Posts tagged with gpci

First, I have to be clear: my knowledge of the arcane RBRVS system, the RUC committees, CMS, etc., is all driven by my work for pediatricians. Thus, I have a very skewed view of how it works. Almost all of the changes to the CMS budget affect my clients indirectly and I have very little understanding of the big picture/politics of it all. Often, when I read through the RVU content, I gloss over big sections of important-looking information because it doesn't seem to apply to pediatrics. I don't know why I'm offering this caveat today, perhaps it's the GI bug I picked up from my kids speaking.

Anyway, the interesting news.

• There is language on the table to remove the scheduled 10.1% reduction and replace it with a .5% increase. However, there may be a related relationship to an expansion of the physician quality reporting system. No idea yet.
• There will be an extension of the 1.0 floor to the work geographic adjustment (the effects of the loss of which were heroically outlined par moi).
• Both of these changes last only until June, 2008, at which point the original proposals will be enacted. I think. We don't know, yet.

You can seem some other reactions to this news in obvious places, such as the WSJ. One thing I find interesting is that it looks like the language to make the changes above may be knowingly vetoed by GWB, but there are enough votes to override the veto. [This is a good example of what I talked about above.]

As the world turns!

All the RVU drama makes it hard for me to get to other things, but here is the latest from my generous and favorite inside source (instead of using an inappropriate 70s adult film nickname, we'll use "Siouxsie"):

1) The new CF for 1/1/08 through 6/30/08 will be $38.0870 [= 0.5% increase from the current CF of $37.8975; what happens after that point is anyone's guess] 2) The work GPCI floor (1.000) will be maintained through 6/30/08 [again, what happens after that point is unknown] 3) The bill did NOT include provisions to "alter or supplant the role" of the RUC

Attached with this cogent explanation was a memo straight from Michael Maves, the E-VP and CEO of the AMA. Now, let's all be tense for six months. Ready? Go! [I can actually update the RVU calculators, now.] Wow, Siouxsie kicks butt and sends me this important AMA Memo about the changes 2 minutes after I post this.

Wow, some shockers.  Anyone here live in Alaska?

Just like last year, I’ve gone through the entire GPCI catalog and have calculated the impact of the geographical adjustment changes for RBRVS in 2009.  While folks focus 99% of the attention on the impact of individual codes or the new annual multiplier, not enough attention is paid to the GPCI impacts.  For some of you, the impact is greater than any change.

Some highlights from the table below:

• Whoa, Alaska!  What has happened there that has called for a 22% increase in Medicare rates?
• OK, New Orleans I understand.  They probably have a problem with doc volume right now and will for a bit.  But why is Ventura, CA enjoying a 3.7% increase over the last two years while Santa Clara, SF, Oakland, etc., are getting killed?  Why is LA “doing well?”
• I’m sure it’s out there somewhere, but does someone have a good resource for explaining the creation and adjustment of this table?  I still scratch my head at having distinct pricing for places like…Brazoria, TX or Beaumont, TX but there’s nothing distinct for San Antonio.  Or even here in VT, where practicing in Chittenden County is not at all like practicing in the Northeast Kingdom (though some could argue that anyone providing medical service up in the Kingdom should get a bonus).  I have plenty of clients who either benefit or are zapped - usually the latter - by this piece of the calculation.

