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I will lose my doctor or there are fewer people who will accept Medicare reimbursements and its all because of health care reform that this is going to happen so it's so here's if any you can address this first of all its met if Medicare is health care reform or not to happen and we just kept doing business the way we've been doing business with traditional Medicare and Medicaid would we be in the same pickle baby record entered ruptures since I raise that I believe the fair answer would be we still have we've always had to some degree access challenges reimbursement great challenges so I donor lay all that on the Affordable Care Act I think it adds so additional questions to the table I think it would be unfair to lay all that because we've had as I said we've had access issues in reimbursement rate issues for long time okay so if mom if we did nothing and did no health care reform these problems have existed in the past and we don't know if they would be worse in the future or would have stayed the same we don't know that that these have always been an existing problems so then the question is garcinia cambogia blast health care reform making me these access issues better or worse I think so first I wouldn’t disagree with senator's comments I'll we really don’t know but I could tell you %uh at Firelandsour mission as part of the Turkish the community into have that integrated model and that includes not only are acute care facility but obviously esker services dialysis home help but also growing though the parlance position group including Urgent Care artist Rob Road we've opened it at four million we have another one that we're in the process of constructing Duncan Clyde Ohio all people that are Medicaid eligible are served at those facilities all positions that are part of our own physician group are served by Medicaid so the point is that we're trying to respond and again through the integration model love tried as a as a as a group and have that economy of scale be able to deliver that service regardless of what plan your work early on including Medicaid so but they rose has been an access problem and then again doctors can opt out participate in Medicaid but if you're referring physician group member wheat accept Medicaid patients okay.