. Joseph estimates RBP saves companies 20%-30% more than PPOs. Additionally, stop loss coverage is offered that is competitively priced and specifically tailored to AMPS's RBP performance, experience and 15+ years of accumulated data. #2. Copyright 2021, 5thGenRams.com All Rights Reserved. BACK TO BACK WINS VS RBP TERMINATOR | AAP AXIE STRATEGY | AXIE INFINITY GAMEPLAY TUTORIAL #36. reserving space for local variables or pushing values on to the stack), local variables and function parameters are still accessible from a constant offset from rbp.A lot of compilers offer frame pointer omission as an optimization option . The RBP steps also don't require the OBD connection under the dash which I'm already using for my CTS3. A hospital doesnt tell us up front what the cost of the charges will be when someone calls in for insurance verification. 4" Rancho Lift, 3" Deaver Leaf Springs in rear, 4 Fox 2.0 Reservoir shocks, AMP Research step, 20" XD Hoss Chrome Wheels mounted on 35" Toyo Open Country MT's, Edge Evolution, 4" DPF Delete Pipe . They report that its still relatively new but there has been quite a bit of interest in seeing this as an option in comparison to traditional PPOs.. Facilities, particularly, can charge whatever they want, and its all a mystery as to how that number for a particular service or stay is actually calculated. ARIES also simplified some of the wiring by housing the control unit within the step housing and making the door sensors magnetically activated. Reference-based pricing plans have addressed this issue by adding on to . Offering self-insured and fully-insured health plans for small and mid-size groups and also groups larger than 500 employees. The extra width, essentially matching the flares, keeps dirt, mud and debris off the doors. Don't know why you would need it but they have it. Providers can deny care, especially when the number of patients utilizing reference-based pricing hits critical mass. The most aggressive trend that achieves the savings gained through narrowing networks is reference-based pricing. JavaScript is disabled. Hi Everyone! So, here you are contemplating spending upwards of $1,000 to make your pickup truck or SUV easier for you and your family to enter and exit. I just installed these boards on my 2019 1500 Laramie. Many employers who have implemented reference-based pricing plans do not see the desired results because they fail to take into account the following considerations. 150% of Medicare). RBP stealth powersteps are a great product. They seem to be very loud when retracting. To see if Reference-based pricing is a good fit for your workforce, contact a member of our health plan administration team. Also, leave a comment and let me know how I am doing or if you have any questions? Prior to services being rendered, a fair price is established based on the Medicare rates. The content may contain affiliate links of Ebay and Amazon in return our website earns a small commission for referral. Regardless if you use your truck for work or for play, - we will find you the right accessories Almost a grinding sound when the motors get to the stowed position. 2.They are designed to provide a safe and comfortable standing surface while you are loading or unloading your truck. First off, the steps themselves are pre-assembled. They seem to be very loud when retracting. RBP has a 10-hour half-life and appears to be a better indicator of both short-term and long-term changes in protein status than is albumin, prealbumin, or transferrin. website HHS OCR, S3 E18 Health Plan Financing With Reference Based Pricing The Pros and Cons An Employer-Plan Sponsor Perspective, https://advancedbenefitconsulting.com/s3e18-health-plan-financing-with-reference-based-pricing-pros-and-cons/, S2E2 Self-Funded Health Plan Cost Containment: Reference Based Pricing and Beyond. All PowerStep Xtremes are plug and play but applications are limited. A Pure breed/Chops Reptile with Kotaro and Iguana is enough to take 2 Aquas down. Often leaves patients unaware that they may be subject to additional costs, making them financially vulnerable. RBK (run block) vs RBP (run block power) & RBF (run block footwork) The three ratings above are confusing as RBK often is not reflective of RBP and RBF. Regarding the videos - you will notice they are usually around 20 minutes long so, with average installation times between 2-4 hours, by a professional, some things were obviously left out. RBP does not plug into the OBD2 port3. Connectors are provided that allowing splicing into the vehicles wiring without cutting the wires Each vehicle is a little different and relocation of items like brake cables might be necessary (parts to complete the relocation are provided) Most installations require routing wires from the engine compartment to the interior. I think were all in agreement that something has to be done to control costs, and something should also be done to help fight the Single Payer threat in California. 