Location	Difference (’08-’09)	Difference (’07-’09)
Alaska	22.24%	21.43%
New Orleans, LA	2.13%	4.31%
Ventura, CA	1.84%	3.70%
Rhode Island	1.55%	3.21%
Miami, FL	1.33%	2.75%
Los Angeles, CA	1.31%	2.69%
Fort Lauderdale, FL	1.22%	2.47%
Hawaii/Guam	0.92%	1.72%
Rest of Pennsylvania	0.85%	1.67%
Rest of Louisiana	0.61%	1.23%
Rest of Missouri*	0.61%	1.22%
Rest of Florida	0.58%	1.12%
Anaheim/Santa Ana, CA	0.52%	1.09%
Idaho	0.46%	0.93%
Mississippi	0.47%	0.89%
Indiana	0.48%	0.87%
Beaumont, TX	0.43%	0.81%
Delaware	0.42%	0.79%
Arkansas	0.38%	0.77%
Connecticut	0.34%	0.74%
South Carolina	0.42%	0.74%
Vermont	0.33%	0.61%
New Mexico	0.33%	0.56%
Rest of Texas	0.30%	0.55%
Northern NJ	0.26%	0.49%
Rest of New Jersey	0.23%	0.47%
Rest of Illinois	0.20%	0.40%
Tennessee	0.24%	0.38%
Rest of Maryland	0.17%	0.30%
Nebraska	0.20%	0.29%
Southern Maine	0.11%	0.26%
Oklahoma	0.11%	0.23%
Ohio	0.13%	0.21%
Rest of Georgia	0.13%	0.20%
Virginia	0.14%	0.18%
North Carolina	0.10%	0.16%
Galveston, TX	0.09%	0.13%
Rest of Oregon	0.09%	0.08%
Metropolitan Philadelphia, PA	0.01%	0.07%
Rest of Maine	0.06%	0.02%
West Virginia	0.03%	-0.00%
Rest of Massachusetts	-0.04%	-0.04%
Rest of California*	-0.07%	-0.15%
Kentucky	-0.06%	-0.19%
Alabama	-0.11%	-0.22%
Kansas	-0.11%	-0.22%
Iowa	-0.10%	-0.26%
Puerto Rico	-0.12%	-0.30%
Montana	-0.18%	-0.36%
Rest of New York	-0.15%	-0.40%
Queens, NY	-0.23%	-0.43%
New Hampshire	-0.22%	-0.44%
Rest of Washington	-0.21%	-0.52%
South Dakota	-0.25%	-0.54%
Poughkpsie/N NYC Suburbs, NY	-0.31%	-0.58%
NYC Suburbs/Long I., NY	-0.32%	-0.68%
Wisconsin	-0.33%	-0.72%
Wyoming	-0.34%	-0.74%
Baltimore/Surr. Cntys, MD	-0.41%	-0.76%
Utah	-0.36%	-0.77%
Rest of Michigan	-0.37%	-0.80%
Nevada	-0.44%	-0.87%
East St. Louis, IL	-0.42%	-0.88%
Manhattan, NY	-0.44%	-0.92%
Metropolitan St. Louis, MO	-0.44%	-0.92%
Metropolitan Kansas City, MO	-0.47%	-1.03%
DC + MD/VA Suburbs	-0.61%	-1.26%
Houston, TX	-0.64%	-1.27%
North Dakota	-0.64%	-1.33%
Colorado	-0.73%	-1.40%
Minnesota	-0.70%	-1.43%
Fort Worth, TX	-0.81%	-1.70%
Virgin Islands	-0.84%	-1.72%
Metropolitan Boston	-0.87%	-1.76%
Chicago, IL	-0.97%	-1.92%
Portland, OR	-1.01%	-2.00%
Brazoria, TX	-1.03%	-2.13%
Suburban Chicago, IL	-1.12%	-2.22%
Detroit, MI	-1.10%	-2.23%
Arizona	-1.11%	-2.24%
Seattle (King Cnty), WA	-1.19%	-2.35%
Dallas, TX	-1.44%	-2.79%
Austin, TX	-1.53%	-3.01%
Marin/Napa/Solano, CA	-1.80%	-3.54%
Atlanta, GA	-1.93%	-3.79%
Oakland/Berkley, CA	-1.98%	-3.88%
San Francisco, CA	-2.20%	-4.31%
San Mateo, CA	-2.20%	-4.35%
Santa Clara, CA	-5.04%	-9.57%

Yesterday, I asked if anyone knows how the awkward RBRVS GPCI system is developed.  Siouxsie, of course, had the answer.  In fact, more than answer.  Those of you who are dinged by the GPCI breakdown should head Reed Tinsley’s quick review of it and then check out CMS’s PDF…and get in touch with CMS! Remember, it worked with the imms admin for 2009, why not for GPCIs as well?

[Note: I have updated this data to reflect the 1.000 min Work GPCI for all locations.]

Among the reasons I don't like being on the road, I find myself falling hopelessly behind on my social media obligations.

Over the past few years, I've taken the time to look at the GPCI changes with each new release of the RBRVS data (you can see past examples here and here). Although the focus each year is, rightfully, on specific CPT changes and the annual conversion factor, I find that the GPCI changes can be substantial...yet ignored.

