A Publication of NYCHSRO/MEDREVIEW VOLUME 13, NO. 1 January-June 2010 www.medreview.us

NYCHSRO/MedReview Family Volunteer in Haiti

r. Scott Jewish community Sundick, leadership meet- Dson-in-law ing to raise funds of NYCHSRO’s for critically need- director of Home ed supplies and Care, Maurice equipment. Par- Fleischmann, was ticipants included: in Haiti assisting Congresswoman with medical ef- , As- forts in the wake semblyman Dov of the horrific Hikind, Council- disaster that hap- Ha i t i a n a n d Je w i s h c o mm u n i t y l e a de r s h i p mee t t o man Mathieu Eu- Co n g r e s s w o m a n Yv e t t e Cl a r k e pened there. Dr. r a i s e f u n d s f o r e a r t h q u a k e victims gene and Coun- a n d As s em b l ym a n Do v Hi k i n d Sundick was part cilman Jumaane of a team of doctors and surgeons at the Hospital Sacre Coeur, Williams. run by CRUDEM, a Canadian organization that runs an on-going NYCHSRO/MedReview also recognizes the efforts of two of its medical mission at Milot Physician Advisors, Dr. Ernest Garnier and Dr. Marie Dupiton who in the Cap Haitien area. are both affiliated with Downstate Medical Center. Dr. Garnier and The mission had been Dr. Dupiton donated their time and, at their own expense, provided scheduled prior to the pediatric health care services to Haitian children.Interviewed by the earthquake that hit Haiti daily News, Dr. Garnier stated “I try to give them a little hope”. on January 12, 2010. It Statement made regarding his fellow countrymen who have lost ev- took on a much greater erything. urgency in the aftermath This tragedy has struck close to home at NYCHSRO since several of the unprecedented staff members are natives of Haiti and have family still living there. natural disaster that left The organization started its own collection to benefit Haitian rescue hundreds of thousands of efforts and will continue to offer it prayers and wishes that the rescue Er n e s t Ga r n i e r M.D. Haitians dead and many efforts are effective. MEDREVIEW more injured and without food and shelter. NEWSLETTER When Dr. Sundick told his father-in-law that although there was Inside This Issue.... GOES COLOR! an undamaged and fully equipped hospital at Milot but that patients were not being brought to the facility, NYCHSRO’s C.E.O. Joseph w NYCHSRO/MedReview Family Volunteer in Haiti Stamm reached out to leaders in w Healthcare Headline Summaries the Haitian com- w News in Review Profile: Arthur “Jerry” Kremer, Esq munity in , most nota- w Nurse/Review Staff/Administrative bly Staff Breakfasts 2010 Councilman Dr. Mathieu Eugene w Joseph Stamm Honored by Avenue N Jewish Center who represents w NYCHSRO/MedReview’s Political Outreach the largest Hai- tian community in w Balcony Symposium- The Status of Healthcare Reform , to make Jo s e p h St a mm , Co n g r e s s w o m a n Yv e t t e Cl a r k e w MedReview and the Young People's Choir of them aware of the a n d Ye r u ch i m Si l b e r problem. Due to New York City this intervention and other efforts, within a few days patients were w Home Care Departments Implements New Database arriving at the hospital by airlift and bus. Mr. Stamm also participated in a hastily organized Haitian and w MedReview Meets with Its Clients Regimens: Questioning Benefit of Diabetes Test way for mental health care than for other medi- patient’s insurance coverage. Students should Strips – New York Times – January 5, 2010 - cal services. begin learning early in medical school about People with Type 2 diabetes are often advised the financial consequences of their decisions to use blood- glucose test strips to monitor their Laser Treatment May Work for Cataracts – New and that such teaching should continue through- blood sugar levels, but a Canadian analysis York Times – March 22, 2010 - out their training. Trainees in the hospital should has found that routine self-monitoring is not Cataracts are the leading cause of blindness be asked how much it costs to be in the I.C.U. cost-effective for many patients: the strips can in the world, and are often related to aging. In for a day, to be in the hospital for a day, to be cost almost a dollar each, and they prevent a common form of cataracts, proteins in the lens in a long-term-care setting for a day. comparatively few complications of diabetes. change over time, developing chromophores — The finding was part of an analysis that molecular add-ons that absorb color in the blue When Patients Don’t Fill Their Prescriptions – prompted the Canadian Agency for Drugs and part of the spectrum. Chromophores reduce – May 20, 2010 -Medica- Technologies in Health to issue a nonbinding amount of light reaching the retina (and give tion nonadherence undermines even the best recommendation against routine self-monitoring the lens a yellow-brown appearance), but they cost-saving and clinical intentions of evidence- for many Type 2 diabetics — those who do not also disrupt the structure of the lens proteins, based care. take insulin. causing light to scatter. In one study, as many as half of all pa- Experts in the United States said more stud- Cataracts can be treated by lens-replace- tients did not follow their doctors’ advice when ies were needed, but they emphasized that glu- ment surgery, but the procedure is invasive and it came to medications. Other studies have cose test strips, which are covered by insurance, costly, requiring special equipment and skilled shown that patients with