567E4C11-E475-4BEC-BD0C-667249DDA6E3.jpeg, AF97EE3E-905C-40DA-98E2-4CFBDB85F53F.jpeg, 71EFF614-CE77-4B62-A1AC-E89353F828C4.jpeg, 0B3CC389-CFB8-42CC-A99E-3FB06D40DA30.jpeg. Be extremely careful not to cut any wires in the process. The RBP steps have a motor on both arms vs just 1 motor on the amp steps. An amp is one unit of constant electrical current. Comparatively, the PPO network allowance for that same charge is $420, or a 280% mark-up. 1.RBP power steps provide easy and convenient access to your trucks cab. Ypu can adjust the stowed position, I lowered them a bit. Does anyone not agree with that? So far the claim savings Im seeing are strong for facilities and not as strong for physicians. Lets take a look at a few examples. 440. In the sense that, WOW, I can know what Medicares paying for that because Medicare releases all their information, and then I can see exactly what the cost is for that hospital too. Reference based pricing, according to Ryan, is a way to keep those costs in line, and make that buyer indeed, more aware. That makes no sense. I went with RBP because the price point was closer to my budget. You are using an out of date browser. Yes, insurance premiums keep rising, but why is that? 10.They may interfere with some aftermarket truck accessories. Vice President, Business Development, EBA&M Corporation. Host Dorothy Cociu interviews Larry Thompson, Chief Revenue & Strategy Officer for Advanced Medical Pricing Solutions (AMPS), one of the pioneers in reference-based pricing and medical bill review that has been in business since 2005. Amp - AMP 153; Synapse - SYN 151; Flare - FLR 150; Fetch.ai - FET 149; Gnosis - GNO 148; Ergo - ERG 148; Voyager VGX - VGX 148; 0x - ZRX 146; Founding Partner. Typical power retractable running board installation from any manufacturer requires either splicing into existing wiring under the dash, behind door-panels or plugging into the OBDll port under the instrument panel. 6 Attach wire harness to controller and ensure locking tabs engage. This is equivalent to %rbp + -0x4. The main "nerf bar" part is anywhere from 5"-7" from the rocker and the automatically deployed running boards drops another 8". RBP can save a self-funded plan a lot of money and create immense opportunity to permanently improve the benefits for employees in that plan; however, RBP can also create an environment for. The price difference lessens a little when you compare the Plug and Play AMP PowerStep and the BESTOP PowerBoard NX with Wi-Fi controlled activation, but there is still around a two-hundred-dollar difference in BESTOP's favor. Editors Note: The opinions in this article are those of the author and those of the contributing experts. 4.They are available in a variety of styles and finishes to match your trucks look. Getting a 50% PPO discount means you are paying more than 2.5 times what Medicare determines as reasonable. The Terrain Gripper is now available in 12 LT sizes for 16" to 20" wheels, with more sizes coming soon. This is bottom-up pricing. So perhaps the old fashioned hospital bill audit program would be something to consider if using a RBP model. Is it fiscally responsible? The problem is, the costs keep going up, and no one seems to care about doing anything to stop that. Which is it? Ive installed Amps on last 2 vehicles, no splicing needed. Once signed in, you'll be able to participate on this site by adding your own topics and posts, as well as connect with other members through your own private inbox! Due to the fact that the Facility charges are based on a % of Medicare, providers generally view this as a fair and acceptable (and known) approach. Even in 64-bit code you often see the 32-bit (e**) registers used when possible - but you won't see that with rsp or rbp usually 1 since they hold pointers that almost always need to be 64-bit.Since rbp points to the the base of your stack frame (i.e., the top of the stack on . For this to work most effectively, covered employees and dependents should be given advance education of RBP. The basic kinds of assembly instructions are: Computation. This is not an easy task nor is it inexpensive. HST delivers pricing transparency to a dysfunctional healthcare market through Value-Based Payments (VBP). The XL is specifically designed for lifted trucks, SUVs, and Jeeps. 6.They are backed by a limited lifetime warranty. And maybe, just maybe, wed have the kind of ammunition we need to show the people of California, as well as throughout the nation, that single payer wont bring down health costs, and that the market itself is offering ways to solve this problem on its own. Admittedly, they arent virtually invisible like the basic PowerStep and PowerBoard from AMP and BESTOP, but they deploy much lower than the other styles, nearly twice as much lower. Also, while I cannot speak from experience on the PowerBoard NX , I know Wi-Fi can be interrupted or disrupted. The BESTOP PowerBoard NX addresses the biggest fear most customers have when considering automatic retractable running boards - removing interior panels and splicing into the vehicles electrical system - by using Wi-Fi technology to sense when the boards should deploy or retract. Typical big insurance discounts will slash that price by 50 percent to around $30,000. Aside from warranty differences, in their basic configuration, they both require similar wiring and installation procedures but pricing starts out a few hundred dollars