1991-10-23 Regular MeetingKODIAK ISLAND HOSPITAL
ADVISORYBOARD MEETING
OCTOBER 23, 1991
PRESENT: Ben Ardinger, William Brewer, Gretchen Saupe, Betty
Springhill, Wayne Stevens, Ed Myers, Administrator, Joe
Smith, VP of Operations, LHS Management Company, Keith
Vorachek, Financial Services Administrator, Pam Foreman,
Director of Human Resources, Corlene Hogg, Director of
Ancillary and Patient Information Services, Scott Allen,
Business Office Manager. Also present was Jack McDonald,
Chief of Police.
ABSENT: Jeannie Volker, Gordon Gould, Lorne White
With a quorum present, the meeting was called to order at 7:12 p.m.
ACCEPTANCE OF AGENDA:
Moved, seconded and carried to accept the agenda.
APPEARANCES AND COMMUNICATIONS
Ms. Springhill welcomed Jack McDonald, Chief of Police. Mr. McDonald
stated that his department wants to work closely and carefully with the
hospital. He expressed his desire that as a follow-up to the interde-
partmental meeting, an ad hoc committee meet to resolve procedural
issues, including protocols for the billing process. Mr. Myers stated
that he would contact City Manager, Gary Bloomquist, to schedule such a
meeting. Mr. McDonald stated that there had been several positive
sessions with Dr. Mala during his recent visit with regard to mental
health and youth service issues. He said that he would be working to
create a closer relationship between the Police Department and the
hospital.
Keith Vorachek introduced Scott Allen, who has accepted the position as
Business Office Manager. Mr. Allen stated that his position is chal-
lenging, requiring that he walk a fine line between firm and profes-
sional. He stated that his department is working to improve billings
and that collections are up from the month previous. Mr. Scott said
that it would take some time to recover the over $1 million in private
pay accounts receivable. Mr. Scott will be meeting with representatives
of CHAMPUS, Blue Cross and Medicare when he travels to Seattle. He
stated that he has clarified the status of concerns raised by Mrs.
Kalcic regarding evening and weekend collections with the Federal Trade
Commission and the Attorney General's office.
Advisory Board Meeting
October 23, 1991
Page Two
Ms. Saupe voiced a concern on behalf of a patient regarding the cost of
chemotherapy drugs. Mr. Myers requested that Ms. Saupe have the patient
involved contact him. Mr. Myers pointed out that this situation may be
one in which there is misunderstanding in the community regarding charg-
es for services. He said that staff is willing to discuss rates and
charges with anyone having a question regarding them.
Ms. Springhill read a letter from a patient regarding billing. Mr.
Myers indicated that he has responded to the patient.
MEETING MINUTES
Moved, seconded and carried to approve the meeting minutes of October 9,
1991.
CONIlq=E REPORTS
Keith Vorachek reported that the Finance Committee met and reviewed the
September financial statement. He reported that the facility has an
overall year to date loss of $888,000, which includes the recent legal
settlement. He reviewed the status of the Accounts Receivable, stating
that cash flow has stabilized and that the facility should begin to
realize an increased cash flow in response to intensified collections.
OLD BUSINESS
A. Long Range Planning committee
Mr. Myers stated that the facility will follow a similar procedure as
that used by the School District to identify and establish a Long Range
Planning committee. Mr. Myers said that he did not feel it would be
possible to establish a functional committee before the first of the
year. LHS has indicated that they are agreeable to establishment of the
committee in this manner, although they would prefer to proceed with the
completion of the Plan more rapidly. Mr. Stevens asked if the Long
Range Plan previously completed had been located. Mr. Myers stated that
LHS had used it in the preparation of the Certificate of Need and had
returned it to the facility. Mr. Stevens suggested that Don Johnson,
the principal at Port Lions School, had facilitated the school district
through their process and might be helpful to the committee as it pre-
pares the plan. Mr. Smith cautioned that although the previous plan can
be used as a base, that emphasis in health care issues have changed, and
that the demographics contained in that report were no longer valid.