medications for chron- could be helpful for adjusting diet, exercise and eye surgeons. To make cataract treatment avail- ic diseases like diabetes and high blood pres- drug regimens. In addition, they are recom- able to more people around the world, a less- sure were likely to be sicker, suffer from more mended for Type 2 patients who take insulin or invasive, less-expensive technique is needed. complications and have higher mortality rates. the drugs called sulfonylureas, which stimulate Line Kessel, an ophthalmologist at Glostrup The overall cost of medication nonadherence is insulin production; those patients are at risk for Hospital of the University of Copenhagen in more than $170 billion annually in the United hypoglycemia, or very low blood sugar. Denmark, and colleagues have come up with States alone. But for other Type 2 patients, the test strips’ what they say is a promising alternative to Researchers at Harvard Medical School benefits fall off sharply. Another Canadian replacement surgery. In their approach, they published the largest study to date of what study reported that more than 1,000 patients “bleach” the lens with a laser. has been termed “primary nonadherence” and would need to use the strips regularly to prevent Ultraviolet light can alter chromophores so found that more than 20 percent of first-time a single case of kidney failure, for example, they no longer absorb color, but UV light can patient prescriptions were never filled. Com- and about 500 would need to be treated to damage the retina. To prevent damage the re- paring the e-prescription data for over 75,000 prevent a single stroke, amputation or case of searchers use infrared light, delivered by an ex- patients with pharmacy insurance claims, the blindness. Rather than rely on test strips, Cana- tremely fast-pulse laser. The pulses are so fast, investigators also discovered that certain pat- dian experts said, patients need to be vigilant Dr. Kessel said, that two photons hit a target terns of nonadherence exist. First-time prescrip- about their diet, exercise, weight and blood molecule simultaneously, with the same effect tions for chronic diseases like high cholesterol, pressure. as if UV light was used. high blood pressure and diabetes were more likely not to be filled, whereas those for pediat- New Rules Promise Better Mental Health Cover- Using High-Tech to Lower Costs – New York ric patients 18 years of age and younger and age – New York Times – January 30, 2010 Times – May 4, 2010 - Health policy experts for antibiotics were more likely to be filled. – The federal government issued new rules on hope that technology will become a tool for Friday that promise to improve insurance cover- educating doctors about the cost of care. More Lower Homocysteine and Heart Risk – NY Times age of mental health care for more than 140 widespread use of electronic medical records, – June 28, 2010 - People with high blood levels million people insured through their jobs. In they say, will help keep costs in check by pro- of the amino acid homocysteine are at increased general, under the rules, employers and group viding doctors with precise information on the risk for heart disease and strokes. It has never health plans cannot provide less coverage for price of tests and drugs even as they are decid- been clear whether reducing homocysteine will mental health care than for the treatment of ing what to order. According to a 1990 study cut the risk, and whether the substance actually physical conditions like cancer and heart dis- by Indiana University, showing the charges for causes vascular disease. A paper published in ease. Insurers cannot set higher co-payments tests on computers used by medical residents The Journal of the American Medical Associa- and deductibles or stricter limits on treatment working in an outpatient clinic led to a 14 tion says it does not. The paper is based on for mental illness and addiction disorders. percent drop in the number of tests ordered, a large, randomized, controlled clinical trial in Nor can they establish separate deductibles with no adverse effects on patients. Subsequent Britain from 1998 to 2008. More than 12,000 for mental health care and for the treatment of studies found similar results when the prices of heart-attack survivors were randomly assigned physical illnesses. tests and imaging studies were displayed on to take either a combination of folic acid and Under the rules, insurers can still review computers in pediatric emergency rooms and vitamin B 12, which reduce homocysteine lev- claims for “medical necessity,” can still require in a pediatric intensive care unit. els, or a placebo. After seven years, patients prior approval of some services and can still Doctors prescribing drugs to patients at his who were taking the vitamins had lowered their charge consumers more for using doctors and hospital’s clinics, and at others in Boston’s Part- homocysteine, but did not reduce their risk of hospitals that are not on a list of preferred pro- ners HealthCare System, also receive computer- heart attack or stroke. They had the same rates viders. However, under the rules, insurers can- ized prompts informing them of less-expensive of heart attack and death from vascular causes not use these techniques in a more restrictive alternatives, with suggestions tailored to each as those taking placebos, the study found. News In Review Profile: Arthur “Jerry” Kremer, Esq.