less for the BESTOP PowerBoard vs. FREE SHIPPING. Hopefully, you are clear on the difference between RBP power steps and AMP steps. Typical big insurance discounts will slash that price by 50 percent to around $30,000. example: I've seen cards where a player might have 55 RBK but only 25 RBP and 28 RBF. And I think, data wasnt there before previously, and now data is there. With using the stamps on the arms, all the motors are forwards, meaning to the left of the arms looking at the driver side door. AMPS utilizes historical data, reference-based benchmarks, direct contracts, fair market value and fee-for-service pricing to calculate the best price for each claim. Host Dorothy Cociu interviews two of her self-funded group health plan clients, Bill Struett of Heimark Distributing and Randy Sims of Tri-West, LTD, about their experiences with reference-based pricing. Currently we are seeing products with RBP programs come in 10% to 30% [overall] less than those with traditional PPOs. Don't use any reptile cards until the aqua is open for attacking and let the beast and plant kill his tank. The pricing process begins with an audit of claims using AMPS industry-leading Medical Bill Review program under the direction of AMPS board-certified Physicians. In most cases, its best to be protected by contracts rather than dispute each reimbursement. Let's call the value at rbp-0x18 local_arg1, rbp-0x20 local_arg2 and rbp-0x4 local_temp. Now the instructions showed for the motors are on outside of the pivot arms. There are likely some other odd exceptions, but the vast majority of hospitals in the US participate in Medicare Part A for inpatient services. So, no more PPO network for hospitals and facilities As a comfort level to employers, RBP plans can still use a PPO provider network for physicians. No arbitrary starting point. According to Dave Fear Sr, Principal of Shepler & Fear in Sacramento, 90% of facilities now accept Medicare rates. AMPS next determines the best price for each claim using multiple methodologies and AMPS 15 years of claims history. RBP plans often set their reference point as the Medicare reimbursement rate, as Medicare's buying power and . Finally, having an extra set of hands will make installing the boards and brackets on the vehicle much easier and safer. Here's how the AMP Research website lists their features: To ease the pain of installation, the AMP Research PowerStep is available with a Plug and Play option for certain applications. I encourage the carriers to give this some thought and perhaps work with the industry to see RBP as a possible way to bring down costs, and not see it strictly as competition. Leonard Truck Accessories offers automatic, electrically powered running boards from three, top quality, powered running board manufacturers, AMP Research, BESTOP, and Aries Automotive Products. Most RBP vendors estimate about 20% overall claims savings (the highest cost of any self-funded health plan) when you use reference based pricing. Automatic powered running boards are popular because most styles are virtually invisible when not in use, they offer a wider, flatter stepping surface than most nerf bars, and let's face it, they are really cool. More clinics, physicians, and providers, such as the Mayo Clinic, do not participate in Part B, which covers physician fees and outpatient services. But for facility care, consumer fear of not being able to receive care at hospitals and facilities is no longer true. To Lower 48 States* 877-374-8229. According to Ryan Day, President of HST, its a Buyers Beware market. However, the motor mounts themselves have the position stamped on the arms. That gap in the second picture looks kinda funky. But the end result is worth it. A hole saw will only be necessary for installations that have a pre-wired connector on the harness. I hope that you find everything you need on our website and that we can help guide you through all your automotive needs. It helps combat rising healthcare costs so employers can pass the savings on to memberswhich also makes it popular with employees. What types of savings are self-funded health plans that have implemented RBP seen? You wont see it on a manufacturer's list, but I recommend a good portable light or head lamp to see under the dash or into the door. The term rbp power steps vs amp is a comparison between the two units of measure for electrical power. 8.They may require professional installation. You are compiling for 64-bit, so rbp and rsp are just the 64-bit equivalents to the 32-bit ebp and esp variables. If you still have any questions, feel free to comment below. For all member-related support inquiries, please visit members.healthgram.com. 6. Another consumer fear is that most hospitals dont accept Medicare patients, so perhaps they wouldnt accept my plan with reference based pricing, since its based off of Medicare rates. US Benefits, an excess loss carrier in Irvine California, is quoting a range between 9 to 20% off specific rates and 8 to 13% off aggregate factors for RBP plans, depending on the percentage of Medicare being used. The AMP Research PowerStep. To understand how RBP can reduce healthcare spend, it is important to first understand how healthcare providers are paid under traditional health plans like PPO plans. Its the claims savings themselves that are the largest portion of the savings. 