helping to sustain some physician practices that are facing increased health care expenses and severe 50-70% revenue losses caused by the public health emergency, social distancing, efforts to conserve personal protective equipment (PPE) and public health orders to refrain from providing non-urgent care.  However, physician practices will need additional funding to remain accessible to patients in their communities given the substantial revenue losses, the extended timeframe for reopening, the ability to only operate at 50% capacity in the future because of social distancing, safety measures, and limited PPE.

Moreover, physicians are essential to the health of their communities, as well as their economic well-being.  Physicians contribute to their local economies and are important employers. The fall-out from this crisis threatens to fundamentally alter the long-term stability of physician practices, and could lead to increased consolidation, which hurts competition and drives up costs for patients and employers. Additional Congressional help is needed to sustain our nation’s health care delivery system.

We also urge adoption of the Provider Relief Fund distribution methodology in the House “Heroes Act,” H.R. 6800. To date, only heavy Medicare-participating physicians have received funding and only 11% of the $50 billion allocation has gone to physicians.  We believe the House formula ensures a transparent, equitable distribution of funding to all providers based on their own proportionate share of expenses and revenue losses caused by the pandemic.  Moreover, it would ensure that pediatricians, obstetricians, and Medicaid-dependent providers receive funding.  These physicians are in the greatest need of funding because their traditionally lower reimbursement rates don’t provide the reserves to sustain their practices through the emergency.

We strongly urge Congress to increase funding to the HHS Provider Relief Fund by another $100 billion to sustain physician practices and protect patient access to care; and to ensure the funds are distributed commensurate with each provider’s COVID-19 related expenses and revenue loss from all payers.

Require all ERISA Health Plans, Medicare Advantage, and TriCare for Military Families to Cover and Pay for Telehealth and Telephone Audio-Only Services

Giving physicians the capability to provide services to patients via telehealth and telephone is essential to preventing the spread of the virus to the public, vulnerable patients, physicians, and their staff.  However, many elderly and low-income patients either don’t have access to telehealth or experience difficulty navigating virtual visits with both audio and video capabilities. Therefore, it is essential that telephone visits also be covered and paid for an in-person rates by all payers.

Recognizing that it is vital for the elderly to be in contact with their physicians and receive timely care, the Centers for Medicare and Medicaid Services (CMS) approved audio-only visits for the Medicare fee-for-service program but have not provided payment for it under the risk-adjusted Medicare Advantage program payments.

We ask Congress to protect the public health and include telehealth video and audio-only services in all federally regulated programs and plans, for our more vulnerable low-income patients and elderly Medicare Advantage patients.

Increase Support for the Production, Distribution, and Availability of PPE and Testing, and Accelerate Contact Tracing

There continue to be massive shortages of PPE and testing, as well as barriers to conducting COVID-19 contract tracing.  We urge Congress to prioritize the production, distribution, and availability of PPE and testing, and accelerate efforts to conduct contact tracing.  All of these are essential to the safe reopening of medical practices and the economy and must be prioritized for all health care workers.
Sincerely,

California Medical Association
Florida Medical Association
Massachusetts Medical Society
Medical Association of Georgia
Medical Society State of New York
North Carolina Medical Society
Texas Medical Association 



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Permanently Higher Telehealth Pay Rates Under Review, CMS Says
CMS Administrator Seema Verma discussed the prospects for extending telehealth coverage and pay rates permanently during a recent STAT virtual event today. “I can’t imagine going back,” she said during the event. But it may not be up to her. While Ms. Verma and President Donald Trump have repeatedly touted the gains telehealth has made for CMS beneficiaries during the pandemic, the federal government has not finalized permanent changes that would expand access to telehealth and coverage rates.

During the pandemic, CMS made telehealth available to all beneficiaries. Previously, it would only cover telehealth in specific regions and circumstances. The rates were also lower than in-person visits and did not include audio-only visits. One of the reasons telehealth was able to expand so rapidly in the last few months was because of the coverage changes.

“People recognize the value of (telehealth), so it seems like it would not be a good thing to force our beneficiaries to go back to in-person visits,” Ms. Verma said, mentioning that virtual visits increased 40-fold in some places during the pandemic.

However, in a CMS press release on June 9, Ms. Verma also acknowledged the value of in-person visits as healthcare facilities reopen for elective care.