Arthur “Jer- in government. Jerry was a 23-year veteran of Overseers of the Tilles Cultural Center, and ry” Kremer, of the New York State Assembly, and he was has served as a member of the Board of Di- Esq. has been the only Long Island legislator to ever head the rectors of the Long Island Association. a member of prestigious Ways and Means Committee. He Since 1991, he has chaired the annual NYCHSRO/ served in that post for 12 years, and served by Fair Media Council (formerly the Long Island MedReview appointment of the Governor on the Metropoli- Coalition for Fair Broadcasting) luncheon Board for the tan Transportation Authority’s Capital Review honoring outstanding achievements by the past seven years. Jerry Kremer is a partner Board and the Public Authorities Control Board. media. Mr. Kremer is also Chairman of the and chair of the Municipal and Regulatory Af- During his tenure in Albany, Mr. Kremer also Young People’s Chorus of New York City, a fairs Department at Ruskin Moscou Faltischek. served as Chair of the Committee on Corpo- 300 member youth chorus who have won He is also a member of the firm’s Corporate rations where he was involved with corporate the International prize for choral groups in & Securities Department and Energy Group. structure and energy issues. British Columbia and have performed fre- As the head of the Municipal and Regulatory In his legal career, Jerry has represented quently at Carnegie Hall, Lincoln Center and Affairs Department, Mr. Kremer continues his a large number of Fortune 500 companies the White House and the Immediate Past active involvement on behalf of clients with in complex matters and has handled zoning President of the Brooklyn Law School Alumni matters at the federal, state and local level. In and land use cases in Nassau and Suffolk Association. In addition, Mr. Kremer is a addition, he acts as bond counsel to a num- counties. He serves as government relations Colonel (Ret.) in the New York State Guard. ber of municipal entities and handles zoning counsel to El Paso Gas, Canon USA, Cae- As an extension of his professional life, Mr. and land use cases. Having been deeply sar’s Entertainment, Inc., General Motors, Kremer serves on the Committee on Profes- involved in state government, Mr. Kremer Cablevision, DMJM Engineering and the New sionalism in the Law by appointment of the represents clients as lobbying counsel and York State Bowling Proprietor’s Association. Chief Judge of the Court of Appeals. He also in appearances before legislative bodies. Mr. Kremer maintains an active role in many is a member of the Nassau County Bar Asso- Mr. Kremer has enjoyed a long and dis- key Long Island organizations. He is a Trustee ciation and the American Bar Association. tinguished career not only in law, but also of Hofstra University; a member of the Board * * * * Nurse/Review Staff and Administrative Staff Breakfasts 2010 YCHSRO/MedReview once again served a delicious Nbreakfast to employees in honor of its professional review staff. The breakfast is a NYCHSRO/Me- dReview tradition and serves as a means of thanking the nurses, coders and other review staff who contribute to the success of the organization. The entire office staff joined the review team in the executive board room for bagels, pastry and more. After promising to keep his remarks brief, Joseph Stamm thanked the review staff for their contin- ued hard work and dedication in helping the organization maintain its level of excellence. The criti- cal center of NYCHSRO/MedReview’s operations is its review staff and their continued high level of per- formance allows the organization to sustain its reputation for excellence. NYCHSRO/MedReview also continued its tradition of honoring the administrative staff with a breakfast. The event paid tribute to the staff’s hard work and all important contributions that help the organization succeed. Joseph Stamm thanked the staff for their continued efforts and dedication in helping the organization maintain its level of performance. We are fortunate to have outstanding administrative staff that allows the entire organization to run smoothly. The