2014 ACDIS CONFERENCE AGENDA

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1 TUESDAY, MAY 6, :00 p.m. 6:00 p.m. Pre-registration (GRAND SALON) By pre-registering you will avoid waiting in line in the morning! 6:00 p.m. 9:00 p.m. Welcome reception and awards ceremony (EVENT CENTER) WEDNESDAY, MAY 7, :00 a.m. 8:00 a.m. Registration (GRAND SALON) and continental breakfast (EVENT CENTER) Poster Session Presentation (GRAND SALON) 8:00 a.m. 8:05 a.m. Introduction and welcome remarks Brian Murphy, ACDIS Director 8:05 a.m. 9:05 a.m. General session Critical Coding Clinic ICD-10-CM/PCS Updates: An Insider s Look, Nelly Leon- Chisen, RHIA This session by the executive editor of AHA Coding Clinic for ICD-9-CM and AHA Coding Clinic for ICD-10-CM and ICD-10-PCS provides an insider's look at critical coding and documentation updates necessary for successful transition to the ICD-10-CM and PCS code sets. This session will review the most critical guidance issued by Coding Clinic in the past year with a focus on what CDI specialists will need to clarify with physicians. 9:15 a.m. 10:15 a.m. BREAKOUT SESSIONS (CHOOSE ONE OF THREE) The Top 20 ICD-10 Documentation Issues That Cause DRG Changes, Donna Smith, RHIA Facing the unknown can be a challenge, especially for those charged with analyzing the impact of ICD-10 on reimbursement. This session will analyze the top 20 documentation issues that cause changes in DRG assignment and offer a step-by-step analysis to determine the areas and service lines with the greatest exposure under ICD-10, as well as mitigation opportunities. Attendees will learn how to determine the reason for a change and investigate ways to use the specificity in ICD-10 to counteract it. Track 2: Physician Education and Engagement Changing Medical Culture and Influencing New Ideas: CDI for Medical Students, Tim Weister, RN, MSN, CCDS Are you thinking about including medical students in CDI training, but stuck wondering what content to include and when? Join the Mayo Clinic CDI team for a presentation on how it partnered with its medical school to create a CDI training program. Learn best practices that you can take back and use in your own facility. Track 3: Quality and CDI SOI/ROM Queries: Why Is That "Healthy" Patient Dead in the Bed?, Sara Baine, MSN-Ed, CCDS, and Rhonda Peppers, RN, BS, CCDS This session will present a professional approach to querying for SOI/ROM. Participants will gain an awareness of the effects on the medical record, financial impact on the facility and physician, educational needs for CDIs and providers, and how SOI/ROM improves quality data metrics. It will include case-specific reviews of expired patients, including what was coded and what could have been coded if properly documented. It will also include sample queries. 10:15 a.m. 11:00 a.m. Networking break in exhibit hall (EVENT CENTER) 10:30 a.m., from ACDIS: ACDIS membership 10:35 a.m., from ACDIS: Free seat to CDI Boot Camp (or other if winner has already attended) Demo: C.O.R.E Solution for Revenue Cycle (HCPro Booth #122 at 10:30 a.m. Page 1 of 8

2 11:00 a.m. 12:00 p.m. BREAKOUT SESSIONS (CHOOSE ONE OF THREE) Is Your Query Process Ready for ICD-10-CM/PCS?, Cheryl Ericson, RN, MS, CCDS, CDIP, AHIMA-Approved ICD- 10-CM/PCS Trainer Although 90% of the guidelines are retained from ICD-9-CM within the ICD-10-CM code set, CDI specialists are expected to be greatly affected by ICD-10- CM/PCS implementation, as they may assume sole responsibility for the query process in order to offset expected losses in coder productivity. Additionally, bill hold times could increase significantly and reduce cash on hand if CDI is unable to anticipate documentation needs. This session will focus on how CDI departments should evaluate their current query practices to see if they require modification to support the transition. Track 2: Physician Education and Engagement Why Won't Doctors Just Change? Leading Change and Keys to Successful Change Management, Sam Antonios, MD, FACP, FHM Do you ever wish that doctors would just change their ways and start documenting better? Why do most change efforts fail? How can we succeed in leading change? Learn all the necessary steps and the foundations for strong change management. This session will provide the steps for establishing a good change management plan for physicians, as well as the steps to prevent failure in change efforts such as documentation. Track 3: Quality and CDI Improving Quality Outcomes Data to Drive Quality Performance and Financial Reimbursement, Cheryl