Posts Tagged ‘CMS’

Trump Taps Orthopedic Surgeon, Medicaid Architect to Helm U.S. Healthcare Posts; Industry Reacts

December 5th, 2016 by Patricia Donovan

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Healthcare industry reaction to President-elect Donald J. Trump’s choices to head the HHS and CMS was largely positive.

Calling his nominees “the dream team that will transform our healthcare system for the benefit of all Americans,” President-elect Donald J. Trump last week announced his plan to nominate Chairman of the House Budget Committee Congressman Tom Price, M.D. (GA-06) as secretary of the U.S. Department of Health and Human Services (HHS) and Seema Verma as administrator of the Centers for Medicare and Medicaid Services (CMS).

“Chairman Price, a renowned physician, has earned a reputation for being a tireless problem solver and the go-to expert on healthcare policy,” said President-elect Trump in a news release. “He is exceptionally qualified to shepherd our commitment to repeal and replace Obamacare and bring affordable and accessible healthcare to every American.”

Prior to serving in Washington, Rep. Price worked in private practice as an orthopedic surgeon for nearly 20 years.

In the same announcement, the President-elect called Seema Verma, his nominee for CMS administrator, one of the leading experts in the country on Medicare and Medicaid. “She has decades of experience advising on Medicare and Medicaid policy and helping states navigate our complicated systems,” he said.

Seema Verma is the president, CEO and founder of SVC, Inc., a national health policy consulting company. For more than 20 years, Ms. Verma has worked extensively on a variety of policy and strategic projects involving Medicaid, insurance, and public health, working with governors’ offices, state Medicaid agencies, state health departments, state insurance departments, as well as the federal government, private companies and foundations.

Ms. Verma has extensive experience redesigning Medicaid programs in several states. Ms. Verma is the architect of the Healthy Indiana Plan (HIP), the nation’s first consumer-directed Medicaid program, and served as the State of Indiana’s health reform lead following the ACA’s passage in 2010.

Responding to the announcement, the American Medical Association (AMA) said it supports the nomination of Dr. Tom Price, who would be the first physician to serve as HHS secretary since President George H.W. Bush appointed Louis W. Sullivan, MD, in 1989, and only the third doctor in the HHS’s 63-year history.

In a statement, Patrice A. Harris, MD, MA, AMA Board Chair, cited decades of interactions with Dr. Price as a member of the AMA House of Delegates, Georgia state senator and House of Representatives. “Over these years, there have been important policy issues on which we agreed (medical liability reform) and others on which we disagreed (passage of the Affordable Care Act). Two things that have been consistent are [Dr. Price’s] understanding of the many challenges facing patients and physicians today, and his willingness to listen directly to concerns expressed by the AMA and other physician organizations.”

On the payor side, America’s Health Insurance Plans (AHIP), the national trade association representing the health insurance community, said in a statement that it anticipates cooperative, collaborative relationships with the new leaders of HHS and CMS.

“For many years, Dr. Price has been committed to ensuring that patients and consumers are well-served,” said Marilyn Tavenner, AHIP president and CEO. “He will bring a balanced and thoughtful perspective to his role as Secretary of HHS. We look forward to working with him to promote competition, increase choice, and lower costs for every consumer.

“Likewise, we look forward to working with Seema Verma to strengthen our nation’s healthcare system and empower Americans to improve their health and financial well-being, particularly those who depend on the valuable support and services provided through Medicare and Medicaid.”

Related Resource: MACRA Physician Quality Reporting: Positioning Your Practice for the MIPS Merit-Based Incentive Payment System

MACRA MIPS

MACRA Physician Quality Reporting: Positioning Your Practice for the MIPS Merit-Based Incentive Payment System delivers a veritable MACRA toolkit for physician practices, with dozens of tips and strategies that lay the groundwork for reimbursement under Medicare’s Merit-based Incentive Payment System (MIPS), one of two payment paths Medicare will offer to practices beginning January 1, 2017.

Are You MACRA-Ready? Physician Groups Prep Members for Medicare Payment Modernization

May 16th, 2016 by Patricia Donovan

Physician groups digested the 962-page MACRA notice of proposed rule-making in order to distill the notice for their members.