“While telehealth has proven to be a lifeline, nothing can absolutely replace the gold standard: in-person care,” she said. Ms. Verma also said the government was evaluating whether to permanently pay the same rates for telehealth visits as in-person visits. A permanent nationwide expansion would be up to Congress because current laws limit coverage, she said.


Gov.: Nursing Homes to Test Employees Once a Week Instead of Twice
Today, Governor Cuomo issued an Executive Order that permits nursing homes which are located in regions of New York State that have reached Phase 2 of reopening to test their employees for Covid-19 once per week, instead of twice per week.


NYS Interim Advisory for In-Person Special Education Services and Instruction
During the COVID-19 Public Health Emergency – June 8, 2020
Special education services and instruction may be provided in-person this summer. For those inquiring about speech therapy as well, there is language contained in this about how that should be handled with respect to PPE/masks/social distancing.
Statewide
Child Care and Day Camps
Phase 1
Higher Education Research
Phase 3
Food Services
Personal Care


The NYSDOH invites you to participate in the Spectrum of Multisystem Inflammatory Syndrome in Children (MIS-C) webcast on Thursday June 11th, 2020 3-4PM 

Speakers below and attached
 
Therefore, this week’s healthcare provider COVID update webinar will be canceledNext week, please join the NYS Department of Health Thursday June 18th at 1-2PM for a COVID-19 update for healthcare providers

Speakers:

Melissa Stockwell, MD, MPH, FAAP
Chief | Division of Child and Adolescent Health
Director | Center for Children’s Digital Health Research
Associate Professor of Pediatrics and Population and Family Health
Department of Pediatrics | College of Physicians & Surgeons
Department of Population and Family Health | Mailman School of Public Health
Columbia University Irving Medical Center
Anu Subramony, MD, MBA
Assistant Professor of Pediatrics
Chief Quality Officer, VP of Quality and Safety
Cohen Children’s Medical Center, Pediatric Service Line @Northwell Health
Adam Ratner, MD, MPH
Associate Professor of Pediatrics and Microbiology
Chief, Division of Pediatric Infectious Diseases
Hassenfeld Children’s Hospital
New York University Grossman School of Medicine
Patricia Hametz, MD, MPH
Interim Medical Director, Pediatric Quality and Safety
Chief, Division of Pediatric Hospital Medicine
Associate Professor of Pediatrics
The Children’s Hospital at Montefiore
Albert Einstein College of Medicine
Stephen M. Blumberg, MD
Associate Professor of Pediatrics
Albert Einstein College of Medicine
Associate Division Director and Fellowship Director
Pediatric Emergency Medicine
NYC Health & Hospitals / Jacobi
Hosts:
Howard A. Zucker, M.D., J.D.
Commissioner of Health
New York State Department of Health
Marcus Friedrich, MD, MHCM, MBA. FACP
Chief Medical Officer
Office of Quality & Patient Safety
New York State Department of Health
Edward E. Conway Jr., M.D., M.S., FAAP, FCCM
Professor of Pediatrics
Division Chief Pediatric Critical Care
Associate Vice-Chairman Department of Pediatrics
Jacobi Medical Center
1400 Pelham Parkway S Bldg1 Room 8-17 West
Bronx, New York  10461
Co-Chair, Pediatric Sepsis Advisory Group
New York State Department of Health
Maria Lyn Quintos-Alagheband, MD, FAAP
Associate Professor of Pediatrics and Director of Health Systems Science
NYU Long Island School of Medicine
Chief Quality Officer for Children’s Services at NYU Winthrop Hospital
NYU Langone Health
Co-Chair, Pediatric Sepsis Advisory Group
New York State Department of Health



 

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DOHMD Launches Home Delivery for Condoms, HIV Self-Test Kits
The city health department will send condoms, lubricant, and HIV self-test kits directly to New Yorkers to supplement sexual health services that may have been affected due to the Covid-19 pandemic, announced officials today.

The home delivery program, Door 2 Door, aims to give New Yorkers access to safer-sex products that are normally distributed to 3,500 nonprofit organizations and businesses citywide, according to the city health department. The city distributes about 30 million male condoms, internal condoms, and lubricant packs to residents each year.

