cash pay specialties

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What are some specialties that allow you to establish private practice and charge cash for service? I have heard cosmetic surgery and concierge medicine...are there other ones out there?
 
It's not a question of being allowed. It's about if you can get pateints to pay. You can do lots of things and try to get cash payments. obviously it would be practically impossible for an EP to take cash only. Very hard for anesthesia, rads or a hospitalist. You could be any sort of primary care doc and demand cash but you probably won't get many pateints. Derm and plastics and hotel docs often get cash up front. In reality the najority of cash docs are the cadre of semi licensed, non boarded docs who shill botox, weight loss programs and hair restoration stuff. Those guys are all cash based which is good because they are probably banned from CMS anyway.
 
docB said:
In reality the najority of cash docs are the cadre of semi licensed, non boarded docs
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What exactly is a 'semi-licensed' doc?

Just wondering.
 
docB said:
In reality the najority of cash docs are the cadre of semi licensed, non boarded docs who shill botox, weight loss programs and hair restoration stuff. Those guys are all cash based which is good because they are probably banned from CMS anyway.
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Aside from Plastics and Derm, I thought FP, OB/GYN and enterprising RNs did alot of this stuff.
 
What about integrative medicine? People have been talking about anti-aging clinic, acupuncture, foot massage and things like that...How lucrative is that?
 
salmonella said:
What about integrative medicine? People have been talking about anti-aging clinic, acupuncture, foot massage and things like that...How lucrative is that?
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if you're interested in those, then you really don't need to be a physician. you could become a podiatrist, work for revlon, or get licensed as an acupunturist.

if you want to do those things as an MD to lend some credence to those "therapies", then i would say that you would be wasting many years of your life.
 
colbgw02 said:
if you're interested in those, then you really don't need to be a physician. you could become a podiatrist, work for revlon, or get licensed as an acupunturist.

if you want to do those things as an MD to lend some credence to those "therapies", then i would say that you would be wasting many years of your life.
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They're interested in making money obviously, that's the point of the thread.
 
We saw a pedi neurologist for a while who was on a cash basis. He was in solo practice and got ticked because the insurance companies were holding out on paying upwards of $40K they owed him, so he went straight cash. Of course, he was also the only one in town, but most of the docs started referring to the one in the next big town over instead, so I don't know that it was such a great move. As a parent, it was pretty hard to squeeze out the $240 for the visit, although we could file under insurance and get reimbursed for it, it was a hassle that most patients won't assume.
 
I'd think specialities where you deal with procedures that typically aren't covered by insurance would be good cash-only practicies. Plastic surgery comes to mind. However, any doctors who owns their own practice can, in theory, demand cash only. The problem is, will you have a big enough patient base to do a cash-only practice? Many patients probably have insurance and would like to not have to pay all upfront in cash.
 
My dentist has it made.

He charges his full payment up front. Then you can have the office file it to your insurance, and insurance will send you a check for their coverage. This guarantees that my dentist collects what he bills. Sweet deal for him I guess.

p.s. -- I skipped my last appointment. :meanie:
 
I tried to post this but doenst look like it posted so forgive double posts if it happens But psych is a huge cash pay speciality. If you go private practice and run your own office as a psychiatrist you usually take cash only simply since insurance refuses to pay for "normal" people with basic depression, anxiety, etc to see a psychiatrist. So its the middle class that gets hammered. Poeple in the middle class who are not sick enough to need intense inpatient care or something but who have real depression or other issues and they want to see a psychiatrist-well it is rarely covered. The upper class well they have no problem cash paying so private practice is usuall catered to the middle-upper class since those are people that can pay and iti s all cash. Of 6 or 7 psychiatrists in private adult practice I have met with this year, since I am interested in it, all have done cash pay only and are doing very well-and they say their favorite part is not having to deal with insurance companies, paperwork, coding blah blah and watchign reimbursments come in at 30 percent of what they bill-you bill and get paid what you bill.
Of course if you are in academia anywhere it is a diff story. But priv. pract adult or child psych you clean up.
 