As they digest the HHS’s momentous proposal to modernize how Medicare provider payments are tied to the cost and quality of patient care, physician organizations are assembling arsenals of educational tools to de-mystify MACRA.

The federal government’s first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was detailed in an April 2016 announcement.

Just nine days after that bulletin, the AAFP arranged a town hall meeting for its members with two high-ranking CMS officials to discuss the law that will greatly influence how physicians are paid. Comments provided by CMS Acting Administrator Andy Slavitt via conference call are detailed here.

While the HHS window to receive feedback on the proposal remains open through June 27, 2016, the AMA has created an extensive set of online resources to support physician preparations for a post-MACRA Medicare. The resources include a guide to physician-focused payment models, key points of the Merit-based Incentive Payment System (MIPS), and five things providers can do now to prepare for the legislation, among other resources, according to a May 2016 press release.

“The core policy elements in MACRA are surfacing in other public and private insurance programs, so understanding these policies will be essential for most physician practices,” said AMA President Steven J. Stack, MD.

The AMA’s MACRA support tools were announced in conjunction with the release of its new interactive module on practicing value-based care authored by Grace Terrell, MD, an internal medicine physician and president of Cornerstone Health Care, who shares the proven steps her clinic used to focus on patients at the center of care.

The value-based care module is the latest in the AMA’s STEPS Forward™ collection of physician-developed practice improvement strategies.

Also readying its membership for MACRA is the AAFP, which last week launched a comprehensive member communication and education effort related to the proposed legislation. The AAFP’s MACRA Ready site is a one-stop shop filled with resources family physicians can use right now such as the following:

  • A timeline of important MACRA dates;
  • A list of acronyms to help digest the alphabet soup associated with MACRA’s complicated regulations;
  • A “MACRA in a Minute” 60-second overview video;
  • A deep-dive review of what value-based payment means to family physicians;
  • and much more.

In announcing the MACRA tools, AAFP President Wanda Filer, MD, MB, told family physicians that the academy’s MACRA communication plan “is designed to help simplify the transition and provide the guidance that you will need to realize the benefits of MACRA and value-based payments.”

A recent AAFP survey indicated that some 40 percent of family physicians already were involved in some kind of value-based payment system, she noted.

As she related the history of MACRA, Dr. Filer reminded members that the legislation not only repealed the sustainable growth rate (SGR) but also established an annual positive or flat-fee payment for the next 10 years as well as a two-track program (the MIPS, and Alternative Payment Models, referred to as APMs) for calculating Medicare payments beginning in 2019.

12 Things to Know About Chronic Care Management

February 24th, 2015 by Cheryl Miller

Despite new CPT codes that reimburse physician practices for select chronic care management (CCM) services, almost half of healthcare organizations lack a formal CCM program, leaving critical reimbursement dollars on the table, according to 125 respondents to the Healthcare Intelligence Network’s (HIN) 2015 Chronic Care Management survey, conducted in January 2015.

However, 92 percent of respondents believe the Medicare CCM reimbursement codes that became effective January 1, 2015 will prompt equivalent quality overtures from private payors, underscoring care coordination’s importance in a value-based healthcare system.

We also asked respondents how they structured their CCM programs, and who had primary responsibility for CCM services. Following are their responses.

  • Almost 45 percent of respondents to HIN’s 2015 CCM survey have yet to launch a CCM initiative, the survey determined.
  • A diagnosis of diabetes is the leading criterion for admission to a CCM initiative, said 89 percent of respondents with existing CCM programs.
  • A primary care physician or healthcare case manager most often bears primary responsibility for CCM, say 29 percent of survey respondents.
  • Just over one-third of respondents — 35 percent — are currently reimbursed for CCM-related activities.
  • Patient engagement is the most difficult challenge of CCM, according to one-third of survey respondents.
  • The majority of CCM tasks are conducted telephonically, say 88 percent of respondents.
  • Almost three-quarters of respondents — 72 percent — admit patients with hypertension to CCM programs, respondents said.
  • Healthcare claims are the most frequently mined source of risk-stratification data for CCM, say 72 percent of respondents.
  • More than half of respondents — 51 percent — include palliative care or management of advanced illness in CCM programs.
  • On average, each CCM patient is seen monthly, say 29 percent of respondents.