Manchenton, RN, BSN New regulations and federal and state payment reforms are linking quality performance to financial incentives and reimbursement. This presentation will discuss best practices for CDI to support accurate quality outcomes data. It will describe processes for flagging potential or actual quality issues and suggest strategies to identify and clarify these in a compliant manner, overcoming the challenge of improving quality metrics while maintaining data integrity related to patient safety indicators and core measures. Additionally, attendees will learn how to undertake an extensive educational process for CDI and HIM staff regarding quality reporting. 12:00 p.m. 1:30 p.m. Boxed lunch in exhibit hall (EVENT CENTER) Demo: Online Learning (HCPro Booth #122 at 1:00 p.m.) 1:30 p.m. 2:30 p.m. BREAKOUT SESSIONS (CHOOSE ONE OF THREE) ICD-10-CM/PCS Documentation Requirements for Children's Hospitals, Natalie Sartori, MEd, RHIA, AHIMA-Approved ICD-10-CM/PCS Trainer, and Rebecca A. Ali Williams, RN, MSN, CCDS Children's hospitals will need to focus CDI efforts to address the specific documentation that is needed for ICD-10-CM/PCS code assignment in the pediatric population. This session will help children's hospitals to recognize additional specificity that will be needed for ICD-10-CM/PCS codes that are most prevalent in children's hospitals. The speakers Track 2: Physician Education and Engagement Gaining Physician Buy-In to CDI Using Quality Data, Timothy Brundage, MD, CCDS, and Sylvia Hoffman, RN, CCDS, C-CDI, CDIP Physician buy-in to CDI is the most frustrating day-to-day aspect of CDI. The tools shared in this educational session will demonstrate how pay for performance, quality metrics, ROM, and SOI scores in conjunction with retrospective physician documentation review create educational opportunities for peerto-peer physician education. Physicians respond when they are shown how documentation can optimize their quality metrics. This session will explain how physicians Track 3: Quality and CDI IPPS FY Final Rule and Expanded CMS Value Initiatives: Learn How Your CDI Program Can Help, Shannon Newell, RHIA, CCS, AHIMA-Approved ICD-10- CM/PCS Trainer, and Richard D. Pinson, MD, FACP, CCS In 2013, for the first time, hospitals began to get paid for their performance by CMS using outcomes derived from ICD-9-CM (soon to be ICD-10-CM) codes. In the IPPS FY 2014 final rule, CMS refined and further expanded these claims-based outcome metrics as defined by the Value-Based Purchasing Program, the Hospital Readmission Reduction Program, Page 2 of 8

3 will enumerate documentation requirements to capture the clinical details to support ICD-10 codes for specific pediatric cases. For each pediatric condition/procedure discussed, the speaker will provide a comparison of the clinical details captured in ICD-9-CM vs. ICD-10- CM/PCS and explicitly describe the clinical elements that must be documented. can demonstrate that patients are as sick on paper as they are in the bed. the Hospital Acquired Condition Reduction Program, and the Inpatient Quality Reporting Program. This session will review these key regulatory changes from a CDI program perspective. Learn how your CDI program can contribute to your organization's success under these evolving challenges. 2:30 p.m. 3:15 p.m. Networking break in exhibit hall (EVENT CENTER) Poster Session Presentation (GRAND SALON from 2:30 p.m. 3:00 p.m.) 2:45 p.m., from ACDIS: ipad mini 2:50 p.m., from CDI Search Group: Pair of tickets to Cirque du Soleil s O Demo: C.O.R.E Solution for Revenue Cycle (HCPro Booth #122 at 2:45 p.m.) 3:15 p.m. 4:15 p.m. BREAKOUT SESSIONS (CHOOSE ONE OF THREE) Deciphering Cardiovascular Disease in ICD-10, James P. Fee, MD, CCS, CCDS, AHIMA-Approved ICD-10- CM/PCS Trainer This presentation will review the changes to the guidelines for the ICD-10 diagnostic coding of acute myocardial infarction, acute cerebrovascular infarction and its sequela, and atherosclerotic coronary artery disease in relation to angina. In addition, ICD-10-PCS guidelines will be reviewed for procedures performed in treating cardiovascular disease. Actual clinical cases will be explored with the mind-set of providing CDI specialists with tools to assist in physician education. The clinical background and pathophysiology demanding increased specificity will be explored. Furthermore, the presentation will provide the audience with knowledge and skills to successfully attain the increased specificity needed through demonstration of compliant