I think another person hit on it earlier but any specialty can potentially be "cash payout" only should you offer services that are unique enough. For instance, there is a dermatologist in my town (doesn't even do cosmetic procedures...just actual medical practices)

He has been so successful and is now attracting so many patients that he actually has to turn many away. He does it be reducing the # of insurance companies that he will accept payment from. (Should you still want to see him, you will have to pay out of pocket)

He does it by charging $500 for an initial consultation. (Apparently, there are many patients who just couldn't get fixed at their regular doctors and would travel all the way to see him and pay the consultation fee because of his great diagnostic skills)

So if you're really good at what you do, have a huge base of patients willing to pay for that service, and have little to no competitors, you could probably get away with charging cash in any field!
 
tiredmom said:
We saw a pedi neurologist for a while who was on a cash basis. He was in solo practice and got ticked because the insurance companies were holding out on paying upwards of $40K they owed him, so he went straight cash. Of course, he was also the only one in town, but most of the docs started referring to the one in the next big town over instead, so I don't know that it was such a great move. As a parent, it was pretty hard to squeeze out the $240 for the visit, although we could file under insurance and get reimbursed for it, it was a hassle that most patients won't assume.
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I find it hard to believe that you could not squeeze out 240 dollars for a doctors visit. Your monthly insurance premiums are most likely that much.

In fact if you go to the dentist, who is all cash, most of those visits are about 150 and up to a couple of thousand.

As a physician I strongly believe that all office visits should NOT be covered by insurace. There is strong evidence that doing that would reduce the overall cost of medical insurance. Hospital visits and major catastrophic issues should be the covered by insurance.

When someone goes to the dentist they have to pay cash, sometimes it costs thousands. It should be the same when they go to their doctor.

The average primary care visit is around 100 dollars. Some of the most expensive office procedures cost around 3 to 4 thousand.

If dentist can do it, physicians should be able to as well.
 
The so called Dental Insurance is not really insurance. It is just a way to get dentist to reduce their fees to lower fees. You can get that from them if you just ask.

So, there is no such thing as dental insurance in the real sense.
 
erichaj said:
I find it hard to believe that you could not squeeze out 240 dollars for a doctors visit. Your monthly insurance premiums are most likely that much.
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I don't know why you wouldn't consider $240 to be enough money to cause someone some financial uneasiness. For the vast majority of pateints I see in the ER $240 cash is out of the question. Back when I was a student and a resident $240 would have been painful.
 
So pay the insurance premium AND squeeze in the $240 for the office visit AND AGAIN for the next visit 3 weeks later? On our budget at the time, that was tough, and I wasn't a student at the time! I was working full time as an RN - getting pretty decent insurance coverage. But, most people don't have that kind of money sitting around to fork over right away. At my pay rate at the time - it would have been a little more than 1/3 of my weekly pay.

Many of the patients I see now are having trouble coming up with $10 copay for their prescriptions. To suggest they have that much money lying around isn't realistic.
 
erichaj said:
The so called Dental Insurance is not really insurance. It is just a way to get dentist to reduce their fees to lower fees. You can get that from them if you just ask.

So, there is no such thing as dental insurance in the real sense.
Click to expand...

I have dental insurance and I pay nothing for my twice a year routine cleanings. I had a couple fillings put in last year for which I paid $80. I find it hard to believe that I could get free cleanings twice a year and $80 fillings were it not for my insurance. BTW, I don't disagree with you regarding what should and shouldn't be covered by insurance, I am just pointing out that actual dental insurance does exist.
 
docB said:
I don't know why you wouldn't consider $240 to be enough money to cause someone some financial uneasiness. For the vast majority of pateints I see in the ER $240 cash is out of the question. Back when I was a student and a resident $240 would have been painful.
Click to expand...

How do EPs make it?
I'm figuring you pull a minimum 200k gross. You work probably 12-14 ~10hr shifts a month. The lazy math says you should be yankin' down ~$120 an hour.
At ~3 pts/hr that's about $40 a piece. I am not seeing the standard denizens of the ED as willing payors of even that much money.

Am I misreading the population, or is there big money voodoo afoot?
 
fuegorama said:
Am I misreading the population, or is there big money voodoo afoot?
Click to expand...

Many emergency departments operate at a loss, subsidized by other hospital operations, which they feed. Modern medicine is all about cost-shifting.

Changing back to the original topic, cash-paying patients, it's totally doable, under two conditions. First, that you can find enough patients who are willing and able to pay for your services (you really have to advertise yourself), and second, that your services are worth their price (value is in the eye of the beholder.)
 