Source: 2015 Healthcare Benchmarks: Chronic Care Management

http://hin.3dcartstores.com/2015-Healthcare-Benchmarks-Chronic-Care-Management_p_5003.html

2015 Healthcare Benchmarks: Chronic Care Management captures tools, practices and lessons learned by the healthcare industry related to the management of chronic disease. This 40-page report, based on responses from 119 healthcare companies to HIN’s industry survey on chronic care management, assembles a wealth of metrics on eligibility requirements, reimbursement trends, promising protocols, challenges and ROI.

Leveraging the PHO Model for Bundled Payment Success

February 5th, 2015 by Cheryl Miller

As Medicare begins its ambitious timeline for moving Medicare payments from volume- to value-based models, alternative payment formulas, including bundled payment arrangements for episodes of care, which CMS has tested in a range of pilots in recent years, will come to the forefront. Here, Travis Ansel, senior manager of the Healthcare Strategy Group, explains why the physician-hospital organization (PHO) provides an attractive framework for bundled payment models.

Bundled pricing is appearing in more and more markets across a number of payors. As I’m sure everyone knows, CMS is testing bundled payment pilots across the country. A number of our clients that have been involved with that have had a reasonable amount of success. Overall, the level of success of the bundled pricing pilot program for CMS leaves one to wonder: is that the future of CMS? Is it some combination of accountable care organizations (ACOs) and bundled payments?

Another interesting program for bundled payments is what’s going on in Arkansas with the Healthcare Payment Improvement Initiative. In this program, the state Medicaid program and Blue Cross have actually worked together to create bundled payments for episodes of care based around high volume diagnosis-related groups (DRGs). The responsibilities for hitting the cost targets in this case are assigned to what they refer to as the “principal accountable provider.” For example, for DRG 470, major joint, the principal accountable provider is the orthopedic surgeon, but the orthopedic surgeon in this case was being held accountable for what goes on in his or her practice.

What goes on before surgery? What goes on during the hospitalization and the surgery, and then what happens 30-90 days post-acute care? They’re being held accountable for care across the continuum. This is relevant to the PHO model, because as this is phased into a number of DRGs—it started with eight, but now it includes quite a few more—the need for a PHO model will bring these physicians together.

PHO Models
Travis Ansel, MBA, is manager of strategic services with Healthcare Strategy Group, LLC. Ansel’s practice focuses on helping hospitals and health systems with physician alignment issues through strategic planning initiatives, such as hospital strategic planning, employed physician group strategic planning, physician alignment planning, and clinical integration. Mr. Ansel holds a master’s of business administration from Vanderbilt University, and bachelor of science degrees in finance and business management from the University of Tennessee.

Source: Preparing for Value-Based Reimbursement Models: PHO Development for ACOs, Bundled Payments and Direct Contracting

Infographic: CMS’ Quality Improvement Programs

December 31st, 2014 by Melanie Matthews

Ninety-two percent of eligible hospitals and 75 percent of eligible healthcare professionals have received an incentive payment for meaningful use, according to an infographic by CMS.

The infographic also examines the progress on other CMS’ quality improvement programs, including: ACOs; physician quality reporting system; ICD-10; and electronic funds transfer.

Physician Quality Rewards for Population Health ManagementHumana recently distributed $76.8 million in quality awards to approximately 4,700 physician practices through Humana’s Provider Quality Reward programs. The program is designed to support providers where they are in their practices as they move through the continuum of care programs focused on the Triple Aim.

Physician Quality Rewards for Population Health Management a 45-minute webinar on December 16th, now available for replay, Chip Howard, Humana’s vice president of payment innovation in the provider development center of excellence, shares how Humana’s program supports physicians’ transition from volume to value and helps them become successful population health managers.

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Infographic: CMS’ Value-Based Modifier Program

November 3rd, 2014 by Melanie Matthews

CMS’ new Value-Based Modifier program is designed to assess both quality of care and the cost of that care under the Medicare Physician Fee Schedule. Starting in 2015, all providers who participate in fee-for-service Medicare need to prepare for VBM because their 2017 Medicare payments will be adjusted based on their 2015 performance.