and effective queries. Track 2: Physician Education and Engagement Physician Partners for CDI: Strategies for Goal Alignment, Abby Steelhammer, MBA/MHA, RN, and Larry Weems II, MD This presentation will provide insight and understanding for partnering and leveraging resources to meet overall organizational goals. It includes an overview of Novant Health's CDI program dynamics and reviews its transformational team approach during a recent database transition. The speakers will discuss ways to collaborate and support providers to accurately capture the clinical picture through appropriate documentation of all pertinent diagnoses and treatment modalities, while also fulfilling evaluation and management guidelines. It will highlight educational examples and describe tactics to fully engage physician partners in the CDI process through strategies to sustain success. Track 3: Quality and CDI Integrating Quality Into Your CDI Program: The Case for All-Payer Review, Katy Good, RN, BSN, CCDS, CCS, and Benjamin Keeler, RN, BSN, PCCN, MHI Learn to leverage your CDI program to improve hospital rankings and SOI/ROM; assist in the transition to pay for performance; initiate real-time quality improvement and monitoring; and improve core measure compliance methods. Attendees will be able to describe a model for integrating with quality (and other departmental) staff to provide best outcomes for the hospital. Learn how to attain buy-in from multiple departments and teams to achieve a true interdisciplinary model while maintaining distinct roles. The attendee will also be able to identify several potential pitfalls and methods to manage fallout, including coding/quality variances. Page 3 of 8

4 4:30 p.m. 5:30 p.m. SPECIAL SESSION ICD-10 Delay What s Next?, Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA- Approved ICD-10-CM/PCS Trainer; Cheryl Ericson, RN, MS, CCDS, CDIP, AHIMA- Approved ICD-10-CM/PCS Trainer; and Trey La Charité, MD 5:30 p.m. Adjourn The news has hit like a thunderbolt: ICD-10 has been delayed at least one more year, to October 1, How did this happen, and what is next for CDI departments and hospitals implementation plans? This session will cover: What happened? An insiders look at the delay ICD-10 advocacy and support Immediate next steps for your CDI department and others Provider engagement, education, and messaging during the delay Advancing your education and implementation timelines Q&A THURSDAY, MAY 8, :00 a.m. 8:00 a.m. Continental breakfast in exhibit hall (EVENT CENTER) 8:00 a.m. 9:00 a.m. Keynote session Inspired Care, Rich Bluni, RN In this thought-provoking and inspirational presentation, Rich Bluni, RN, author of Inspired Nurse and Oh No! Not More of That Fluffy Stuff, reminds all healthcare employees why we chose this profession. He provides a wealth of action-oriented spiritual stretches that help us more fully integrate the gifts of healthcare joy, wonder, gratitude, insight, and grief into our daily lives. His personal stories illuminate those sacred moments we all experience. 9:15 a.m. 10:15 a.m. BREAKOUT SESSIONS (CHOOSE ONE OF THREE) Final Check-In Before ICD-10 Go-Live, Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10- CM/PCS Trainer Being ready for ICD-10 is critical. CDI programs and staff need to learn about preparing their query forms, making revisions, and creating new forms. Learn about this and other aspects of ICD-10 readiness for go-live. The session will cover the revision of query forms and go over the final details leading up to ICD-10. Compliance in Documentation and Clarification: Honesty Is the Value-Based Policy, Robert S. Gold, MD Clinical and pathologic discussions of common diseases can lead to bad statistics, bad data, and compliance risk. This session includes an in-depth discussion of the proper way to analyze the patient and to ask the right questions of the physician. You'll learn more about diseases to avoid asking the wrong questions and gain an understanding of differences between diseases in ICD-9 vs. ICD-10, with an eye toward compliant clarifications. Where Are We Going? Why Healthcare Reform Should Drive Your CDI Program, Trey La Charité, MD This session will review U.S. healthcare performance, medicine, and the Patient Protection and Affordable Care Act with an eye on how they pertain to CDI. Participants will see why our current healthcare system is broken and how this frames the strong drive for current reform efforts. Attendees will also gain insight into the strategies employed by our government to promote reform and how those initiatives affect their hospitals and medical staff. Page 4 of 8