“Even during a global pandemic, sex remains an important part of overall health and well-being for many people,” said Dr. Oni Blackstock, assistant commissioner for the health department’s HIV bureau, in a statement. “As New Yorkers have had to adapt to the realities of the pandemic, so have the health department’s service models.”

The rate of sexually transmitted infections was increasing prior to the Covid-19 pandemic, and officials at health departments across the country say they are worried the lack of screening and testing will cause a spike in transmissions.

The health department does not encourage New Yorkers to go in-person for regularly scheduled testing for HIV or other sexually transmitted infections, but recommends

people seek care through telemedicine, according to the city’s website.


COMPLIMENTARY WEBINAR by Garfunkel Wild

Returning to Work in the COVID-Era: Employee Issues, What to Expect and How to Prepare

WHEN: Friday, June 12, 2020 | 10:00 am – 11:00 am (EDT)

As businesses prepare to reopen or have already reopened, there are common questions facing employers. This webinar will address the challenges to reopening and how best to respond to new types of employee questions and issues that arise. Below are just a few types of questions we will be addressing:

  • What guidelines should or must my business put in place to comply with social distancing and reopening requirements?
  • How do I respond to employees who are not following our protocols?
  • Can you require employees, customers, or patients to submit to medical testing? And, if so, what types of tests are acceptable?
  • How do I handle employee requests to stay out of work longer because they are uncertain or afraid of COVID-19 and returning to work?
  • If an employee refuses to return to work, how will that affect my PPP loan?
  • How should I handle all the unemployment requests I am receiving?
  • Should I contest them if I offered the employee his or her job back? What are 
    the consequences of not contesting?

REGISTER NOW


Pandemic Exacerbated Shortage of Injectable Opioids by Hospitals
In a “Special Report,” Reuters examines how the coronavirus pandemic has exacerbated a shortage of injectable opioids, which are regularly used in hospitals to treat patients on ventilators. Reuters adds that while the abundance of some types of opioids fueled the opioid crisis, “hospitals faced chronic shortages of the same painkillers in injectable form – narcotics vital to patients on breathing machines.” Reuters examines the contributing factors that led to a shortage of the opioids needed by hospitals including market forces and supply chain issues.


WHO Clarifies Position on Asymptomatic Spread of Coronavirus
The Washington Post (6/9) reports, “The World Health Organization moved Tuesday to clarify its position on whether people without symptoms are widely spreading the new coronavirus, saying much remains unknown about asymptomatic transmission.” Monday’s comment by a WHO official who called “such asymptomatic transmissions ‘very rare’ – touched off a furious scientific debate over the unresolved question and attracted widespread criticism of the organization.” The Post says that “less than 24 hours later, WHO convened a special news conference to walk back its comments, stressing that much remains unknown.”


New Cases of Coronavirus Nearly Doubled in CA and TX After States Reopened
New cases of coronavirus “in California and Texas, the country’s two largest states, have nearly doubled this month, from the daily case numbers recorded when the states began reopening in May, according to data compiled by Johns Hopkins University.” A month after reopening, California “recorded around 3,200 new cases on June 8, according to Johns Hopkins University.” Meanwhile, Texas reported around 2,000 new cases on May 31 and June 5 after it started the first phase of reopening on May 1. Newsweek (6/9)


MSSNY Offers Practice Administrator/Group Manager Membership
Group manager or practice administrator qualifies for free Affiliated Interest Group (AIG) membership if 50% of physicians in the practice are members.

Benefits include publications, information delivered electronically, access to online Medical Directory of New York State, access to Members Only section of MSSNY website, faxes on legislative calls to action, MSSNY reference guides, insurance and financial services, educational benefits, and the opportunity to serve as committee advisors and to participate in MSSNY political activities. call Ruzanna: 516-488-6100 x 403.


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COVID-19 Update June 9, 2020

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COVID-19 Testing Survey
MSSNY is conducting a short survey to ensure community physicians’ ability to test their patients for COVID-19. This information will be used by MSSNY leadership and staff to advocate to ensure community physicians’ offices have the ability to conduct this testing as we move forward in confronting this pandemic.

Please take just a few minutes to complete the survey.