Igor helped me out this week and picked up the changes for 2010 to 2011, noted here below.  It's generally better news than in years past with more winners than losers.  Can't be exciting to be in Boston, MA, though!

---

2011 vs. 2010 GPCI Values

	2010 Work GPCI	2011 Work GPCI	Diff	2010 PE GPCI	2011 PE GPCI	Diff	2010 MP GPCI	2011 MP GPCI	Diff	TOTAL Diff
Metropolitan Boston	1.029	1.021	-0.78%	1.291	1.238	-4.11%	0.764	0.776	1.57%	-2.1%
Northern NJ	1.057	1.051	-0.57%	1.228	1.206	-1.79%	1.116	1.077	-3.49%	-1.2%
New Orleans, LA	1.000	1.000	0.00%	1.044	1.018	-2.49%	0.956	0.933	-2.41%	-1.2%
Detroit, MI	1.036	1.029	-0.68%	1.040	1.026	-1.35%	1.906	1.855	-2.68%	-1.1%
Ventura, CA	1.027	1.030	0.29%	1.265	1.251	-1.11%	0.766	0.684	-10.70%	-0.8%
Manhattan, NY	1.064	1.063	-0.09%	1.298	1.263	-2.70%	1.010	1.137	12.57%	-0.7%
Rest of New Jersey	1.042	1.031	-1.06%	1.126	1.125	-0.09%	1.116	1.077	-3.49%	-0.7%
Los Angeles, CA	1.041	1.039	-0.19%	1.225	1.220	-0.41%	0.804	0.722	-10.20%	-0.7%
Houston, TX	1.016	1.012	-0.39%	0.986	0.992	0.61%	1.345	1.131	-15.91%	-0.6%
Metropolitan Philadelphia, PA	1.016	1.015	-0.10%	1.097	1.084	-1.19%	1.617	1.619	0.12%	-0.6%
Dallas, TX	1.009	1.009	0.00%	1.001	1.001	0.00%	1.110	0.969	-12.70%	-0.5%
Connecticut	1.038	1.031	-0.67%	1.185	1.168	-1.43%	0.980	1.102	12.45%	-0.5%
Chicago, IL	1.025	1.028	0.29%	1.080	1.062	-1.67%	1.940	2.005	3.35%	-0.4%
Atlanta, GA	1.009	1.006	-0.30%	1.014	1.006	-0.79%	0.836	0.890	6.46%	-0.2%
Rhode Island	1.013	1.015	0.20%	1.088	1.071	-1.56%	0.996	1.089	9.34%	-0.2%
Suburban Chicago, IL	1.017	1.021	0.39%	1.068	1.056	-1.12%	1.629	1.665	2.21%	-0.2%
Delaware	1.011	1.012	0.10%	1.046	1.041	-0.48%	0.678	0.678	0.00%	-0.2%
Miami, FL	1.000	1.000	0.00%	1.069	1.072	0.28%	3.167	2.984	-5.78%	-0.1%
NYC Suburbs/Long I., NY	1.051	1.050	-0.10%	1.289	1.278	-0.85%	1.235	1.335	8.10%	-0.1%
Rest of Massachusetts	1.007	1.010	0.30%	1.106	1.100	-0.54%	0.764	0.776	1.57%	0.0%
Anaheim/Santa Ana, CA	1.034	1.039	0.48%	1.269	1.271	0.16%	0.811	0.742	-8.51%	0.0%
Austin, TX	1.000	1.000	0.00%	0.984	0.995	1.12%	0.969	0.859	-11.35%	0.0%
Alaska	1.500	1.500	0.00%	1.090	1.092	0.18%	0.646	0.648	0.31%	0.1%
San Mateo, CA	1.072	1.072	0.00%	1.433	1.418	-1.05%	0.394	0.454	15.23%	0.1%
San Francisco, CA	1.059	1.065	0.57%	1.441	1.422	-1.32%	0.414	0.464	12.08%	0.2%
DC MD/VA Suburbs	1.047	1.048	0.10%	1.218	1.218	0.00%	1.032	1.081	4.75%	0.2%