Advisory Board Meeting
October 23, 1991
Page Three
B. PR Plan - Kodiak Marketing and Consulting
Pam Foreman presented the marketing and public relations proposal pre-
pared by Kodiak Marketing and Consulting. She stated that the PR Com-
mittee had reviewed the proposal and was positive about the services
provided and the cost. Ms. Foreman pointed out that some services were
not included in the proposal, including the preparation of the Annual
Report, quarterly newsletter, and the preparation of the Facts Program
(a program designed to get employees and medical staff involved in
marketing and public relations). Ms. Foreman explained that the devel-
opment of a facility video would create a recruitment tool which could
also be used at trade shows. The need for better signs for the facility
has been identified. Maintenance will be preparing quotes as to cost of
replacing the painted sign with one visible from the road. Mr. Stevens
stated that he felt the proposal incorporated Board concerns voiced in
the past, and that the proposal would be useful in improving the
hospital's image and community support. He pointed out that it was
necessary to involve the staff so they would be positive emissaries for
the facility, and stated that he felt this proposal was a step in the
right direction. Ms. Foreman said that staff and administration would
be working closely with Kodiak Marketing and Consulting.
Mr. Ardinger stated that such a comprehensive marketing and public
relations plan was long overdue for the facility.
Ben Ardinger moved and Dr. Brewer seconded the motion that the Advisory
Board recommended acceptance of Kodiak Marketing and Consulting's propo-
sal in the amount of $17,500 to provide marketing and public relations
services to Kodiak Island Hospital B Care Center. Roll Call vote:
Ardinger, Aye; Brewer, Aye; Saupe, Aye; Springhill, Aye; Stevens, Aye.
Motion Carried.
C. Credit and Collection Policy
Pursuant to a request by the Finance Committee, the information regard-
ing the credit and collection policy contained in the Patient Financial
Information sheet was amended to include a statement that the facility
is a revenue fund and does not receive tax support. It was suggested
that #6 contained in the policy be rewritten to read as follows: "There
have been occasions when it has been necessary to refer an account to a
collection agency. Once an account has been turned over to a collection
agency, it will not be recalled." Mr. Ardinger asked why this statement
was necessary. Mr. Myers explained that there is a common perception
that the hospital can recall accounts once they have been turned over to
collections, when in fact, they cannot. It was suggested that the
statement regarding acceptance of credit cards be renumbered as #2.
Advisory Board Meeting
October 23, 1991
Page Four
NEW BUSINESS
A. KIB Ordinance 91-26
Mr. Myers reviewed the changes in the ordinance as recommended by Mayor
Selby. It was the recommendation of the Advisory Board that the Kodiak
Borough Assembly accept Ordinance No. 91-26 amending KIB Code 8.04.030,
Hospital and Health Facilities Advisory Board Powers and Duties.
B. Budget FY -92
Mr. Myers asked that this item be deferred until a later meeting, so
that the Board would have ample opportunity to review the proposed
budget. The budget will be delivered by courier.
C. Promissory Note - ICF Resident
Mr. Myers stated that the facility was considering accepting a promisso-
ry note on property owned by an ICF resident as partial payment of the
amount owed. Acceptance of the note would enable the resident to become
Medicaid eligible.
ADMEWSTRATOR'S REPORT
Written report as attached.
Mr. Ardinger asked for clarification of statements made by Mr. Myers at
the KIB meeting of October 17. Mr. Myers explained that he had made the
statement that it was the opinion of some people that if the new hospi-
tal was not built, that the community would save $19 million. He ex-
plained that Mayor Selby had felt it important to explain that if a new
facility was not built, that major capital outlays would still be re-
quired to bring the current facility to code. Noting that the Borough's
health powers and responsibilities are as important as their education
powers, Ms. Springhill suggested that the Advisory Board continue meet-
ing with the City and Borough to keep them informed about the need for
a new facility. Ms. Saupe stated it was important to point out the
great inconvenience which would be experienced by patients and the
community if the facility was required to undergo major renovation and
remodeling while continuing to provide services.
Mr. Myers distributed copies of the Risk Management consultant's assess-
ment of the facility. He stressed the confidentiality of the report and
asked that each member taking a copy of the report return it at the next
meeting.
Advisory Board Meeting
October 23, 1991
Page Five
Mr. McDonald thanked the Advisory Board for the opportunity to attend
the meeting. He noted that the hospital and police department shared
common problems and concerns.
Corlene Hogg stated that the department heads who attended the last
Board meeting had shared with her their positive observations and in-
creased understanding about the Board and its function.