In a new infographic, Health Fusion examines how the value-based modifier is calculated, how physician practices might measure up and what practices will need to do in 2015.

CMS' Value-Based Modifier Program

Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and MethodologyIf one trend has transformed the healthcare industry post-ACA more than any other, it is the market’s new business model rewarding value over volume.

Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and Methodology provides a framework for healthcare’s new value proposition, with advice from thought leaders steeped in the delivery and reimbursement of value-based care.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Rectifying System Disparities within ACO Improves Data Capture, Quality Reporting

October 30th, 2014 by Cheryl Miller

Addressing the disparity between data systems was one of the operational and information technology (IT) issues the John C. Lincoln (JCL) Accountable Care Organization (ACO) addressed at the end of its first year as a Medicare Shared Savings Program (MSSP) ACO, says Karen Furbush, business consultant with JCL ACO. Here she explains the steps taken to rectify the situation.

I was brought on board in July 2012 and was given the ‘playbook,’ or answers that John C. Lincoln provided to the Centers for Medicare and Medicaid Services (CMS) on how they would structure their ACO over the next three and a half years. It was my job to figure out from the IT perspective how to address all the new advancements with the Transition Coach program.

My job was to figure out this new EMR EPIC® system that was being installed, and how we were going to get data back out. It took us a while once we got our membership list from CMS to find addresses and do the mailing, which we decided to do. This is not required, but we wanted to get the information out to patients about what an ACO was; that we were now providing their basic primary care physician (PCP) services. And we wanted to communicate that as early as we possibly could.

Along with doing those initial mailings, we determined any additional data we needed from our system in order to respond to CMS reporting requirements for 33 quality measures. We took a two-day workshop in November 2012 and realized that not everyone was on the same EMR at the very beginning.

We have a lot of disparity between systems; not all data comes from one system to the next, due to business decisions. We had to go back and determine what we needed from each different system and how long this was going to take. Then we had to figure out how we would normalize or make sure that this data was specific for reporting back to CMS.

In this two-day workshop, we broke it down measure by measure. There are 15 different categories in which CMS places all of their reporting. We went through each — for example, for the emergency area, the hospital and in the physician practices — and asked ourselves what we were doing for each. Just because you’re on one EMR doesn’t mean the data capture model is the same. But I still needed to account for every time those things occurred; they are discretely reportable. That’s not always easy; even though you’re on one single platform, there are a lot of factors that play into why that’s very difficult to get to.

Source: Beyond the EMR: Mining Population Health Analytics to Elevate Accountable Care

http://hin.3dcartstores.com/Beyond-the-EMR-Mining-Population-Health-Analytics-to-Elevate-Accountable-Care_p_4900.html

Karen Furbush is a business consultant with John C Lincoln (JCL) Accountable Care Organization in Phoenix. She is responsible for coordinating and managing all things related to IT integration, data analysis and reporting for JCL’s CMS MSSP ACO and Employee ACO programs. She has over 20 years of technical program and IT management experience, and has held a wide variety of information technology roles in the healthcare industry.

Lessons from the CMS ACE Bundled Payment Project

April 3rd, 2014 by Cheryl Miller

Simply put, payment bundling is one of the few policy alternatives available to the healthcare industry in which patients, providers and payors do better, explains Jay Sultan associate vice president and chief product portfolio architect, Trizetto® Corporation. Here, he explains the model, in light of lessons learned from CMS’ recent Acute Care Episode (ACE).

I worked on the CMS ACE Demonstration as an agent for two of the hospitals participating in it; I helped them set up and design the program. Going through all the different constituents, the payor received a discount, they shifted risk, the hospital was able to decrease cost and increase market share.

In one fairly straightforward instance, a single diagnostic-related group (DRG) in the ACE Demonstration Project covered roughly 38 DRGs related to hips and knees. It was all of the implantable related cardiac DRGs, like valves, stents and AICDs. It also included coronary artery bypass grafting (CABG). On one of the DRGs, , they were able to get a $2,000 case reduction in their internal costs.

The hospitals and the physicians both had their revenues go up through their share of the cost savings by the 25 percent that CMS limited them to. Had CMS not placed a limit on how much revenue the physicians could collect, at least one hospital said they thought that they could have doubled the physicians.