5 10:15 a.m. 11:00 a.m. Networking break in exhibit hall (EVENT CENTER) 10:30 a.m., from ACDIS: ACDIS membership 10:35 a.m., from Berkeley Research Group: Kindle Fire HD Demo: C.O.R.E Solution for Revenue Cycle (HCPro Booth #122 at 2:45 p.m.) 11:00 a.m. 12:00 p.m. BREAKOUT SESSIONS (CHOOSE ONE OF THREE) Querying for ICD-10-PCS Documentation, Natalie Sartori, MEd, RHIA, AHIMA- Approved ICD-10-CM/PCS Trainer, and Rebecca A. Ali Williams, RN, MSN, CCDS Hospitals will need to expand CDI efforts to include the specific documentation needed for ICD-10- PCS code assignment. This session will help CDI professionals recognize additional specificity needed in common ICD-10-PCS codes. It will enumerate documentation requirements to capture the clinical details to support ICD-10 codes for specific surgical cases. For each surgical procedure discussed, the speaker will provide a comparison of the clinical details captured in ICD-9 vs. ICD-10-PCS and explicitly describe the clinical elements that must be documented; where applicable, relevant clinical indicators will be shared. Where Did THAT Diagnosis Come From? Recognizing and Addressing Unreliable/Invalid Diagnoses, Andrew Rothschild, MD, MS, MPH CDI specialists and coders are taught not to question a physician's clearly documented diagnosis. But what happens when that diagnosis seems to have come from left field? Specialists and coders are also bound to clarify apparent discrepancies rather than code something that doesn't appear to be supported. Increasingly, industry guidance (OIG, AHIMA, ACDIS, etc.) reinforces the hospital's responsibility to address unreliable diagnoses, and ignoring the presence of these diagnoses can risk accusations of fraud or result in overtreatment. Debate case examples, review options, consider implications, and bring recommendations back to your CDI program for internal discussion. Emerging Outpatient CDI Drivers and Technologies, Elaine King, MHS, RHIA, CHP, CHDA, CDIP, FAHIMA Emerging legislation and technology has created tremendous demand for CDI that extends beyond the traditional inpatient-focused initiatives into the outpatient arena. This session will explain how organizations can implement practical and relevant outpatient CDI programs that address the real-life situations coders and providers face every day. It will describe how to design an effective, long-term outpatient CDI program that engages staff and as a result drives the kind of documentation change that leads to enhanced data quality, better patient care, cleaner claims, and an improved revenue cycle. 12:00 p.m. 1:30 p.m. Boxed lunch in exhibit hall (EVENT CENTER) Demo: Online Learning (HCPro Booth #122 at 1:00 p.m) 1:30 p.m. 2:30 p.m. BREAKOUT SESSIONS (CHOOSE ONE OF THREE) Engaging Oncology/Hematology Providers in CDI and ICD-10, Christine Block, RN, BSN This presentation is designed to benefit all audiences as it provides the significance of documentation related to SOI/ROM in the oncology service line. It demonstrates how teaching results in more specific documentation, which in turn leads to more Successful Strategies to Improve Surgical ICU Documentation, Brent Hadder, MD The ICU is a dynamic area where multiple issues involving multiple organ systems and diagnoses occur simultaneously. This session will share strategies implemented at the University of Iowa to improve surgical ICU documentation and coding. Presented by a practicing CDI in Your ED: What Worked and What Didn't at Stony Brook Medicine, Bernadette Slovensky, RN, MSN, CCDS This session will detail how Stony Brook Medicine designed a CDI program for its emergency department with a focus on quality and capturing POAs. It will also explain how the effort required more than physician engagement Page 5 of 8

6 accurate coding. Participants will discover how to identify opportunities directed at the hematology/oncology population and learn strategies for engaging and involving physicians. Case studies on high-dose IL2 administration will be included. physician and anesthesiologist certified in critical care, hospice, and palliative medicine, it will cover postoperative care for complex surgical patients, end-of-life discussions and care, and common diagnoses in surgical ICU patients. and support. Practical solutions and best practices based on experience of starts and stops will be offered. 