KentW said:
(value is in the eye of the beholder.)
Click to expand...

That about sums it up.
Several years ago, to my embarassment, I suffered some pretty good multi-digit trauma involving extreme Camembert cutting with a fillet knife.

An enterprising FP in the nearest township had set up a practice for just such "resort casualties". He agreed to sew me w/the caveat that it was cash/credit card only. "We will give you the paperwork to send to your insurance company."

On day 2 of a 9 day vacation, I agreed to let him sew. He "allowed" me to use visa for the $400 bill. 😱

If you can't see yourself doing hair transplant...envision yourself in a remote place near the monied middle class without competition.
 
The point of the post was that the Medical Model needs major change. That is why people are asking about a cash practice.

Most people pay very high premiums to insurance and use it very little.

I'll give you an example of one of my patients.

This is not a special case, it is the norm.

This patient has 3 kids, he pays 400 dollars a month to insure his whole family.

He came to see me once last years. His visit would have cost 85 dollars if he paid cash. His kids got sick in the winter, he brought them in and I think their visits cost 85 for the first visit and there was some follow up work for the next visits. But I'm sure their total bill was around 550 dollars or near that. His wife had their third child a few month ago and that cost around 5000 dollars. That is it.

So, their total bill was around 5800 dollars for the year including the baby.

He told me in one visit that he got his oldest daughter braces. That cost him around 3000 cash to the dentist.

Lets keep in mind that you don't get pregnant every day. This was his last child.

In my original post I stated that OFFICE visits should not be covered by insurance. ONLY hospital fees.

If his hospital fees are covered, (his wife having a baby), then his total cost for insurance for the years was 4800 dollars but he would have only used around 500 to 600 dollars of health care. This is not even counting the co-pay he had to pay when he walked in the office.

So, where is the bargain, he paid 4800 dollars and recieved around 600 dollars of service. The dental part was cash.

Had he gotten catastrophic insurance and had a low premium and just payed for the office visits as he went along (JUST LIKE HE PAYS FOR HIS INSURANCE) he would have saved at least 2000 dollars. (his premium for catastrophic would be lower).

So, I understand that 240 dollars is lots of cash, but in the big picture it is less cash than the annual cost of insurance. Remember, you don't pay 240 every year or all years long. you may have a expensive month followed with no visits for several months.

Do the math, it's cheaper.
 
tiredmom said:
So pay the insurance premium AND squeeze in the $240 for the office visit AND AGAIN for the next visit 3 weeks later? On our budget at the time, that was tough, and I wasn't a student at the time! I was working full time as an RN - getting pretty decent insurance coverage. But, most people don't have that kind of money sitting around to fork over right away. At my pay rate at the time - it would have been a little more than 1/3 of my weekly pay.

Many of the patients I see now are having trouble coming up with $10 copay for their prescriptions. To suggest they have that much money lying around isn't realistic.
Click to expand...

I don't think they are having trouble coming up with the 10 dollar copay. I think they don't like to pay it.

You know that big screen TV and that x box and the other toys, thats where they want to spend it. It is about priorities.

Why should we as physicians take the hit when the patients don't want to have to pay for their copay so they can by other things.

I know there is a segment of the population that truly can't afford healthcare in any way. But the average middle class american is not in that boat.
Besides, as you can see from my other post, you actually save money.

Medical insurance can be a form of false security.
 
randomedstudent said:
I have dental insurance and I pay nothing for my twice a year routine cleanings. I had a couple fillings put in last year for which I paid $80. I find it hard to believe that I could get free cleanings twice a year and $80 fillings were it not for my insurance. BTW, I don't disagree with you regarding what should and shouldn't be covered by insurance, I am just pointing out that actual dental insurance does exist.
Click to expand...

Ok, just out of curiosity how much do you pay for dental insurance per month?

My guess is it's about 15 to 20 dollars per pay period or 30 to 40 dollars per month.

Teeth cleaning is about 60 dollars.

60 x 2 = 120
80 x 1 = 80
200 dollars plus 360 dollars for the insurance = 560.

I know of at least 5 dentist that would have just given the discount to you if you asked. It's called cash discount. Pay as you go.

If you had to get major dental work, there would be little savings. Dentist don't negotiate those much because it's how they make most of their money.
 