Poughkpsie/N NYC Suburbs, NY	1.014	1.013	-0.10%	1.077	1.074	-0.28%	0.822	0.945	14.96%	0.4%
Oakland/Berkley, CA	1.053	1.055	0.19%	1.286	1.286	0.00%	0.425	0.469	10.35%	0.5%
Portland, OR	1.002	1.003	0.10%	1.015	1.016	0.10%	0.472	0.542	14.83%	0.7%
Virgin Islands	1.000	1.000	0.00%	0.978	0.994	1.64%	1.009	1.007	-0.20%	0.7%
Marin/Napa/Solano, CA	1.034	1.042	0.77%	1.265	1.272	0.55%	0.432	0.443	2.55%	0.7%
Fort Lauderdale, FL	1.000	1.000	0.00%	1.018	1.041	2.26%	2.250	2.112	-6.13%	0.7%
Minnesota	1.000	1.000	0.00%	0.983	0.994	1.12%	0.245	0.262	6.94%	0.8%
Galveston, TX	1.000	1.000	0.00%	0.959	0.985	2.71%	1.223	1.100	-10.06%	0.8%
Fort Worth, TX	1.000	1.000	0.00%	0.953	0.982	3.04%	1.110	0.966	-12.97%	0.8%
Nevada	1.002	1.000	-0.20%	1.026	1.042	1.56%	1.083	1.149	6.09%	0.8%
Southern Maine	1.000	1.000	0.00%	1.025	1.029	0.39%	0.492	0.584	18.70%	0.9%
Colorado	1.000	1.000	0.00%	0.992	0.997	0.50%	0.641	0.754	17.63%	0.9%
Queens, NY	1.032	1.047	1.45%	1.239	1.233	-0.48%	1.220	1.351	10.74%	1.0%
Santa Clara, CA	1.083	1.080	-0.28%	1.294	1.310	1.24%	0.377	0.445	18.04%	1.1%
Vermont	1.000	1.000	0.00%	0.983	1.002	1.93%	0.489	0.523	6.95%	1.1%
Rest of Washington	1.000	1.000	0.00%	0.974	0.991	1.75%	0.693	0.770	11.11%	1.2%
Rest of California	1.007	1.016	0.89%	1.058	1.078	1.89%	0.549	0.546	-0.55%	1.3%
Seattle King County, WA	1.014	1.020	0.59%	1.085	1.098	1.20%	0.706	0.785	11.19%	1.3%
Metropolitan Kansas City, MO	1.000	1.000	0.00%	0.945	0.973	2.96%	1.188	1.204	1.35%	1.4%
Brazoria, TX	1.019	1.014	-0.49%	0.922	0.967	4.88%	1.223	1.070	-12.51%	1.4%
Hawaii/Guam	1.000	1.000	0.00%	1.161	1.198	3.19%	0.665	0.685	3.01%	1.5%
Rest of Florida	1.000	1.000	0.00%	0.939	0.976	3.94%	1.724	1.635	-5.16%	1.5%
Ohio	1.000	1.000	0.00%	0.927	0.961	3.67%	1.232	1.230	-0.16%	1.6%
Arizona	1.000	1.000	0.00%	0.957	0.983	2.72%	0.822	0.913	11.07%	1.6%
Rest of Pennsylvania	1.000	1.000	0.00%	0.925	0.958	3.57%	1.081	1.101	1.85%	1.6%
Metropolitan St Louis, MO	1.000	1.000	0.00%	0.931	0.968	3.97%	1.075	1.064	-1.02%	1.7%
Baltimore/Surr. Cntys, MD	1.012	1.019	0.69%	1.057	1.084	2.55%	1.086	1.147	5.62%	1.7%
Rest of Michigan	1.000	1.000	0.00%	0.923	0.960	4.01%	1.083	1.075	-0.74%	1.7%
Rest of Maryland	1.000	1.002	0.20%	0.982	1.013	3.16%	0.874	0.930	6.41%	1.7%
North Carolina	1.000	1.000	0.00%	0.925	0.960	3.78%	0.634	0.664	4.73%	1.9%
