credit for having reduced the magnitude of these distortions and a revamping of the methods under mcclelland leadership but the distortions of hospital payment remain for many private payers who are not using drg either the old system or the new updated medicare system but they are paying on the basis of per diem for discounted charges and so this for privately insured patients the incentives for hospitals are still there now physician procedures involving new technology are more profitable for physicians ban evaluation and management services. now there are two aspects of this and this is getting into a little bit of detail. the medicare fee schedule is calibrated to the big component is the officious -- decision work that physicians personally put in to the services and fielder major component is what we call the technical office of the or practice expense component basically payment for the rent, service technicians, nurses, staff and providing the service. the biggest distortions are actually on the technical side. these patterns are not -- were not intended by payers. let me talk about