that are relatively modest, quoted earlier, adjustments for oncology and rheumatology. is also adjustments up in the primary care arenas but we published an impact table because we want to be transparent about the current proposals affect. if adjustments are made we were then published a final impact table with the effects across practice types, also urban, rural, the type of issues we care deeply about them want to be transparent. >> all right, thanks. last year medicare part d spent about $20 billion on prescription drugs. does this sound about right? because shared by seniors, disabled. several drug countries that provide -- incher patience and medicare are getting the best out of and outcomes in return for a fair we enforcement. my question is does the proposed part d demonstration project help semester effectively evaluate value-based payment models for prescription drugs? and the second half of that is, is the first phase of demonstration necessary for advancing these alternative models for prescription drugs? >> yes. so we proposed the two-phase approach. they ar

their proposed actions will at least cause a degraded overall health outlook for many rheumatology and sign death warrants for patients like me. another wrote the cms experiment is an intrusion on the close relationship our doctors have with patients and their clinical decision-making. this experiment will backfire costing patients and taxpayers even more for cancer care. now, according to the statute, cmi is to test innovative payment and service delivery models to reduced program expenditures while preserving or enhancing the quality of care. that's where i think we are running smack into trouble. how are you going to ensure the beneficiaries don't have trouble accessing appropriate timely treatments in the setting they prefer against example of a patient going to a rural oncology doctor in a rural area sent to a hospital about 100 miles away. there is any data indicating these proposed payment changes will improve quality of care or patient outcomes? >> yes. so first, the goal of the innovation center is to improve quality, as you said, or maintain quality. i'll say i, and this is w