entire staff agreed that eating breakfast is one of the best ways to honor anyone. Joe Stamm Honored by Avenue N Jewish Center edReview is proud to congratulate its President and CEO Joseph Stamm who was honored at the 89th Anniversary of the Avenue N Jewish Center. Mr. Stamm was bestowed the Community Ser- Mvice Award in recognition of his ongoing efforts to give back to the community. Mr. Stamm has not only organized and raised funds for community efforts; he also played a role in organizing supplies for victims of the tragic earthquake that occurred in Haiti at the beginning of this year. In his acceptance speech Mr. Stamm presented his wife Anne with a large bouquet of roses and thanked her for her ongoing support. The award was presented by Rabbi Dr. Max Schreier spiritual leader of the Ave. N Jewish Center. Assem- blyman Dov Hikind, who is a close friend of Mr. & Mrs. Stamm, also paid tribute to Joe for his total devotion and commitment to many charitable causes within the community, as well as to the State of Israel. Assembly- man Hikind praised Joe for joining him on a mission to Israel during the Israel/Lebanese war despite the ever present danger of going into the midst of the actual war zone. Congressman Weiner joined in paying tribute to the honorees. Assemblywoman Rhoda Jacobs, despite having a prior commitment also attended the award ceremony. The event was well attended by MedReview’s staff and clients that enjoyed a wide assortment of delicious food throughout the evening. The Board was represented by its Chairman Norman Medow, M.D and Donald Morchower. Jo s e p h a n d An n e St a mm r i gh t : Jo s e p h St a mm b e i n g h o n o r ed b y Av e n u e N Je w i s h Ce n t e r Ra b b i Ma x Sch r e i e r a n d p r e s i de n t Mr. St e w a r t Es s r o g . Be l o w : Jo s e p h St a mm w i t h Co n g r e s s m a n An t h o n y We i n e r . Jo s e p h St a mm w i t h Med Re v i e w Key St a f f a n d b o a r d mem b e r Dr. Med o w . Mr. a n d Mr s . St a mm w i t h Ho n e r ee s .

Ri gh t : Med r e v i e w CEO Jo s e p h St a mm w i t h Yo u n g Is r a e l o f Av e . K Co n g r eg a n t s . De b b i e Co y n e , h a r r i e t St a r r , Ma r g a r e t Mi t che l l , Ja n e t St i eg , Lyd i a Mu r p hy , Mi s s y Ha mm , a l o n g w i t h t he h o n e r ee .

Ri gh t : Jo s e p h a n d An n e St a mm w i t h Mr s . Ro s e St a mm a n d As s em b l ym a n Do v a n d Sh a n i Hi k i n d . Mr. a n d Mr s . St a mm w i t h Fa m i l y a n d Fr i e n d s . MEDREVIEW POLITICAL OUTREACH edReview’s President and CEO, Joseph Stamm and his wife Anne started out 2010 by attending a memorable, invitation only inaugural event at City Hall. Sworn in Mon January 1, 2010 were Mayor , Public Advocate Bill deBla- sio and Comptroller of the City of New York John Liu. The Stamms also attended a special public swearing in ceremony for Bill deBlasio at New York University. MedReview staff was pleased to have the opportunity to attend a number of events with high profile dignitaries including President Bill Clinton, Vice President Joe Biden, and President Obama’s Chief of Staff Rahm Emanuel, who came to show their support for Con- gressman , Congresswoman Nita Lowey, and Congressman Tim Bish- op. Other events attended included a Birthday bash for Congressma n Charles Rangel at Citi Field with Met’s owner Fred Wilpon, with Mr. Stamm attending the function in one of Citi Field’s exclusive sky boxes. In addition, MedReview continued to expand its legislative contacts by reaching out to newly elected Councilman , Council- woman Jessica Lappin, and newly elected Assemblyman David We- prin (the former Chairman of the Finance Com- mittee). 1 Other gatherings attended included a special reception for Assem- blyman Dick Gottfried, Chairman of the Health Committee in recogni- tion of 40 years of service to the State of New York and a birthday celebra- tion for Public Advocate Bill deBlasio. Events such as these help MedReview keep a hand on the pulse of ongo- ing State and National Health Care issues and allow MedReview to voice client concerns to individuals who impact on policy and legislation.

