dr. albert yu as we are using combination of charges and cost to look at productivity how we add joust our measurements to account for what we're doing in terms of the rates i think that is again as i said earlier in this case the actual impact on the patients it's generally we're getting paid through other mechanism i see that as a relevant point to have a coharnt schedule for our analysis and evaluation what we're doing in the clinics >> commissioners any other questions >> it would be helpful to have context for these rates in terms of the target we're getting to. so we can see how we're doing. i know you guys are internalizing that and thinking hard about it but it would be easy to present to us so we kind of get how your logic goes >> we absolutely will provide that kol lean showed me the most recent numbers we will get those for you but the historical numbers that have caused us to go on a pattern of increase was when we started this we were at 35% cost to charge ratio most with significant exceptions most of the hospitals are in the mid 20s so we have a significant amount of ground