Dr. Brewer stated that KANA and the facility had signed a contract this
date.
Ms. Saupe noted that the sign at the new facility site needed repair and
repainting. She stated that she felt it was important for the facility
to continue to stress and address wellness issues such as weight con-
trol, cholesterol screening, smoking cessation, etc.
Mr. Ardinger stated that he would like to see the credit and collection
policy worded less aggressively.
Mr. Stevens stated that he had discussed the Dutch Harbor situation with
representatives last week at Fish Expo. The chairperson for the board
of the clinic noted in conversations with fishing companies that they
were working closely with Kodiak. Mr. Stevens said that he felt an
affiliation with Dutch Harbor was forthcoming. Several members of the
Board commended Mr. Stevens for the diligence and enthusiasm he has
brought to this venture.
There was a brief discussion of the general surgeon and his recruitment
for a partner. Mr. Smith noted that Dr. Mason has indicated a strong
desire to provide surgical services for Dutch Harbor and other Southwest
Alaska communities. Mr. Smith also noted that LHS will be presenting a
proposal to the Bristol Bay health facility for management services.
Ms. Springhill asked when the Advisory Board would meet with the Assem-
bly in work session to discuss quality assurance matters and patient
surveys. The recording secretary was asked to contact the Borough Clerk
to determine the date for such a work session. Ms. Springhill noted
that the Auxiliary had asked for a "wish list" from staff. Ms. Spring-
hill asked about the status of the security service. Mr. Myers stated
that the hospital now has its own security staff. He stated that Mr.
Gregory has been very helpful and supportive of the new staff.
Advisory Board Meeting
October 23, 1991
Page Six
Ms. Springhill asked about the status of the surgical equipment request-
ed by Dr. Mason for gallbladder surgery. Dr. Mason has stated that the
facility is losing two surgeries per month because of lack of this
equipment. Mr. Myers stated that Requests for Proposals have been sent
out.
EXECUTIVE SESSION
Moved and seconded to adjourn to Executive Session to discuss legal and
personnel matters at 9:00 p.m. Motion Carried.
Returned to Regular Session at 9:30 p.m.
ADJOURNMENT
Moved, seconded and carried to adjourn at 9:30 p.m. Recorded by Debra
Raper.
I
/ -
A)36 k4 t
CSCUSSION PAPER
KIH/CC ISSUES
I have been asked to address several issues which came before
the last Borough Assembly meeting, namely medical -surgical
staffing, quality of care, and the need for a replacement hospital.
I want to preface my comments by saying that the staff of
KIH/CC works very hard to provide the very best care possible and
we take exception to any comments that we provide any lower quality
of care than other small hospitals or any urban or large
hospitals. I know that for the most part, there was no intent to
impugn the quality of care at the Hospital without something to
measure quality against.
ON THE ISSUE OF MEDICAL -SURGICAL STAFFING:
The Hospital employs an acuity staffing system which is common
in Hospitals throughout the U.S. Acuity staffing is a method
which measures the intensity of nursing needs, number of patients,
and related needs to a scoring system. Hence, you may have ten
medical patients whose nursing needs are less demanding than ten
post-surgical patients who have high nursing needs. There would be
lower staffing requirements for the former as opposed to the
latter.
This is scored in an acuity system. However, I want to stress
that at all times the charge nurse has the option to call in
additional staff at any time the need exists. I assure you that
the staffing ratios are generally higher at our Hospital
than many urban hospitals facing serious financial constraints.
Discussion Paper
October 17, 1991
Page Two
Our lowest level is generally 3 staff, often to 5 or 6 patients, or
a 1 to 2 ratio. As to the possibility of a momentary instance
where where all staff are tied up - it happens here and in very
large hospitals. You simply cannot predict every eventuality and
staff it - NO ONE could afford the care. Even unit secretaries
have duties which take them away from the nurses station to the
Emergency Room and other places. Night time is our lowest activity
level, averaging less than 2.0 patients per night in the ER.
Hence, while every eventuality cannot be forecast, there are
safeguards built in which permit response to unusual situations.
With the change to in-house security service, that person will
also be available to the charge nurse when not actively involved in
patient safety.