Just to be clear, the physicians doing ACE on average, based on the data that’s been reported so far, are getting paid 125 percent for doing traditional Medicare. They could have gotten 200 percent if CMS had not capped their savings.

Is all of this bad for the patient? It’s led to improved quality measurement, improved patient satisfaction. And in this particular program, the members actually got a rebate; a portion of the savings CMS negotiated was given to the patient for going to the facility doing the bundles. I’ll come back to that point later when we talk about the role of steerage and winners and losers in these new payment methodologies.

Excerpted from Blueprint for Bundled Payments: Strategies for Payors and Providers.

4 Trends for Healthcare Providers in 2014

January 30th, 2014 by Jessica Fornarotto

Dual-track medical homes, e-visits, retooled patient handoffs and more post-acute care are predicted provider trends for 2014, according to Steven Valentine, president of The Camden Group. HIN interviewed Valentine prior to his presentation during an October webinar on Healthcare Trends & Forecasts in 2014: A Strategic Planning Session.

HIN: What is the physician practice going to look like in 2014? How has the primary care team evolved to meet the Triple Aim values inherent in the PCMH and accountable care models?

(Steven Valentine): We should expect to continue to see consolidation amongst the medical groups. The independent practice associations will begin to assimilate together because they need to put more money into their infrastructure. And many of the organizations have underperformed, in all honesty.

The primary care team is still critical. We’ve benefitted by keeping many primary care doctors around because they were negatively hurt with their net worth in the recession in 2008-2010. But it’s slowly coming back and we’re starting to see those physicians thinking about retirement again. The reality is, we’re never going to replace all of these primary care doctors as they wind down their practice. We need to do a better job of getting telehealth going and utilizing e-visits. We’re seeing the health plans starting to pay for those e-visits, as well as having the consumer who uses them use a credit card and pay at that time, just like a visit.

We’re going to have to look at different models. Obviously, the nurse practitioner is getting more involved with the primary care. And yes, they’re still pursuing the Triple Aim. We know that quality scores, satisfaction scores and trying to manage cost per unit is still a critical focus of the triple aim moving forward with population health.

Lastly, with a PCMH in accountable care, while some of the pioneer accountable care organizations (ACOs) reduce themselves out of pioneer into the Medicare Shared Savings Program (MSSP), we still have a number of organizations and it’s growing. The commercial ACOs have been very successful in California.

We fully expect accountable care to continue. We think the PCMH will evolve into two tracks. The first track is a primary care PCMH. The spinoff is a chronic care medical home that has the multidisciplinary team organized around a chronic disease. This is a model developed by CareMore years ago in Southern California and it’s been expanded across the country. As I travel the country, I run into organizations that have set up these chronic care centers around the chronic disease.

HIN: Regarding the Pioneer ACO program, one of the top performers in the CMS pioneer program, Monarch HealthCare, told us that it’s going to be working to engage specialists in care coordination roles in year two and year three. What’s ahead for specialists in terms of quality and performance improvement as well as shouldering perhaps more care coordination duties, especially for Medicare patients?

(Steven Valentine): The specialists are going to be a critical piece to this whole solution. They have been a tremendous asset in the area of bundled payments, where you have the facility fee and physician fee combined into one payment. That works for both the Medicare as well as the commercial side. You’re beginning to see more of the bundled payments within an ACO.

The ACO manages what we call ‘frequency’ — in other words, the number of procedures to be done. Specialists are involved in satisfaction, quality scores, and resource consumption once the decision is made that the procedure needs to be done.

We expect the specialists to be involved with quality and performance. Everybody is putting in incentive programs to help drive higher quality, better performance, and a lower cost.

HIN: Hospitals have tightened the patient discharge process as a means of shoring up care transitions. But what other work needs to be done in terms of collaborations, perhaps with skilled nursing facilities (SNFs), long-term care and home health, for example, to improve patient handoffs and reduce hospital readmissions?