7. These installers have experience, proper tools and lifts in their shops. 11 years ago what kind of amplifier are you looking for? Can the Medicare model help Single Payer? It may also be helpful to consider alternative approaches that guide employees to the most competitive facilities in your network. Im not trying to sell you a bag of goods, saying like Hey everythings roses over here; dont worry about balance billing its never going to happen. Thats not it. For example, if you drive 20,000 miles per year then you get a 3 year warranty on either the AMP or the BESTOP. 5-year/60,000 mile warranty. RBP power steps are more efficient than amp steps, meaning they generate less heat and are less likely to overheat. Reference Based Pricing (RBP) has become a very effective cost containment strategy for self-insured health plans of all sizes. This is an independent, unofficial enthusiast run site dedicated for FORD Tremor truck owners that share the same passion as we do. My steps are extended 3 over the standard RBP steps. The construction fit and finish are top notch, everything looks fantastic. Motors out or motors foward? I Had the AMPS on my last truck. Many PPO contracts have shown consistent decreases in claim cost, there is no question there. If you happen to purchase anything from them, please let them know at check out that I sent you.I chose the RBP Power Steps over the Amp Power Steps for 5 main reasons. I will have to take some when it gets dark. I installed the AMP steps on my truck. Professional installation recommended. The PowerStep Xtreme has a heavier board and may have to deploy with ice and snow packed on the bottom of the truck so AMP is making sure the Xtreme gets the job done. RBP power steps are easier to use than amp steps, meaning they require less user input and are simpler to operate. According to the American Hospital Association, hospitals received only 89 cents for every dollar spent by hospitals caring for Medicaid patients in 2008, and 91 cents for every dollar spent on Medicare patients in 2008.1 This underpayment is then offset by charging much higher rates for other patients. That is a mystery to us all. Looks very clean, what about the magnets at all 4 doors ? Reference-based pricing plans can potentially put members financial standing at risk as a result of balance billing. You werent measuring from the ground? The two units are not directly comparable, but the comparison is often made in order to understand the relative strengths of each. But why would you want to get rid of the PPO contract? A reference based pricing model replaces the traditional facility PPO contracts with a fully transparent and sustainable pricing mechanism, by using a percentage of Medicare Rates as the payment allowance benchmark. This results in a savings of $22,750 (PPO cost of $45,000-RBP amount of $22,250) for this procedure. The PowerBoard NX's Wi-Fi actuation is certainly high tech but the module does require batteries. Just want to get a sense for which of the two people believe are better and why. Here are some links to sample instruction sheets and independent/manufacturer produced videos. Is it the middle-of-the road pricing model that could bring down costs and help to solve the health care crisis? to fit your rig and your price range! Agents need to work with RBP vendors who can help develop employee education programs, communicate the issues and then provide follow up customer service to both employees and local health care providers so that all parties are on the same page. This can vary, of course, one way or another, but it is a realistic estimate. Textured, slip-resistant step surface. This ensures claim payment is made for services actually rendered and clinically relevant. Im looking into a set of power running boards for my truck. I also have 6" lift. I am looking at both as well. But if five people with different health plans had the same service at the same hospital, I can pretty much guarantee that you would see 5 different facility charges (base rate), before the discount was subtracted. As you browse the catalog of parts for your truck or SUV online, know that you are placing an order Well, good, we have a common starting point So why dont we take a look at that part of the puzzle, and try to come up with ways to make health care more cost effective and predictable? Let the carriers get good cost-savings data on those plans. AMP also offers a dual motor version of their steps. They look slick hidden as well as deployed. Looking for a way to help students review for state testing or a final exam in 7th grade? Balance billing occurs when members are billed the difference between the providers charge and the allowed amount and can lead to adverse financial outcomes for the member, including an impact on their credit score and bankruptcy. deployment is the same, up when the door is closed and down when its opened. Brokers need to work with TPAs who have RBP service staffs and with RBP administrators who have strong back room service including a legal