Highlights from Governor Cuomo’s Daily Briefing:
– 101 days since first COVID case in NY
– Day 16 of civil unrest

NYS Police Reform:
– NYS Will Pass Aggressive Reform
– Banning of chokeholds
– False race-based 911 reports prohibited
– Gov. applauded Legislature for beginning to pass reforms yesterday
– Gov. stated he will sign these into law, hopefully this week

Reopening:
– Westchester/Rockland/Hudson Valley reopening today
– “NY had the worst situation and we handled it the best.”
– As we continue to reopen, Metro-North is taking steps to be safe
– Deploying 500K masks and 10K gallons and 100K 2oz bottles of hand
sanitizer
– Masks are mandatory when riding on public transportation systems
– Stay six feet apart when possible
– Long Island will enter Phase II tomorrow
NYC reopened yesterday
– 19.9% positive cases in all of NYC
NYS Testing Network
– 800+ testing sites in NY

– Daily testing will be biggest indicator of progress reiterating that 50K
are administered daily
– Governor stressed the need to be smart, citing a Wall Street Journal article on
COVID cases accelerating in more than a dozen states

Q&A:
Dashboard/Reopening:
– In response to a question on what percentage increase is considered a spike,
Governor stated that, “it depends”
– If those who tested positive can be  traced back to one event/workplace
then it is considered a hotspot not a spike
– Governor continued stating that if a specific connection cannot be found
then it is a spike
– Dr. Zucker added that the rate of transmission is also taken into
consideration and that as total number of cases drop it will make the
percentage of higher cases seem higher


AMA: Relief Pool for Physicians Who Participate in Medicaid and CHIP
Important information from the AMA about the next release of funds from the HHS Provider Relief pool, specifically to those physicians that participate in Medicaid and CHIP, and who did not receive a payment in the first 2 rounds.

The AMA has continued to press HHS to swiftly distribute funds to assist those physicians who have not previously received any money from the Provider Relief Fund. We are pleased the Department announced it is moving forward to provide some relief. HHS expects to distribute approximately $15 billion to eligible physicians and organizations that participate in state Medicaid and CHIP programs and have not received a payment from the Provider Relief Fund General Allocation. Starting June 10, HHS plans to launch a portal that will allow eligible physicians and organizations to report their annual patient revenue data and other necessary information to receive a payment equal to at least 2 percent of reported gross revenues from patient care.


Nassau County Medical Society Seminar “Reopening Healthcare” June 11
Emerging From COVID-19: Guidelines for Re-opening Healthcare at 7PM

Whether you work in a hospital, ambulatory surgery center, or a physician office practice, you have faced the unprecedented and rapidly evolving challenges associated with the coronavirus disease 2019 (COVID-19) pandemic.

As the pandemic begins to recede, questions will arise about how best to return to your normal operations. The unprecedented nature of the COVID-19 outbreak might make navigating this process confusing and stressful.

Join us as Elizabeth Moy a Risk Management Consultant from MLMIC Insurance Company and Will Hassett, an attorney from Fager Amsler Keller & Schoppmann, LLP discuss the evolving changes to state and federal law associated the pandemic, and provide a strategic roadmap towards safely resuming previously suspended operations.

At the end of this presentation, the participant will be able to:

1. Understand the current legal updates associated with COVID-19.
2. Determine the resources necessary to safely reopen.
3. Create new workflows and effectively manage patient backlog.
4. Identify areas of need in anticipation for a future surge.

Target audience: Physicians of all specialties
DATE: THURSDAY JUNE 11, 2020 TIME: 7PM

Register Here 


NYC Small Business Loans Program: Up to $75K Zero-Interest
Applications for the city’s small-business loan program, which offers zero-interest loans up to $75,000 to businesses affected by Covid-19, went live on June 5. City businesses in operation for two years or more with fewer than 100 employees across all locations are eligible to apply. They must be able to prove 25% or more in revenue lost as a result of the crisis, have no outstanding tax liens or legal judgments against them, and show they are able to pay off the loan. (Crain’s Business


Astrazeneca Plans to Distribute Up to 2 Billion COVID-19 Vaccines Doses
AstraZeneca said June 4 it has partnered with several organizations to help manufacture and distribute up to 2 billion doses of the experimental COVID-19 vaccine it is developing with Oxford University.

