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Thank you for this concise and thoughtful summary. These policy changes also create potential for a grey zone between the roles of hospitals and public health agencies. As community-based preventive services, (particularly "environmental abatement" which potentially involves toxins) become part of the definition of community benefit, it raises the question of program quality and the qualification of providers. Public health agencies are addressing these through accreditation (e.g., Public Health Accreditation Board http://www.phaboard.org/) and competency-based hiring. Hospitals should adhere to no lesser standards. But if Dr. Kindig's statistics hold, this may not be an issue for awhile.

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