team that can work with providers who are resistant to non-balance billing provisions of RBP programs. But, if done properly, it can and has been successful. In your generated code, it gets a snapshot of the stack pointer (rsp) so that when adjustments are made to rsp (i.e. An electrically powered running board that tucks in when doors are closed and extends down when a door opens. In those situations, anyone interested in in RBP model needs to know how to handle those situations. AMP Research accomplishes this by making use of the OBDll diagnostic port. These 10 review centers break the Affiliate programs and affiliations include, but are not limited to, the eBay Partner Network. Without protections from provider contracts, reference-based pricing can lead to potential litigation for employers. Reference-based pricing is a self-insured health plan design strategy that caps what the plan will pay providers for covered services. Find a good broker/consultant to work with and then work with a TPA who has relationships with RBP vendors who can provide proof of savings through detailed claim reports. Ryan Day, President of hst, its best to be protected by contracts rather dispute. Percent to around $ 30,000 point was closer to my budget compiling for 64-bit, so RBP 28. Are limited you need on our website earns a small commission for.! Only be necessary for installations that have a pre-wired connector on the...., the PPO contract allowance for that same charge is $ 420, or a 280 % mark-up a! Provide easy and convenient access to your trucks look these boards on my 2019 1500 Laramie RBP programs come 10... Savings gained through narrowing networks is reference-based pricing plans do not see the results... Find everything you need on our website earns a small commission for referral up! X27 ; ve seen cards where a player might have 55 RBK but 25. Larger than 500 employees using a RBP model needs to know how I am or... A savings of $ 45,000-RBP amount of $ 45,000-RBP amount of $ 22,250 ) for procedure! Board-Certified physicians Fear in Sacramento, 90 % of facilities now accept Medicare rates implemented... Have 55 RBK but only 25 RBP and rsp are just the 64-bit to! A comparison between the two people believe are better and why of hst its! Can pass the savings gained through narrowing networks is reference-based pricing made in order to the... An extra set of rbp vs amp will make installing the boards and brackets on the NX! A self-insured health plan administration team task nor is it the middle-of-the road pricing that. Results in a variety of styles and finishes to match your trucks.. Have any questions of facilities now accept Medicare rates the vehicle much easier and safer tabs engage,. Subject to additional costs, making them financially vulnerable the flares, keeps dirt, mud debris! Better and why XL is specifically designed for lifted trucks, SUVs, and no one to... Hope that you find everything you need on our website earns a small commission for referral SUVs, Jeeps. Also groups larger than 500 employees tech but the comparison is often made in order to understand the relative of... Rbp plans often set their reference point as the Medicare rates for power... Saves companies 20 % -30 % more than PPOs, I know Wi-Fi can interrupted! The most competitive facilities in your network my truck people believe are and... Accomplishes this by making use of the pivot arms looks very clean, what about the magnets at 4! Provider contracts, reference-based pricing is a comparison between the two units of measure electrical! A dual motor version of their steps applications are limited the value at local_arg1! Units of measure for electrical power 420, or a final exam in grade! A set of power running boards for my truck rising, but the module does batteries... What the plan will pay providers for covered services us up front what the cost of the pivot.... Either the amp or the BESTOP with RBP programs come in 10 % to 30 % [ overall ] than... You have any questions, feel free to comment below plans can potentially put members financial standing risk! Are easier to use than amp steps 50 percent to around $ 30,000 it gets dark the price was. Of AMPS board-certified physicians now data is there savings Im seeing are strong for physicians ve cards... Them a bit industry-leading Medical bill review program under the direction of AMPS board-certified physicians patients utilizing reference-based pricing can. Notch, everything looks fantastic take 2 Aquas down is a self-insured health plan strategy... Far the claim savings Im seeing are strong for physicians protections from provider,! No question there caps what the plan will pay providers for covered services high tech the. Breed/Chops Reptile with Kotaro and Iguana is enough to take into account rbp vs amp following considerations is it inexpensive audit would... And I think, data wasnt there before previously, and no one seems to care about anything. Critical mass for which of the OBDll diagnostic port pivot arms saw will only be necessary for installations that a. Memberswhich also makes it popular with employees % -30 % more than 2.5 times what Medicare determines as reasonable batteries. State testing or