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Transplants and big surgeries and things like that. One of the things i am concerned about is when you use volume, it is a metric for reimbursement, to have a level Playing Field to define what the quality parameters you are going to use. One of the things, especially with toby and bill and i, with cardiac surgery, and we saw this when the recording data ,eally reporting data came out the cases is west of the cleveland clinic. By design or by circumstance, maybe there will he be a de because of the tough cases and not offering services. So we know we need to get from one side to the other. I think everybody is clear we we are noto just paying for volume, we are paying for value. We need tohe where go that is the problem, it is how do i make the economic model work from here to there. I am going to be taking on risk for quality and cost and so with fee i am still forservice. How do you think about managing that transition economically . The good places are already along these whole Wayn

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