Not that anyone asked, but my dental insurance cost me about $4.63 a pay period, or around $10 a month. The hospital picks up the rest and I get two free exams and cleanings a year, just like most other plans. It should be the same for most students and residents.

Then again, I'm single and have no need for insurance to cover things like orthodontics, etc.
 
erichaj said:
I don't think they are having trouble coming up with the 10 dollar copay. I think they don't like to pay it.

You know that big screen TV and that x box and the other toys, thats where they want to spend it. It is about priorities.
Click to expand...


These people I'm talking about aren't going out buying that stuff. These are folks that take 4-6 buses to get to clinic and are really trying to make ends meet. The system won't change - we had catastrophic coverage for my first 2 years of med school. It worked okay until we had a medical problem in one of the kids that needed an ER visit, xrays and CT scans. I can fork over $75 for an office visit that I've got planned in, but suddenly getting hit with a huge bill is tough. And my husband is an accountant - he can move money around with the best of them. But if it's not there, its not there. And - we were paying MORE for the catastrophic coverage than we were for the total HMO coverage we had while I was working for the hospital. So how does that work into your equation?
 
tiredmom said:
These people I'm talking about aren't going out buying that stuff. These are folks that take 4-6 buses to get to clinic and are really trying to make ends meet. The system won't change - we had catastrophic coverage for my first 2 years of med school. It worked okay until we had a medical problem in one of the kids that needed an ER visit, xrays and CT scans. I can fork over $75 for an office visit that I've got planned in, but suddenly getting hit with a huge bill is tough. And my husband is an accountant - he can move money around with the best of them. But if it's not there, its not there. And - we were paying MORE for the catastrophic coverage than we were for the total HMO coverage we had while I was working for the hospital. So how does that work into your equation?
Click to expand...


But, you have to read my whole post. I did say that there are those who can't afford insurance no matter what we do. I believe that has been estimated to be about 10 to 12 % of the popullation.

To comment about the rest of your post.
1. The reason you pay more NOW for catastrophic insurance is because insurance companies have to cover the loss for all those office visits. They are in business to make money. If they are paying for all office visits it raises the fees.

2. You had one event where your child had to go to the ER. How often does that happen. If you made payments for the cost of the visit, at the end of the day it would come out the same. By the way I did say hospital costs should be covered because they are far more costly than the office visits.

You have to read my posts more clearly. I have already commented on both the points you made.
I'm not sure how far along you are in your training. But once you get into private practice (if you are not there yet) you will see that you spend 50K per year chasing after insurance companies and late payments. All that can be avoided by charging cash and giving big discounts to those who can't afford to be seen. You can give the discounts because you save big on staff.

No more chasing the insurance companies.

HMOs don't save people money. Last year the CEOs of the top HMOs made a combine salary of over 80million dollars. I don't think they give a rats ass how the patients get care.
 
I think a world without insurance is like communism. Perhaps good in theory, but doesn't work in practice.
 
(nicedream) said:
I think a world without insurance is like communism. Perhaps good in theory, but doesn't work in practice.
Click to expand...

Thats a big stretch. Communism?

I wish people would read the whole post before placing a post. I never said NO INSURANCE, I did say limited coverage for the right things.
 
erichaj said:
Thats a big stretch. Communism?

I wish people would read the whole post before placing a post. I never said NO INSURANCE, I did say limited coverage for the right things.
Click to expand...

You misunderstood. What I meant was, the idea of no insurance is similar to the idea of communism in that both have theoretical appeal (in communism this would be economic equality), while in practice they appear flawed.
 
No - I'm not in practice yet - still a MS4. But I don't see what you propose as working until double coverage isn't needed. If you have to pay as much for the catastrophic/hospital only coverage and have enough set aside to pay for the cash only office visits - it's too much for most families. So, if you are single or have really healthy kids, that's great - go cash for visits. But, if you have a special needs kid like I do - it's not so easy to say I'll just pay cash for everything but needing to be hospitalized.

So, you go cash only... are you going to post your prices for office visits, shots, etc outside in your waiting room like McDonalds? How do patients plan for expenses if they don't know what you are charging?