2:30 p.m. 3:15 p.m. Networking break in exhibit hall (EVENT CENTER) 2:40 p.m., from SOAP: Free medical records audit 2:45 p.m., from ACDIS: One free year of access to the C.O.R.E Solution for Revenue Cycle Library (CDI section/newsletters and books) 2:50 p.m., from CDI Search Group: Pair of tickets to Cirque du Soleil s O Demo: C.O.R.E Solution for Revenue Cycle (HCPro Booth #122 at 2:45 p.m.) 3:15 p.m. 4:15 p.m. BREAKOUT SESSIONS (CHOOSE ONE OF THREE) Track 6: Program Management Multi-Facility Management: Using Data to Drive Improvement, Nancy Rae Ignatowicz, RN, BS, MBA, CCDS Find out how one hospital system chooses specific CDI data, presents it depending on the specific audience (administrators, providers, etc.), and uses it to obtain the resources and support needed to drive improvement. This presentation will include audience polling questions to quantify the types of reporting that participants perform at their facilities and present ways to show how CDI affects quality. The learner will be able to explain how data can be used differently across multiple facilities, including urban academic versus rural nonacademic centers; the departmental level; the physician specialty level; and the individual provider level. Updated Clinical Definitions of Acute Kidney Injury, Renal Failure, Sepsis, and Malnutrition, William Haik, MD, FCCP, CDIP, AHIMA- Approved ICD-10-CM/PCS Trainer, and Garry L. Huff, MD, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer Join a lively discussion of the updated clinical validation guidelines of acute kidney injury, sepsis, and malnutrition from two experienced physicians. The speakers will provide the most current clinical definitions of these conditions, as derived from the medical organizations that define them, and provide selected case examples. Formatted queries involving these conditions will also be made available. Inpatient Psychiatry: Are There Opportunities for Documentation Improvement?, Teresa Hegard, RN, BSN, CCDS, and Emily Jazdzewski, RN, BSN, MAN Too often the area of psychiatry is overlooked as not having a significant impact on severity of illness, but paying close attention to the details of this patient population can improve overall severity of illness and risk of mortality. CDI staff can emphasize the importance of the physician and staff nurse to document accordingly and accurately to improve patient outcomes. This session will identify opportunities related to borderline personality disorder, describe the impact of ICD-10 comorbid conditions related to mental health, explain the use of DSM-V documentation, and offer tips for getting staff buy-in. 4:15 p.m. Adjourn Page 6 of 8

7 FRIDAY, MAY 9, :00 a.m. 8:00 a.m. Continental breakfast in exhibit hall (EVENT CENTER) 8:00 a.m. 9:00 a.m. BREAKOUT SESSIONS (CHOOSE ONE OF THREE) Track 6: Program Management Success Strategies Associated With Bridging Clinical Documentation Gaps in the Electronic Record, Cassi Birnbaum, MS, RHIA, CPHQ, FAHIMA, and Michael Yanuck, MD, FAAFP (PLATINUM) The speakers will chronicle their EHR journey to illustrate how electronic notes quickly snowballed, detracting from new information while becoming unreadable to other physicians. Best practice solutions and approaches with specific documentation will be showcased including the development of specialty-specific templates to facilitate patient care communication, the transition to ICD-10 required diagnoses and procedural specificity, and the capture of meaningful use measures. Who's Driving the DRG Bus: Selecting the Appropriate Principal Diagnosis, Angela Kertz, RN, and Karen Newhouser, RN, BSN, CCDS, CCS, CCM (GOLD) The audience will enjoy an easy-tofollow, light-hearted analogy on choosing the most appropriate principal diagnosis. The proper "driver" ensures the CDI professional is capturing the maximum benefit by assisting with precise documentation of the patient's visit. Further attention should be paid to the alignment of additional codes for CC/MCCs, SOI/ROM, and mortality scores, as they all impact the DRG. The audience will retain the coding guidelines and UHDDS standards using a simple, visual analogy. They will understand the full potential impact all the passengers have on the final DRG. Obstetrics: A New Beginning for Clinical Documentation, Trisha McCauliff Streb, RN, BSN, CCDS This session is focused on the little understood and explored obstetrics service line. Most obstetrics patients are not Medicare, but many opportunities for improved APR billing/coding exist in this population. Participants will leave able to identify frequently missed secondary diagnoses, recognize common documentation pitfalls, define good obstetrics documentation habits, and measure outcomes to ensure success. 