Virginia	1.000	1.000	0.00%	0.942	0.978	3.82%	0.657	0.692	5.33%	1.9%
Indiana	1.000	1.000	0.00%	0.918	0.957	4.25%	0.599	0.603	0.67%	1.9%
New Hampshire	1.000	1.000	0.00%	1.039	1.046	0.67%	0.462	0.658	42.42%	2.0%
East St Louis, IL	1.000	1.000	0.00%	0.919	0.962	4.68%	1.793	1.851	3.23%	2.2%
Utah	1.000	1.000	0.00%	0.907	0.953	5.07%	1.026	1.059	3.22%	2.4%
Beaumont, TX	1.000	1.000	0.00%	0.875	0.937	7.09%	1.346	1.131	-15.97%	2.5%
Tennessee	1.000	1.000	0.00%	0.889	0.945	6.30%	0.608	0.566	-6.91%	2.5%
Rest of Oregon	1.000	1.000	0.00%	0.927	0.968	4.42%	0.472	0.542	14.83%	2.5%
South Carolina	1.000	1.000	0.00%	0.906	0.952	5.08%	0.446	0.482	8.07%	2.6%
Rest of Louisiana	1.000	1.000	0.00%	0.878	0.936	6.61%	0.892	0.816	-8.52%	2.6%
New Mexico	1.000	1.000	0.00%	0.890	0.947	6.40%	1.096	1.054	-3.83%	2.7%
Rest of New York	1.000	1.000	0.00%	0.921	0.964	4.67%	0.425	0.492	15.76%	2.7%
Rest of Texas	1.000	1.000	0.00%	0.879	0.943	7.28%	1.065	0.936	-12.11%	2.7%
Wisconsin	1.000	1.000	0.00%	0.921	0.966	4.89%	0.409	0.476	16.38%	2.8%
Idaho	1.000	1.000	0.00%	0.883	0.943	6.80%	0.546	0.572	4.76%	3.2%
Nebraska	1.000	1.000	0.00%	0.890	0.943	5.96%	0.245	0.280	14.29%	3.2%
Rest of Georgia	1.000	1.000	0.00%	0.883	0.943	6.80%	0.829	0.876	5.67%	3.2%
Rest of Illinois	1.000	1.000	0.00%	0.880	0.941	6.93%	1.219	1.274	4.51%	3.2%
Iowa	1.000	1.000	0.00%	0.870	0.934	7.36%	0.434	0.443	2.07%	3.3%
Rest of Maine	1.000	1.000	0.00%	0.893	0.947	6.05%	0.492	0.584	18.70%	3.4%
Mississippi	1.000	1.000	0.00%	0.854	0.929	8.78%	0.808	0.782	-3.22%	3.7%
Alabama	1.000	1.000	0.00%	0.853	0.928	8.79%	0.496	0.484	-2.42%	3.8%
Kentucky	1.000	1.000	0.00%	0.860	0.932	8.37%	0.652	0.701	7.52%	4.0%
Arkansas	1.000	1.000	0.00%	0.846	0.923	9.10%	0.446	0.444	-0.45%	4.0%
Kansas	1.000	1.000	0.00%	0.882	0.939	6.46%	0.557	0.746	33.93%	4.2%
Oklahoma	1.000	1.000	0.00%	0.850	0.927	9.06%	0.627	0.671	7.02%	4.3%
West Virginia	1.000	1.000	0.00%	0.827	0.912	10.28%	1.353	1.279	-5.47%	4.3%
Rest of Missouri*	1.000	1.000	0.00%	0.821	0.913	11.21%	0.997	1.004	0.70%	5.0%
South Dakota	1.000	1.000	0.00%	0.864	1.000	15.74%	0.420	0.424	0.95%	7.0%
North Dakota	1.000	1.000	0.00%	0.844	1.000	18.48%	0.387	0.453	17.05%	8.8%
Wyoming	1.000	1.000	0.00%	0.842	1.000	18.76%	0.889	1.052	18.34%	9.0%
Montana	1.000	1.000	0.00%	0.847	1.000	18.06%	0.673	0.887	31.80%	9.2%
Puerto Rico	1.000	1.000	0.00%	0.694	0.845	21.76%	0.250	0.249	-0.40%	9.6%