ON THE ISSUE OF QUALITY:
Quality of care is a very formal program at our hospital and
extends from patient care activities to laundry activities. No
other organization expends more effort on quality of care issues
than Kodiak Island Hospital. In your packet, you have access to
one measure used in our Quality Assurance Program, which is patient
evaluations. I am proud to state that even the casual observer can
see that our services are rated very highly by the patients using
them. The fact is that patients who use our services
generally like the care they receive. What we cannot provide to
Discussion Paper
October 17, 1991
Page Three
you because of confidentiality are the many hours in our quality
care program devoted to clinical care, peer review, physician
credentialing and risk management. I can assure you that these
issues are handled seriously and with impact.
We have an exceptional risk manager in Corlene Hogg, a member
of the Hospital management team, who spends many hours in these
activities.
AS TO THE PRIORITY AND NEED FOR A NEW HOSPITAL:
I want to emphasize that our commmunity survey indicates that
the community understands the need for a replacement facility --
62% responded positively to this need. I would also like to advise
you that after an extensive tour of our facility that the
Commissioner of the Department of Health and Social Service, Ted
Mala, stated that he clearly understood our need for a new
facility.
I think that there are some who believe that we can save $19
million by not building a new facility (actually $2 million has
already been spent), but that is simply not the case. If we do not
build a replacement facility, we will have to raise $12-$14 million
to bring the current facility up to required standards.
Eventually, this expense cannot be avoided, not to mention
that we will still be left with a limited and inadequate facility.
In my opinion, it is better to get the funds from the state to
build a new facility rather than to task the local population to
Discussion Paper
October 17, 1991
Page Four
spend these funds.
Keep in mind that just to maintain the status quo over the
next few years, it will require in excess of $1 - $2 million in
plant maintenance and replacement of worn out equipment. The real
question is whether we want to make an all out effort to
obtain state funding or face the likelihood that the Borough would
have to fund $12 million to bring the existing facility up to
current hospital standards, or to make no changes -- something
which I am sure none of us want. The state has been kind to us
because they know we have been attempting to obtain state funds for
construction, but should we structurally renovate any area, we will
be held to bringing the entire facility up to standards.
Thank you - I and my management staff will be happy to answer
any questions.
Ed Myers, Administrator
Kodiak Island Hospital & Care Center
1915 E. Rezanof Drive
Kodiak, AK 99615
(907) 486-3281
SUMMARY
KODIAK ISLAND HOSPITAL & CARE CENTER
MEDICARE/STATE LICENSE SURVEY
The Hospital and Care Center were surveyed during the week of
September 9, 1991. The survey team consisted of six people (large for
this size facility) and the Hospital and Care Center were inspected for
compliance with federal and state laws.
Every aspect of operations were reviewed including staffing, quality
assurance, clinical operations, administration, and support services. The
entire Hospital management structure was outbriefed on September 13,
1991 and I am happy to say that there were no MAJOR deficiencies
defined by the survey team.
The only item of major concern of which we were advised by the team
chief was a mechanical problem in surgery. Our old structure is unable
to maintain adequate temperatures in the operating room. We are having
this looked at for possible solutions.
Overall, the survey was cordial, informative, and constructive. Because
of patient confidentiality issues, if the Assembly desires to review and
discuss the survey in detail, I will be happy to have appropriate people
attend a work session.
KODIAK ISLAND HOSPITAL AND CARE CENTER
BUSINESS SURVEY AND QUESTIONNAIRE
DRUG TESTING
Are you familiar with drug testing laws?
Is your company required to do drug testing?
Do you currently do drug testing of employees?
If not currently testing, are you interested
in a testing service?
If currently testing, would be interested
in using a local laboratory for testing?
Yes _ No
_ Yes _ No
Yes _ No
Yes _ No
_ Yes _ No
EMPLOYEE ASSISTANCE PROGRAMS
Are you familiar with Employee Assistance
Programs (EAP) to improve workplace performance? _ Yes _ No
Do you currently have an EAP in place? _ Yes _ No
If yes, what type of program do you have?
_ Assessment & Referral _ Comprehensive
If you do not have an EAP in place, would you like to
learn more about the benefits of a program? _ Yes _ No
Contact Name:
Telephone #:
WELLNESS
Do you offer any wellness programs to employees? _ Yes _ No
If yes, what type:
Cardiac Screening
Lifestyle Screening
Cholesterol
Physical Fitness
_ Health Fair
Other (Please specify)
If "No," would you be interested in a low cost program? _ Yes _ No
CONTINUED ON REVERSE
0
DISCUSSION PAPER
KIH/CC ISSUES
I have been asked to address several issues which came before
the last Borough Assembly meeting, namely medical -surgical
staffing, quality of care, and the need for a replacement hospital.