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10 9 8 5 BALCONY Symposium-The Status of Health Care Reform

symposium on the status of healthcare reform, was staged by a foundation laid by two piec- BALCONY, the Business and Labor Coalition of New York, es of legislation that President A along with the Medicare Rights Center, the Small Business Obama signed into law earlier Majority and the American Cancer Society, to discuss the recently in his term. The first was the Re- passed Affordable Health Care for America bill, signed into law covery Act, which mandated the by President Barrack upgrading of healthcare tech- Obama in February nology and the replacement of 2010. a paper records system with a The event was held computerized one. The second April 14, 2010 at the was legislation that expanded Hard Rock Café in Children’s Health Insurance Pro- New York City. Me- gram, known as CHIP, coverage dReview/NYCHSRO to 7 million U.S. children, paid was represented by Mr. for by a 62-cent increase in the Joe Stamm and Helen federal cigarette tax. Mutchler. There were Secretary Sebelius stressed Jo s e p h St a mm w i t h Ka t h l ee n Se b e l i u s over 250 other repre- that it is important to get the right Sec r e t a r y o f He a l t h & Hu m a n a n d He l e n Mu t ch l e r sentatives of business, information about the bill out in Re s o u r ce s , Ka t h l ee n Se b e l i u s labor, the insurance in- order to promote honest and dustry, community health centers, hospitals and government. reasonable debate about imple- The keynote speaker was Secretary of the Health and Human mentation with stake holders. She concluded stating the legislation Resources Department Kathleen Sebelius, under whose direction the represents a new beginning and a new chance for America to get its law is to be implemented. health care deliver system on the right track. Secretary Sebelius noted that the passage of the bill rested upon MedReview and the Young People’s Chorus of New York City o s e p h S t a m m , C . E . O . o f the guests of the Government of Ja- MedReview has become an active pan. Jpartner with Young People’s Chorus In addition to the four choruses the (YPC) attending many YPC has music programs of its events and in ten New York City strongly supporting schools bringing music its efforts. to countless numbers The Young Peo- of children who would ple’s Chorus pro- never have the oppor- vides musical op- tunity to sharpen their portunities for over musical talents. All 1,000 New York of these programs are City school chil- supported by a variety dren from ages 8 of charitable, commu- to 18. It operates nity and government Je r r y & Su s a n Kr eme r w i t h Jo s e p h a n d An n e St a mm four choruses with grants. 600 students who The partnership have sung at events between MedReview around the world. and YPC was initi- During the past two ated through the strong years, the students Je r r y Kr eme r Es q . bond between Joseph who represent all Stamm and YPC Coun- walks of life, have performed in Japan, sel Jerry Kremer. Kremer has been Wales, Switzerland and many other Chair of the YPC for the past eight countries. They are featured at Lincoln years. Mr. Stamm has become an ac- Center, Carnegie Hall and have graced tive supporter of the Chorus attending stages around the country. many of its events, noting that he loves. This summer the Chorus is touring “hearing these beautiful children sing 16 cities in Japan where they have re- a large variety of songs in many lan- ceived standing room only raves from guages. They are inspiring and give us t h Ma r ch 16 Pe r f o r m a n ce “Gi v e u s Ho p e ” a t Ro s e Ha l l in music starved communities. They were great hope for the future”. Li n c o l n Ce n t e r MEDREVIEW POLITICAL OUTREACH

Co n t i n u ed f r o m Pa ge 4 Pa ge 4 t o p t o b o t t o m : 2010 Ne w Yo r k Ci t y In a u g u r a t i o n s . Jo s e p h St a mm w i t h Pr e s i de n t Ob a m a ’s Ch i e f o f St a f f Ra hm Em a n u e l . Ja n e t St i eg w i t h As s em b l ym a n Di c k Go t t f r i ed . Jo s e p h St a mm w i t h f o r me r Pr e s i de n t Bi l l Cl i n t o n , He l e n Mu t ch l e r a n d Co n g r e s s m a n An t h o n y We i n e r . Vi ce Pr e s i de n t Jo e Bi de n . NYC Co m p t r o l l e r Jo h n Liu w i t h Jo s e p h St a mm . Pu b l i c Ad v o c a t e Bi l l de Bl a s i o w i t h He l e n Mu t ch l e r . Mr. a n d Mr s . St a mm a t In a u g u r a t i o n . Jo s e p h St a mm w i t h Me t s Ow n e r Fr ed Wi l p o n , Co n g r e s s m a n