mr. chairman. f i could, i think in order of who is here it would be senator enzi next, then senator cassidy and then senator cantwell of the senators who are here. senator hatch: appreciate that. senator enzi, why don't you proceed. senator enzi: thank you. i come from the least populated state in the nation oumple biggest city is 60,000. and all of our towns are at least 40 miles apart. we only have 19 towns where the population exceeds the elevation. i have one county that is the size of delaware and the city, and you get to be a first class city when you hit 2,500 people and they just did is 2,500 for the whole county. so we just tried to keep a hospital open there which usually means having a physician's assistant. so this -- this is a critical hearing for us. and i'll begin my question with ms. thompson. the way medicare pays rural hospitals, including critical access in sole community, like we have in wyoming, it's closely related to inpatient services. medical providers started to shift toward prviding more and more services on an outpatient basis is the inpatient metric the most appropriate