I want to preface my comments by saying that the staff of
KIH/CC works very hard to provide the very best care possible and
we take exception to any comments that we provide any lower quality
of care than other small hospitals or any urban or large
hospitals. I know that for the most part, there was no intent to
impugn the quality of care at the Hospital without something to
measure quality against.
ON THE ISSUE OF MEDICAL -SURGICAL STAFFING:
The Hospital employs an acuity staffing system which is common
in Hospitals throughout the U.S. Acuity staffing is a method
which measures the intensity of nursing needs, number of patients,
and related needs to a scoring system. Hence, you may have ten
medical patients whose nursing needs are less demanding than ten
post-surgical patients who have high nursing needs. There would be
lower staffing requirements for the former as opposed to the
latter.
This is scored in an acuity system. However, I want to stress
that at all times the charge nurse has the option to call in
additional staff at any time the need exists. I assure you that
the staffing ratios are generally higher at our Hospital
than many urban hospitals facing serious financial constraints.
KODIAK ISLAND HOSPITAL & CARE CENTER
BUSINESS SURVEY SUMMARY
KIH/CC conducted an informal survey of 231 businesses utilizing mailing
labels provided by the Kodiak Island Chamber of Commerce. Sixty-seven
responses were received, representing a 29% response rate. Respondent
businesses ranged in size from one employee to over 450 employees.
The responses indicated high interest in employee assistance programs,
wellness programs, and drug free workplace programs. Other program
interest areas were pre-employment and periodic physicals, health insur-
ance claims analysis, and other trust consulting servicess (self-insured
health care trusts).
Each specific area of interest will be covered in detail at future KIH/CC
sponsored seminars.
Presenter: Ed Myers, Administrator
Kodiak Island Hospital & Care Center
1915 E. Rezanof Drive
Kodiak, AK 99615
(907) 486-3281
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WELLNESS PROGRAM
(COMPONENTS)
SMOKING CESSATION
WEIGHT CONTROL
HEALTH HEART DIET
CHOLESTERAL CHECKS
HEART NUTRITION
FITNESS/EXERCISE
STRESS EDUCATION/REDUCTION
GENERAL NUTRITION
SCREENING EXAMS
TRIGGERED BY AGE OR HISTORY
Footnote:
(9% of Respondents had One or More Elements)
EMPLOYEE ASSISTANCE
* TELEPHONE ASSESSMENT
* SHORT-TERM COUNSELING
* COMPREHENSIVE
SUPERVISORY TRAINING
EDUCATION
DRUG TESTING
* APPLICANT TESTING
(PRE-EMPLOYMENT)
*RANDOM
* SAFETY TESTING
* VOLUNTARY
* FOLLOW-UP TO COUNSELING/
REHAB
IMPACT
* MORALE
* LABOR RELATIONS
* WHO IS INCLUDED
I KODIAK ISLAND HOSPITAL
CommunityHealthcareSurvey
I & CARE CENTER
Kodiak Island Hospital & Care Center is committed to providing high quality health care
services at a reasonable cost, and in a manner that is accessible to everyone in the
communities we serve. Your answers are strictly confidential and cannot be attributed
to you. This survey affords you the opportunity to help plan for the future of medical
services in your community. Please complete and return this survey in the enclosed
return envelope as soon as possible. Thank you for your input. It is valuable!
1. Do you have a family doctor or clinic you generally use? ❑ Yes ❑ No
If yes, please name the town where your family doctor is located.
2. During the last 2 years, have you or any member of your household visited a
doctor outside of Kodiak? ❑ Yes ❑ No
If yes, why did you visit a doctor or clinic outside of Kodiak?