9:15 a.m. 10:15 a.m. BREAKOUT SESSIONS (CHOOSE ONE OF THREE) Track 6: Program Management Leading the Way: Program Management for an Innovative CDI Team, Vicki Sullivan Davis, RN (PLATINUM) This session will provide participants with the tools to achieve excellence while confidently managing their CDI team. The speaker will outline qualities a good leader should possess and review techniques to help you become a more successful leader. She will introduce industry innovations available to help further enhance already-established CDI programs. Case presentations and conflict resolution strategies will also be included. Finally, this session will introduce tools/forms for goal setting, productivity benchmarking, physician education, and staff motivation. Physician Queries: The Good, the Bad, and the Ugly, Fran Jurcak, RN, MSN, CCDS (GOLD) This interactive session will test your thoughts regarding the query process and appropriateness of queries through discussion of the difficulty in writing compliant and accurate queries. Discussion will include an overview of the 2013 AHIMA/ACDIS Query Brief and its practical application to your query process, including examples of querying for difficult diagnoses. Join the audience and test your knowledge as we explore "the good, the bad, and the ugly" of physician queries. Writing RAC Appeals, RAC Denial Prevention, and Case Management Collaboration, Kathy Shumpert, MSN, RN, CCDS Discover how CDI can have a positive impact on RAC and other auditor denials and integrate your CDI program with revenue recoupment strategies in a true documentation integrity model. This session includes case studies with examples of RAC denials and RAC appeals, examples of both good and bad case management documentation, and tips to engage physicians in the appeal. Page 7 of 8

8 10:15 a.m. 10:45 a.m. Networking break in exhibit hall (EVENT CENTER) 10:30 a.m., from ACDIS: ACDIS membership 10:35 a.m., from ACDIS: Kindle Fire HDX1 10:40 a.m., from ACDIS: Free seat to 2015 ACDIS Conference Demo: C.O.R.E Solution for Revenue Cycle (HCPro Booth #122 at 10:20 a.m.) 10:45 a.m. 11:45 a.m. BREAKOUT SESSIONS (CHOOSE ONE OF THREE) Track 6: Program Management CDI for the Newcomer, Nancy A. Entwistle, MPA, RHIT, CCDS, CCS, ACE, AHIMA-Approved ICD-10-CM/PCS Trainer (PLATINUM) This session will help the new CDI specialist understand the components needed to effectively code the record, identify what he or she needs in order to submit a compliant claim, and gain a better understanding of the guidelines pertaining to the physician's written record. It will include an overview of common guidelines challenges, offer new opportunities for querying, and develop specialists' overall understanding of the complex MDCs that drive case-mix index. Simplifying the Query Process: Directed Step Queries, Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP, CHITS-CP, MCP (GOLD) For many CDI programs, queries often go unanswered, or the physician disagrees with the purpose of the query. Participants will learn how to create and use a directed step query in order to increase physician participation in the query process and to maximize specificity as demanded by ICD-10. The audience will take with them the knowledge and skills necessary to implement this clinically oriented method of query creation while maintaining compliance, avoiding leading queries, and providing targeted physician education. Example queries will be provided. Advancing CDI Through Leveraging Technology, Nick van Terheyden, MD, and Paul L. Weygandt, MD, JD, MPH, MBA, CCS, FACPE This presentation will provide insight into innovative technologies, including primary real-time documentation methodologies, computer-assisted physician documentation, dynamic problem lists, and computer-assisted coding. It will address physician engagement through enhanced workflow, including immediate closed loop feedback without burdening clinicians with additional non-patient-facing tasks. The session will also address compliance considerations, including safeguards necessary to ensure appropriate monitoring of innovative technologies and ensure physician discretion in clinical documentation. 11:45 a.m. Adjourn Obtain your CEUs online In order to receive your continuing education certificate(s), you must complete the online evaluation at within two weeks of the program. Page 8 of 8

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