The U.K.-based drugmaker has partnered with the Coalition for Epidemic Preparedness Innovations, or CEPI, and Gavi, a public–private global health partnership with the goal of increasing access to vaccines in poor countries, STAT reported.

Under the partnership, the companies will spend $750 million to manufacture and distribute 300 million doses of the vaccine by the end of 2020, assuming it is proven safe and effective, according to STAT. Data on the vaccine isn’t expected before August.

The partnership between AstraZeneca, CEPI and Gavi is the first made through the Access to COVID-19 Tools (act) Accelerator, a program co-chaired by the Bill and Melinda Gates Foundation and the World Health Organization designed to ensure the fair allocation and distribution of the vaccine across the world.

AstraZeneca said CEPI will lead development and manufacturing of the vaccine, and Gavi will lead the procurement.

AstraZeneca also reached a licensing agreement with the Serum Institute of India to supply 1 billion doses of the vaccine to low and middle-income countries. The institute committed to providing 700 million doses of the vaccine before the end of the year, STAT reported.

AstraZeneca also previously announced plans to ship 100 million doses of the vaccine to the U.K. and 200 million to the U.S. (Becker’s, June 5)


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Probable Coronavirus Cases and Deaths Reported by Fewer Than Half of States
The Washington Post (6/8) reports, “Fewer than half the states are following federal recommendations to report probable coronavirus cases and deaths, marking what experts say is an unusual break with public health practices that leads to inconsistent data collection and undercounts of the disease’s impact.”

A review by the Washington Post “found that the states not disclosing probable cases and deaths include some of the largest: California, Florida, North Carolina and New York.” This “is one reason government officials and public health experts say the virus’s true toll is above the U.S. tally as of Sunday of about 1.9 million coronavirus cases and 109,000 deaths – benchmarks that shape policymaking and public opinion on the pandemic.


New Report Finds Low Levels of Teenage Well-Being in The U.S.
A new report on teen well-being in the U.S. finds that 60% of those ages 13-18 are not flourishing — defined as experiencing positive emotions as well as positive emotional and social functioning. Teens are also reporting higher stress levels than older adults, the majority of which is due to mass shootings, concern about peers with anxiety and depression, and rising suicide rates.

Majorities of teens have also been discriminated against, and almost all report hearing the word “gay” used disparagingly at school. The report also identifies 47 action items that policymakers at local, state, and national levels can take to improve the well-being of teens. These items range from engaging with social media platforms and influencers to promote more content that encourages teens to spend time helping others in their community to encouraging lawmakers to design budgets with teenage well-being in mind.


ED Visits Down 49% Since January, Analysis Reveals
Emergency department volume fell 49 percent between January and April, with facilities in urban areas seeing the largest drop, according to an analysis from the Emergency Department Benchmarking Alliance.

The analysis includes self-reported comparative ED volume data for the first four months of 2019 and 2020 from EDBA members representing 2,240 EDs nationwide. EDBA examined trends in overall ED volume, along with volume differences based on facility type and location. ED volume rose 7 percent year over year in January and 4 percent in February, likely due to flu season.

“We started off the year with a positive increase in volume from the previous year across the board,” Mike Gibbons, RN, executive director of EDBA, told Becker’s. “That’s been kind of consistent in what’s going on in emergency medicine. Year-over-year, there is about a 2.5 percent annual increase in volume.”

However, ED volume fell 19 percent year over year in March, when COVID-19 spurred nationwide lockdowns. By April, ED volume was down 48 percent. This figure depicts a larger hit to EDs compared to a recent CDC analysis, which found that average weekly ED visits fell 42 percent year over year in April.

“The most surprising thing to me is the drastic reduction in pediatric emergency departments,” Mr. Gibbons said, noting that the analysis includes data from 24 pediatric EDs — a relatively small sample size.

These facilities saw a 71 percent decrease in volume between January and April — the largest drop of all ED types. Freestanding EDs had a 49 percent drop in use over the same time period, while general EDs saw a 50 percent drop. When sorted by location, facilities in urban areas had the largest drop in volume. Urban EDs went from treating an average of 128 patients daily in January to just 56 daily in April.

“This suggests that urban centers in major metropolitan areas were affected more from a volume decrease than in community hospitals and suburban settings,” Mr. Gibbons said. (Becker’s Hospital Review, June 9)


 

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