Services or specialty not available locally
(Please list service or specialty):
Quality of services better elsewhere
Referred by local physician
Referred by non -local physician
Takes too long to get an appointment
Was away from Kodiak when medical need arose
Other (please specify):
3. Have yon. ever been treated by a:
Nurse Practitioner ❑ Yes ❑ No
Midwife ❑ Yes ❑ No
If yes, was the care you received:
As good as that provided by a physician
Better or Not as Good
4. Are more physicians needed in the Kodiak area? ❑ Yes ❑ No
5. What additional physician specialties are needed?
OB/GYN (childbirth)
Pediatrics
Family Practice
Internal Medicine
General Surgery
Other (please specify):
6. Has any member of your household (including yourself) been hospitalized in the
past 2 years? ❑ Yes ❑ No
7.
If yes, what is the name of the hospital most recently used?
Kodiak Island Hospital
Providence Hospital, Anchorage
Humana Hospital, Anchorage
Fairbanks Memorial Hospital
Other (please specify):
If other than Kodiak Island Hospital, why was this hospital chosen?
Services or specialty not available locally
Quality of services better elsewhere
Referred by local physician
Referred by non -local physician
Most convenient
Other (please specify):
8. Would you use the same hospital again? ❑ Yes ❑ No
9. What Cher types of services should be provided in Kodiak?
10. Based upon your own experience and/or the reputation of Kodiak Island
Hospital & Care Center in the community, please rate the following
characteristics on a scale of 1 to 5 (1 = poor; 5 = excellent).
Hospital Catetory: 1 to S No Opinion
Services provided
Quality
Courtesy
Physical plant (building, etc.)
Equipment
Teamwork
Cost (compared to area)
Cleanliness
Hospital Departments & Staff.
Medical services
Surgical services
Obstetrical services
Emergency Room services
Nursing qualifications
Qualifications of staff
Quality of meals
Lab, X -Ray, etc. services
Business Office & Admissions
Physician Services in the Clfnie & Hosnitah
Qualifications
Quality of care
Timeliness of care
Patient relations
Support for Kodiak Island Hospital/
Care Center
11. How knowledgeable do you feel you are about the kind of services provided at
Kodiak Island Hospital? (1 = not at all; 5 = very knowledgeable about
services)
11 El 11 11 D
12. How long have you lived in the Kodiak area. Years
What is your Zip Code?
13. What is your age? _ Years
What is your gender? ❑ Male ❑ Female
14. As you may have heard, the Advisory Board and Borough Assembly are
considering building a new hospital. Do you feel a new hospital should be built?
❑ Yes ❑ No
Comments:
Please feel free to provide any other comments that may assist Kodiak Island Hospital
& Care Center in planning to meet your future health care needs.
Thank you for completing this survey. We appreciate you taking the time to answer these
questions. Please return this surrey within one week in the enclosed stamped, addressed
envelope.
Facility owned by residents of the Kodiak Island Borough
LHS Management Company
A Subsidiary of Lutheran Health Systems .................................................
KODIAK ISLAND HOSPITAL & CARE CENTER
COMMUNITY SURVEY RESULTS
Of 2,361 surveys in a random sampling of registered voters, 481 were returned
(a 20.37% return).
The majority of respondents were females between the ages of 30 and 49.
(Graph #1.)
' 47.19% of respondents or family members have been hospitalized in last two
years.
` Of those, 60.33% (or 146) were hospitalized at Kodiak Island Hospital & Care
Center. 34.24% would stay at KIH again, 7.53% would not, 58.23% had no
opinion. (Graph #2.)
Of those hospitalized in the past two years in places other than Kodiak, the
reasons listed are as follows (Graph #3):
Services or specialty not available locally 31.3%
Referred by local physician 22.0%
Quality of services better elsewhere 13.2%
Most convenient 4.4%
Referred by Non -local physician 1.8%
Other 6.2%
` 50.72% of respondents felt there is a need for additional physicians in Kodiak.
' The following chart (Graph #4) demonstrates the areas of need as seen by the
respondents. (Reminder, the survey was sent out prior to the arrival of Dr.
Mason.) In the "other" category, the following represent the top five.
1) Dermatology (tied with #2)
2) Orthopedics
3) Cardiology
4) Women's Health (other than OB/GYN)
5) Ear/Nose/Throat
• When survey participants were asked "Based upon your own experience and/or
the reputation of KIH/CC in the community, please rate the following
characteristics." The following graphs represent those ratings (Graphs #5, 6,
7).
' When survey respondents were asked "Do you feel a new hospital should be
built?", 62% said "yes", 22% said "no", and 16% had no opinion.
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