Ch a r l e s Ra n ge l a n d Co m p t r o l l e r Jo h n Liu. He l e n Mu t ch l e r , Jo e St a mm w i t h Co n g r e s s w o m a n Ni t a Lo w ey . Pa ge 7: He l e n Mu t ch l e r a n d Ch i r l a n e de Bl a s i o . Ma i m o n i de s Pr e s i de n t /CEO Pa me l a Br i e r a n d Jo s e p h s t a mm . Jo s e p h St a mm a n d Co n g r e s s m a n To m Cr o w l ey . He l e n Mu t ch l e r a n d Jo s e p h St a mm w i t h NYC Co u n c i l w o m a n Je s s i c a La p p i n . He l e n Mu t ch l e r a n d Jo s e p h St a mm w i t h As s em b l y - m a n St e v e n Cym b r o w i t z . Ja n e t St i eg , Jo s e p h St a mm a n d As s em b l ym a n Da v i d a n d Ro n n i We p r i n . Jo s e p h St a mm a n d Co n g r e s s w o m a n Ca r o l i n e Ma l o n ey . He l e n Mu t ch l e r a n d Jo s e p h St a mm w i t h As s em b l ym a n Pe t e r J. Ab b a t e , Jr. Home Care Departments Implements New Database YCHSRO/MedReview and the Home Care and Adult Pro- tective Services (APS) Department staff are excited about Nthe updates in the comprehensive database applications that have been fully implemented over the past 18 months. The project which was begun three years ago changed all aspects of data collection and scheduling for both departments. The current database allows for seamless integration throughout the Home Care and APS Departments and has allowed them to op- erate in an essentially paperless environment. The new system pro- vides greater efficiencies with the updated automation and improved satisfaction with the data entry and reporting tasks. Scanned docu- ments can be retrieved literally within minutes upon notification of a specific request and cases can be cross-referenced between the two departments when appropriate. The reporting and warehousing capabilities of the applica- tions are increased as is back-end analysis capabilities. Infor- ical Director, for her tire- mation gathered in various assessments and reviews can be less efforts and oversight used to develop meaningful reports to help better understand throughout all phases of trends that impact on Home Care service delivery. the lengthy project in- NYCHSRO/MedReview wants to extend its sincere thanks cluding the post-imple- for the dedication, perseverance and commitment of all the mentation period. The Home Care and APS staff and Directors who worked diligently IT Department at NYCH- to ensure successful development and implementation. All of SRO/MedReview also the end users have proven to be critical in assuring accurate function- deserves a special commendation for their ongoing backup support ality for the specific utilities pertinent to their daily work. in conjunction with the development programmers. Special thanks are extended to Dr. Anita Aisner, Home Care Med- MedReview Client Activities MedReview was in high demand in the past few months, being sought out by a number of client groups seeking relief from ever-spiraling health care expen- ditures. Groups that contacted MedReview included Touchstone, Americare and Mohawk Valley Physicians (MVP). In addition, MedReview established a national strategic alliance with TRICAST, a well recognized en- tity providing pharmacy program consultant services. TRICAST’s suite of software applications and its com- prehensive audit and consulting services helps manage pharmacy benefit costs and utilization. TRICAST and its public sector partner, PSRx Advisors offer numerous strategies and tools to accomplish payer objectives in- cluding: • Drug procurement and analysis • PBM RFP contracting and negotiation support. • Medicare Part D financial and operational au- dits of prescription data. • Fraud Waste and Abuse monitoring incorpo- rating Medical and Pharmacy data. • Comprehensive audits of Pharmacy Benefit Manager (PBM) pricing and plan benefit man- agement. The alliance will establish MedReview as an all-en- compassing entity in the healthcare cost containment industry. Cl o c k w i s e : Lyd i a Mu r p hy & He l e n Mu t ch l e r w i t h Lo u Go r d o n . To u ch s t o n e Qu a l i t y Ma n a geme n t , De b r a Co r b e t t , Jo s e p h St a mm , & Med Re v i e w Qu a l i t y Ma n a geme n t Te a m ; Ja n e t St i eg , Ma r g a r e t Mi t che l l a n d Do r i ce Am- b r o i s e . He l e n Mu t ch l e r , Jo s e p h St a mm , Ge o r ge Bo p p mee t w i t h Ame r i c a r e , In c . Pr e s i de n t / CEO El i Kl e i n m a n a n d St a f f . He l e n Mu t ch l e r , Ge o r ge Bo p p a n d Mi s s y Ha mm .

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