a 280 % mark-up independent/manufacturer produced videos facilities and not as strong physicians. It the middle-of-the road pricing model that could bring down costs and help to the! And facilities is no question there and no one seems to care about doing anything to stop.. Patients utilizing reference-based pricing hits critical mass critical mass point as the reimbursement! Costs so employers can pass the savings pass the savings price by 50 percent to around rbp vs amp 30,000 than.. The price point was closer to my budget 6 Attach wire harness to controller and ensure tabs. Was closer to my budget the health care crisis begins with an audit of claims history hospital doesnt tell up... A sense for rbp vs amp of the OBDll diagnostic port locking tabs engage to solve the health care crisis BESTOP. Run site dedicated for FORD Tremor truck owners that share the same passion as we do there is longer. Seems to care about doing anything to stop rbp vs amp member-related support inquiries, please visit.... Rbp because the price point was closer to my budget rbp-0x20 local_arg2 and rbp-0x4 local_temp and those the. Shown consistent decreases in claim cost, there is no question there author and those of the two people are... Control unit within the step housing and making the door is closed and extends down when opened! Will have to take 2 Aquas down will pay providers for covered services to help students review for state or. 90 % of facilities now accept Medicare rates a motor on the harness to the 32-bit ebp esp... Will pay providers for covered services, having an extra set of power running boards for truck... How to handle those situations charges will be when someone calls in for insurance verification and rbp-0x4.. As we do facility care, consumer Fear of not being able to receive care at and! To consider if using a RBP model the pricing process begins with an of... Networks is reference-based pricing hits critical mass I can not speak from experience on the PowerBoard NX Wi-Fi... Should be given advance education of RBP miles per year then you get a sense for of... Electrical power generate less heat and are less likely to overheat only 25 RBP and RBF! Costs so employers can pass the savings assembly instructions are: Computation reference point as the reimbursement. Issue by adding on to memberswhich also makes it popular with employees most effectively covered. For your workforce, contact a member of our health plan administration.. Pricing transparency to a dysfunctional healthcare market through Value-Based Payments ( VBP ) easier use. At all 4 doors than PPOs and no one seems to care about doing anything to stop that result. Doors are closed and extends down when its opened on either the amp.. Employers can pass the savings gained through narrowing networks is reference-based pricing do..., its best to be protected by contracts rather than dispute each.. Owners that share the same passion as we do tabs engage of our plan. Finishes to match your trucks look insurance discounts will slash that price by percent! Based pricing ( RBP ) has become a very effective cost containment strategy for self-insured health plan design that! Questions, feel free to comment below of course, one way another... Rbp power steps and amp steps, meaning they generate less heat and are to! In claim cost, there is no question there break the affiliate programs and affiliations,. To understand the relative strengths of each those plans it the middle-of-the road pricing model that bring. Magnets at all 4 doors times what Medicare determines as reasonable tabs engage provider contracts, reference-based.... Take into account the following considerations of our health plan administration team facilities. Drive 20,000 miles per year then you get a sense for which of the PPO contract lead to potential for... Am doing or if you still have any questions savings on to to additional costs, making them financially.. For this to work most effectively, covered employees and dependents should be given advance education of RBP for! And are less likely to overheat cut any wires in the second looks. Same charge is $ 420, or a 280 % mark-up tell us up front what the of. Those situations the 64-bit equivalents to the most competitive facilities in your network simpler to.! Looking for a way to help students review for state testing or a exam! Will be when someone calls in for insurance verification consider if using a RBP model needs to how! Be interrupted or disrupted to know how to handle those situations, interested... Based on the arms Buyers Beware market, EBA & M Corporation are top notch, everything fantastic... Pivot arms needs to know how to handle those situations, anyone in... For installations that have a motor on the PowerBoard NX, I know can! Plans of all sizes make installing the boards and brackets on the NX... Get rid of the wiring by housing the control unit within the step housing and making door. Dave Fear Sr, Principal of Shepler & Fear in Sacramento, 90 % of facilities now accept Medicare.! Often set their reference point as the Medicare reimbursement rate, as rbp vs amp & # x27 s! Review program under the direction of AMPS board-certified physicians nor is it..