With the announcement that the AAP has updated its RBRVS guide for 2012, I guess I have to get off my duff and work on the 2012 RVUs.

Part 1: My annual  GPCI comparison.  AFAIK, this is still the only place where anyone actually breaks down the GPCI changes from year to year.  While some people jump up and down about a 1% change in a particular code or the annual conversion factor, we all need to pay attention to the GPCI scores.  For some parts of the country, the impact has been significant.  

What do we see this year?  Some big hits this year.  The average locality should expect a 1.76% decrease in their payments in 2012 before any changes to the CF or individual codes are taken into account.  OUCH.

Locality	2011 → 2012	2009 → 2012
AL	-3.7%	-0.2%
AK	-0.8%	-0.8%
AZ	-1.3%	0.0%
AR	-4.5%	-1.0%
CA – Anaheim/Santa Ana	-1.9%	-1.7%
CA – Los Angeles	-2.9%	-3.3%
CA – Marin/Napa/Solano	-0.5%	0.2%
CA – Oakland/Berkley	-1.0%	-0.9%
CA – San Francisco	-1.9%	-2.3%
CA – San Mateo	-2.2%	-2.7%
CA – Santa Clara	1.0%	1.6%
CA – Ventura	-2.2%	-2.8%
CA – Rest of CA	0.7%	2.1%
CO	0.3%	0.7%
CT	-2.5%	-3.3%
DC + MD/VA Suburbs	-0.6%	-0.5%
DE	0.1%	0.0%
FL – Ft. Lauderdale	-0.1%	0.7%
FL – Miami	-1.3%	-1.5%
FL – Rest of FL	-1.5%	0.0%
GA – Atlanta	0.3%	-0.1%
GA – Rest of GA	-3.2%	-0.4%
HI/Guam	-1.8%	-0.2%
ID	-3.3%	-0.5%
IL – Chicago	-0.2%	-0.7%
IL – East St. Louis	-1.7%	0.3%
IL – Suburban Chicago	1.0%	0.7%
IL – Rest of IL	-2.7%	0.2%
IN	-3.2%	-1.5%
IA	-4.5%	-1.6%
KS	-3.8%	-0.8%
KY	-4.3%	-0.9%
LA – New Orleans	-2.8%	-3.9%
LA – Rest of LA	-4.7%	-2.2%
ME – Southern ME	-0.9%	-0.6%
ME – Rest of ME	-3.8%	-1.2%
MD – Baltimore/Surr	1.1%	2.7%
MD – Rest of Maryland	1.6%	3.2%
MA – Metropolitan Boston	-3.9%	-6.2%
MA – Rest of MA	-1.4%	-1.5%
MI – Detroid	-0.5%	-1.6%
ME – Rest of MI	-2.2%	-0.5%
MN	0.7%	1.2%
MS	-5.0%	-1.7%
MO – Kansas City	-1.9%	-0.6%
MO – Metropolitan St. Louis	-0.8%	0.9%
MO – Rest of MO	-5.3%	-1.0%
MT	-2.6%	5.0%
NE	-3.6%	-1.1%
NV	0.7%	1.4%
NH	-0.2%	0.4%
NJ – Northern NJ	-1.2%	-2.4%
NJ – Rest of NJ	-0.5%	-1.2%
NM	-2.2%	0.4%
NY – Manhattan	-3.7%	-4.9%
NY – NYC Suburbs/Long Island	-2.4%	-2.8%
NY – Poughkeepsie, N NYC	-0.2%	-0.2%
NY – Queens	-0.6%	0.1%
NY – Rest of NY	-1.7%	0.4%
NC	-3.0%	-1.4%
ND	-1.7%	5.9%
OH	-1.6%	-0.1%
OK	-5.7%	-2.2%
OR – Portland	1.5%	1.7%
OR – Rest of OR	-1.2%	0.8%
PA – Metro Phil.	-1.1%	-1.7%
PA – Rest of PA	-2.7%	-1.2%
PR	-13.5%	-6.6%
RI	-0.5%	-1.0%
SC	-3.2%	-1.1%
SD	-2.7%	3.6%
TN	-3.8%	-1.3%
TX – Austin	-0.4%	-0.1%
TX – Beaumont	-3.8%	-1.4%
TX – Brazoria	0.4%	1.9%
TX – Dallas	0.5%	0.2%
TX – Forth Worth	-0.4%	0.6%
TX – Galveston	0.8%	1.7%
TX – Houson	-0.1%	-0.4%
TX – Rest of TX	-2.8%	-0.1%
UT	-3.2%	-1.1%
VT	-0.9%	0.0%
VA	-0.4%	1.4%
VI	0.3%	1.0%
WA – Seattle	2.4%	3.4%
WA – Rest of WA	0.8%	1.6%
WV	-6.0%	-2.3%
WI	-0.8%	1.4%
WY	-1.2%	6.7%