The HMO coverage I spoke of was self-funded by the hospital - no outside HMO companies involved. It was good coverage that didn't break the bank.
 
tiredmom said:
No - I'm not in practice yet - still a MS4. But I don't see what you propose as working until double coverage isn't needed. If you have to pay as much for the catastrophic/hospital only coverage and have enough set aside to pay for the cash only office visits - it's too much for most families. So, if you are single or have really healthy kids, that's great - go cash for visits. But, if you have a special needs kid like I do - it's not so easy to say I'll just pay cash for everything but needing to be hospitalized.

So, you go cash only... are you going to post your prices for office visits, shots, etc outside in your waiting room like McDonalds? How do patients plan for expenses if they don't know what you are charging?

The HMO coverage I spoke of was self-funded by the hospital - no outside HMO companies involved. It was good coverage that didn't break the bank.
Click to expand...


If catastrophic insurance was less costly, then you could pay cash for the office visits. You do it at the dentist. Do you think that the dentist cares if you have a special need child. If his/her needs were dental needs he would still charge you cash.

Do you know why? Becasue he did the work, and want to get paid for that work. He does not want to wait 6 months to get paid, he does not want to get 3 denials before he gets paid, and he does not want to hire someone to chase the insurance company down.
Do you think the plummer thinks to himself, gee let me allow this person to pay me in 6 months. Or do you think the car dealer cares that if you don't get a car you have to take the bus and go thorugh 10 different stops, NO, they don't.

Why don't you call the insurance company and tell them that you have a special needs child and ask them to give you the discount. Do you think they will? You know the answers to all the above questions. It's NO.

And Yes, I will post my prices on the wall. People have the right to know what something is going to cost them. What's all the mystery about.
 
Problem is - I've never seen the prices up on the wall. And the dentist does care that my kid has special needs - they won't see him without him being put to sleep because they are scared of him because he wiggles and makes a lot more noise than most kids. So the dentist puts my son to sleep to do his teeth... which requires more $$$ and health insurance.

I agree with you in principle that the insurance companies are a PITA, and they do whatever they can to make $. But, I don't think a doc here and there not taking insurance will make a difference in the big scheme of things. It's nice to talk about Utopia, but I don't see it changing the world. I do think it's great to post prices for cash payments up front - then you may be able to convince more people that it's the way to go. In my future practice - it will be rather impractical to do only cash - since I'll be an ob/gyn. Reimbursement for prenatal care/delivery stinks as it is; but I don't need my patients deciding whether that $75 should go for a prenatal care visit or for groceries.
I think a cash only service makes medical care a discretionary commodity - which is the opposite of most preventive care minded physicians. How do you get someone to come in for an annual exam that they don't really want to have anyways if you're really going to hit them hard in their checkbook?
 
tiredmom said:
Problem is - I've never seen the prices up on the wall. And the dentist does care that my kid has special needs - they won't see him without him being put to sleep because they are scared of him because he wiggles and makes a lot more noise than most kids. So the dentist puts my son to sleep to do his teeth... which requires more $$$ and health insurance.

I agree with you in principle that the insurance companies are a PITA, and they do whatever they can to make $. But, I don't think a doc here and there not taking insurance will make a difference in the big scheme of things. It's nice to talk about Utopia, but I don't see it changing the world. I do think it's great to post prices for cash payments up front - then you may be able to convince more people that it's the way to go. In my future practice - it will be rather impractical to do only cash - since I'll be an ob/gyn. Reimbursement for prenatal care/delivery stinks as it is; but I don't need my patients deciding whether that $75 should go for a prenatal care visit or for groceries.
I think a cash only service makes medical care a discretionary commodity - which is the opposite of most preventive care minded physicians. How do you get someone to come in for an annual exam that they don't really want to have anyways if you're really going to hit them hard in their checkbook?
Click to expand...


SEEE, now the real issues come into play.

"Discretionary commodity", this phrase has deep roots. It screems for me to ask the question, Is medicine a Right or a privilege?

Next question; How far does my responsibility as a doctor go? If I tell a patient time and time again to take their blood pressure medicine and they don't do it and end up with a stroke, is it my fault?

Your statement "get someone to come in for an annual exam and they don't" suggests that as physicians our responsibility extends outside our office walls. And it does (as far as medical advice and correct diagnosis and follow ups), but we are not their parents and they are adults. If they choose to not come in and something goes wrong, they made that choice.

As a caring and preventive minded physician you can screem, beg, and do what you have to do to get your patient to get the best care while they are in your office, but you can't go to their house and take them by the hand and walk them to your office.