(Steven Valentine): Handoffs have probably been one of the areas where we’ve seen the most disappointment or underperformance within many ACOs. They have not effectively involved the hospitalists and the care/case managers who are typically embedded within the medical group that would oversee the patient throughout the care continuum. Or if it’s a health system, emanate centralized care/case management function where they manage all of the transitions from pre-acute, acute to post-acute. We think this will get better. As the doctors are more at risk, they will get more engaged with the care/case managers to manage these transitions and handoffs.

We also know that, while not in 2014 but the trend will start, we’ll see lower acute care utilization, pushing more patients to post-acute care. This means, in any given area, acute care hospitals will begin to convert excess capacity to post-acute care services like skilled nursing, long-term care, palliative care, hospice care, home care and rehab care. You will begin to see a closer proximity. The care managers will be able to work more effectively with the doctors and hospitals to manage the patient through the continuum, smooth out these transitions and have a better patient experience with better satisfaction scores at a lower cost.

Excerpted from: Healthcare Trends & Forecasts in 2014: Performance Expectations for the Healthcare Industry

Community ‘Feet on the Street,’ HRAs Improve Dual Eligibles’ Health

January 14th, 2014 by Jessica Fornarotto

A local approach — the integration of public health with managed care — is what a lot of states and CMS are starting to look for, explains Pamme Taylor, vice president of advocacy and community-based programs for WellCare Health Plans.

In HIN’s special report, Community Care Connections for Dual Eligibles: Closing Social Gaps to Improve Health Outcomes, Taylor describes some of WellCare’s efforts to connect its dually eligible population to health services, including making contact, identifying services for each member and assessing health status via health risk assessments (HRAs) that are part of these community services.

Question: What is WellCare’s strategy and practice for contacting dual eligible members and ensuring follow-through with recommended referrals to community support services?

Response: This question is two-fold; first, how do we reach the members and get them engaged? And second, how do we verify that services were rendered? For members, we have street teams that go out into the community investments. We also have community health workers on our interdisciplinary team. It’s their job to connect with our members on a face-to-face basis while also connecting them to community supports. It’s through that model that we heavily rely on engagement and connectivity, etc.

Our first line of outreach is through the phone; our second line is through the community health workers and the individuals that are ‘feet on the street.’ And then, how do we verify that services were rendered, and how is that data collected? We have a command center, which is the warehouse of all that information, and then the social service electronic health record (EHR), which bolts onto the member’s medical record. That process produces a provider roster that we then put into the hands of our field teams, who use that as part of relationship management, much like a provider relations representative would use in their engagement with the primary care physician (PCP). We meet with them on a regular basis to confirm that services were rendered, and review the successes.

The secondary piece to that is our case managers also reach out to the members that they have referred to services and activities. They verify through the members they received it and their level of satisfaction. So there’s two points of feedback: one from the provider themselves and one from the member.

Question: How do you identify community services to meet members’ needs?

Response: It’s similar to the United Way 2-1-1 directory. We did community health needs assessments, which identified a number of different needs. And using epidemiological information, we come at it in terms of identifying the need, and then determining the service model. Then we took it a step further and asked, ‘How do we define the services so it’s a blend between public health, social supports and managed care terminology?’

We use about 67 different categories of social supports. We turn that into research. We go ‘feet on the street’ to canvas the neighborhoods to make sure that we have all of the organizations represented. Then that’s put into a ‘pend’ status in our databases and it is vetted on a secondary level of review by our team of liaisons. Once it’s vetted and confirmed, it’s then put into the final database, which is used for searching by our case managers. It’s a combination of public health practice using both public health and managed care terminology.

There is no magic number of categories or organizations. No one’s ever systematically inventoried or catalogued the network of social services. That’s what we’re hoping to do — explain and quantify what organizations exist, then identify their service area, their reach, their service portfolio, and the volume of connectivity that the health plans have with these organizations for specific services. It’s an exciting time.

Question: What other components of the comprehensive health assessment are administered to the duals as they come on board?

Response: A number of different factors go into the HRA that’s completed. There are health factors, socioeconomic factors, living environment, and activities of daily living (ADL). What are their social needs, what are their social supports, etc.? There’s a whole number of different tiers of questions that we ask as part of the HRA. We use very specific tools that are either state-dictated or guidelines produced by the state or in partnership with CMS. It depends on which side of the equation that we’re being contracted for, and it depends on what’s already in existence.