 Uh, we don't have any sort of set order, but I'll just ask any board members who have questions or comments to, to please go ahead and obviously don't be shy. I can start to be like, oh, no, go ahead. You go ahead. Yes. All right. Um, I'm just, I'm trying to understand, um, the commercial rate, the commercial price increase. And I know that, you know, from the narrative, it says 3.6% increase, but I also realized there's additional rate growth expected because of unrealized prior rate increase allowances that didn't occur. And so I'm just looking at, you know, the tables here, and I see, if you can just turn to the, let me just say, think of which, which, yeah, so there's 2 places where I see commercial price. One is in the 10.2% here. And then on the other page, I see the 3.6%, which is presumably the, uh, charge master increase just for this year. And then the 8.6, which is just for this year, and I just want to understand Sal and then maybe Jen, if you want to add on to this, I'm trying to make sure that I understand what is the actual, uh, in the pocket cost of commercial, you know, rate payers in your community, what are they going to feel this year in terms of the commercial rate increase? Is it the 8.6? Is it the, yeah, just maybe if everybody could answer that, somebody could answer that. I'll just start by saying, so yeah, this is designed to just catch the annual from 23 to 24. And this would factor in that 1.5 million that again, I think is an area of risk, uh, in terms of, uh, Gifford's ability to, um, realize, uh, the full amount. So that would be the highest amount if they were to get that all in their negotiation, which in other words, if the carriers were willing to retroactively apply previously approved rate increases, it would be the increases this year would reflect those that have been approved in previous years, but not implemented due to the, um, work on the charge master as well as the, um, EMR upgrade that they're rolling out. Is that fair, Jen? I don't want to. It is, but I think if I could say that the total, um, Board Member Holmes for the one and a half million is from the 22 3.5%. And as well as the FY 23 3.65% requests that we had, those are the dollars of combined of those two years. This year is 3.6%. As you see on the chart here, that is $853,000. So in total, it would be 2.3 million in net, um, that we are requesting of the commercial payers. Hopefully that helps with the pie. It does. And in terms of the charge master increase from 2022 or the last time that it was actually updated to now, what is that going to look like? That would be the total of 10.2 that you saw on the other chart between 20. This one's 23 to 24. The other percentage is 22 to 24. Okay. That's what I thought. I just wanted to make sure it was is all. Everybody's on the same page about where all these moving parts are the price. Okay. And then the other area that was a bit unclear for me was in the labor expenses. Um, and I recognize that some of that is driven by provider transfers that are, you know, distorting that I also, in the narrative, it was a little bit unclear. In the section under labor expenses, there's a discussion about having, you know, a wage analysis done and it said that the wage analysis suggested that, you know, the wages were significantly below market. Considering affordability, GMC implements it only half of the increases in fiscal year 22 deferred the remaining half to fiscal year 23. And then it said that the next paragraph talks about the expertise of the compensation consultant. Suggesting that there's going to be proposed increases in again to catch up in the fiscal year 2024 budget. So I'm trying to understand exactly what the wage increases were. Exclusive of provider transfers. I don't want that muddied in here, but just what were the wage increases for existing employees between 21, 22, 22, 23, and now 23, 24, just so that I can understand where some of this is coming from and when they were implemented. Is that a possibility? If you have to follow up with that, Jen, that is totally fine. I'm just trying to understand what's in the narrative where this 22% growth rate in labor expenses is coming from apart from provider transfers. And so tracking that over time. Sure. And I apologize. I really should have been a bit more clear in that statement. So what I really should have said was we incorporated the consultant's proposed 2024 cost of living adjustment of 4% into our budget. And if it helps, I can share the word wide board member homes if that helps. So in FY 2022 between market increases and a cost of living adjustment of 3%, that expense was $1.7 million in total. In FY 23 between the market increases, the remaining market increases that we mentioned in the narrative, as well as a 3%, or excuse me, 4% aggregate cost of living adjustment that we just did here in the beginning of May. That was a $2.3 million expense. And then for the 4% increase in FY 2024, and this is for a cost of living adjustment. So unless the market moves again, we're hoping that we're remaining a bit static there. That expense is $835,000 in total. Hopefully that helps clarify it. And I apologize for the terms. So what was the market adjustment plus the cost of living in each year? So you've given me dollars and the cost of living for each year. So it'd be just helpful to understand what was the market adjustment plus the cost of living for each of those years. Just so we can get a sense of how much catch up had to happen because of the market. Oh, I can isolate the market, but I could definitely get that back to you. That's great. Yeah, that was aggregate for both items. So I can certainly isolate the market adjustments and send that to you. Certainly. And then my final question is, in I think most experiences, EMRs implementation always come with some productivity reductions. It's, you know, just it's sort of par for the course it seems when hospitals implement these big EMR shifts. And I'm just wondering how you've factored in, if you factored in reduction in utilization simply because of the EMR implementation. Great question. That doesn't normally happen with an implementation. However, we feel that the operational efficiencies because we're going from a lot of manual processes in the current EMR to more automated processes in the new EMR. We feel that's going to counteract any productivity decline that we would see in the FY 2024 budget. We feel pretty confident about that with the way we've built the new EMR. Okay. All right. Well, thank you so much. Back to you, Chair Foster. All right. Thank you. I heard member lunch. Go ahead if you have some questions. Thanks. Hi, Jen. Thanks. And Dan thanks for joining us. I'm wondering if you could speak a little bit to your ACO participation in 2024 what you're expecting for programs. We will be participating in the Medicaid and MVP programs that are offered through one care for FY 24. Thank