dr. cosgrove to you have anything to add? >> no, i don't. thank you. >> continuing, to help manage the program cms often uses cost-plus contracts but if the contract team at seamus writes a contract that manages the wrong things like outputs instead of outcomes then cms has to spend millions of dollars perhaps on the wrong thing. how can this be prevented? >> you are right that they do use cost plus contracts under the federal acquisition regulation and that is one of the things that congress authorize them to do during contractor reform. we are now looking at some of the incentives that are provided to the macs under their contracts to see if perhaps there could need better incentives put in the contracts. and in some cases in contracts we evaluated recently the fraud and abuse control program, it's hard to measure outcomes there because we don't know what the baseline is. we don't know what the baseline is for fraud so that is an inherent challenge. >> my time has expired. the chair recognizes the ranking member for five minutes for questi