By the way, If a patient has to choose between prenatal care and groceries, they may want to re-think having a baby in the first place.

That is called being fiscally responsible.

You mentioned UTOPIA. But arent you the one that is thinking UTOPIA.
I quote " how do I get the patients to come in".

In a perfect world, they would all come in.
 
(nicedream) said:
You misunderstood. What I meant was, the idea of no insurance is similar to the idea of communism in that both have theoretical appeal (in communism this would be economic equality), while in practice they appear flawed.
Click to expand...

I did not say no insurance at all. I just feel that the current form of insurance needs to change. Cash pay office visits will reduce a huge burden on patients premiums.

In fact, if all physicians switched to a cash pay basis, then critical care and all ER and hospital care can be placed under one national insurance plan. It can be administered in a PRIVATE manner to avoid the pitfalls of socialized medicine.

If we don't do something in the near future, we will end up with socialized medicine.
 
So they don't come in for prenatal care - become a train-wreck uncontrolled diabetic, preeclamptic (or ecclamptic) who comes in when I'm on call and sues me when their baby doesn't come out perfect? I'd rather see more people getting care rather than less - which would happen if everything went to cash pay.

Back to the original post... there was a letter in the Texas medicine journal from an ER trained doc who runs a cash only practice outside of Dallas. It says he doesn't take appointments, either. Not sure how that works.
 
And if they don't have to drop cash at the visit... they do come in.
 
fuegorama said:
How do EPs make it?
I'm figuring you pull a minimum 200k gross. You work probably 12-14 ~10hr shifts a month. The lazy math says you should be yankin' down ~$120 an hour.
At ~3 pts/hr that's about $40 a piece. I am not seeing the standard denizens of the ED as willing payors of even that much money.

Am I misreading the population, or is there big money voodoo afoot?
Click to expand...
~$120/hr is a fair guess across the country. The average patient per hour is more like 2 to 2.5 depending on the acuity. You are really shooting for more of a payment of $120-140 per pateint per visit. You get nothing from the majority of the uninsured. So it all comes down to payor mix. if your uninsured percent is ~20% you'll make a lot more than the guy who sees 40% uninsured. For demonstration purposes you 2.5 patients per hour and 20% are no pays you'll get

120*2.5=300*.80=$240/hour

then you take out overhead like med mal, billing, admin, etc. and the leftover is yours.

I don't want to hijack the thread so check out some of the other billing, revenue threads on the EM board.

http://forums.studentdoctor.net/showthread.php?t=147070&highlight=uninsured
 
tiredmom said:
So they don't come in for prenatal care - become a train-wreck uncontrolled diabetic, preeclamptic (or ecclamptic) who comes in when I'm on call and sues me when their baby doesn't come out perfect? I'd rather see more people getting care rather than less - which would happen if everything went to cash pay.

Back to the original post... there was a letter in the Texas medicine journal from an ER trained doc who runs a cash only practice outside of Dallas. It says he doesn't take appointments, either. Not sure how that works.
Click to expand...

while i sympathize with your fear of litigation, it really isn't a justification for our current system. if it were, then we would never charge anyone for anything because we would want them to always come to the doctor whenever anything went wrong so that we could do a million dollar work-up to make sure we never got sued.

i'm with you on this one, erichaj 👍 but tiredmom is definitely right insofar as your system will never be implemented.
 
Two words: Pain Management

These guys make hundreds of dollars / hour.
 
colbgw02 said:
while i sympathize with your fear of litigation, it really isn't a justification for our current system. if it were, then we would never charge anyone for anything because we would want them to always come to the doctor whenever anything went wrong so that we could do a million dollar work-up to make sure we never got sued.

i'm with you on this one, erichaj 👍 but tiredmom is definitely right insofar as your system will never be implemented.
Click to expand...


Never say never, you have heard in this post about several ER docs going all cash or working on the concept. It is working for them.
There are practice all over the US doing Retainer medicine. There are Retail clinics opening up all over the US in Wallmarts and Kmarts and CVS pharmacies.

They take cash at reduced rates.

I don't think all the people will be the best candidate for a cash clinic. However, in time there will be enough people that will demand a different kind of insurance plan. One that gives them significant discount if they pay cash at the office visit level. There may still be traditional insurance options.

The market is all about supply and demand. 😀
 
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