you. And then also I'm wondering how you are thinking about the Medicaid redeterminations and if you've included any budgetary impacts related to changes in coverage. We've not included any assumptions regarding the redeterminations in this budget. One could estimate that we would possibly return to our 2019 percentages for bad debt and free care, but I hesitate to do that for two reasons. Honestly board member lunch. One is the changes that we've been implementing with our pre registration process that we mentioned in the narrative. That would certainly have a more positive impact for those particular patients. And the other way other item that we have was the way we were classifying our average generally billed discount prior. That was in bad debt instead of in the contractual line. So it was an accounting change that we did. And that would certainly have an impact. You know, and the other thing obviously is I really don't want to run the risk of understating my net revenue and overseeing my bad debt assumptions for something that's a bit unpredictable for us at the moment. That makes sense. One thing I'm a little curious about in terms of the approach that we've seen in this area is there doesn't seem to be a lot of assumptions related to people moving from Medicaid reimbursements to commercial reimbursements which certainly I think that you wouldn't expect the entire population, but you would expect a little bit of that to some degree. So I don't know if you have any thoughts on that, Jen, but I welcome them if you do. How much just in our experience thus far, it's been a couple of months here when I have conversations with our financial advocate and fortunately has been in the other direction. It's going to self pay. I think she maybe had one individual that she was able to see recognize going to commercial. It's a little early in that I think at the moment, but you know, obviously we would like to see it going into the commercial bucket as well. But from current experience just in the last couple of months in my conversations with her, it's really been going from Medicaid to self pay currently. Thanks. I think that's, I think my other questions have already been answered. Thank you. Good morning, Jen and team. This is Tom Walsh. I just have a question about the cost report. If we could go back to that tab please, Sarah. Jen, it was very helpful. I think, as you explained, things like nursing education can be categorized in one bucket allocated to one bucket for a cost report and allocated to another bucket for a finance report. And I'm wondering if you could just help us understand, you don't have to go into any great detail about your particular organization, but help us understand how a finance team decides which bucket to place those kind of shared services that are not either directly administration or direct patient care. How do people decide where to allocate those? There are some rules that we do follow from a cost reporting standpoint that we do adopt when we're classifying those as well in our financial statements. There's some variation though that is that happens among the hospitals, the one that I pointed out, obviously. And so you try to look at those of what is really directly associated on the clinical side and try to parse those out as best as possible versus those that might have dual purpose. So for example, they have administrative duties, but also may have clinical duties and try to isolate those two components of an FTE, so to speak, or salary. And that's how we do it here. We really scrutinize the difference between the two so that we can make sure we're putting it in the right place. And as you heard me mentioned, we continue. It takes some time when you're evaluating cost reports over the years to start just refine that and where those departments should actually be and we've been making those necessary changes. But I think that really kind of sums up how we look at it and how we would want to classify those on both the income statement and the cost report. So it seems that's excellent. Thanks. It helps me a lot. And it seems like each of the reporting requirements has its own set of rules that every organization would have to follow. But there are also areas where discretion is needed. And when say a regulator starts looking at one, it's only then that there would start to be a standardization among the facilities the regulator is looking at, because there's quite a bit of discretion allowed if I'm hearing you correctly. There is I think, you know, Sarah and I had sidebarred on coming up with maybe a more standardized approach for all of us to report. So that you're evaluating an apples to apples versus an apples to oranges, because that particular line on the cost report can also, I don't want to get too weedy, but there's something called a home office cost report. In my past we have filed one of those and it takes all of the overhead expenses from, let's say, a network structure and put some all in that line where there could be some clinical functions and that that you would want to parse out. And I think, you know, I'm happy to work with the staff as well in creating maybe work apples to apples standard approach to, you know, this and I think there's definitely some variability when you're in a small home. Study when you're in a small hospital because you wear many hats. So, you know, we do time studies so we can isolate some of that as well but I think to try to mitigate that variability we can maybe come up with a standardized approach for the hospitals to report. So I hope we're able to take you up on that offer of helping create a standardized way that we could use across the state, because the discreet the different forms, having different rules, and still allowing for discretion is true across the country, with all the hospitals that make up the peer groups. So, helping us create a standardized way within our state would be, I think, really helpful long term. So, thank you very much. Dr. Irving, do you have any questions or comments? Yeah, I just have one quick question. Thank you both for the. There's more than two of you all three of you so far spoke for the presentation and submission. Mr. Bennett, I just had a quick question for you. I could go to either I guess with regards to the New England Alliance for Health Group Purchasing. Does that also help you with insurance contracts and negotiations? So we participate in NIA both in terms of our employee benefit insurances and also with our normal group purchasing supplies, that sort of equipment, that sort of thing. So we do get, you know, we do have advantage of that purchasing power on the employee benefit side of things. And some of the business insurance has been on all of them. We don't, we don't go through them for all of our, for all of our business type insurances. But when you negotiate with insurance carriers, they're not involved in that process. Oh, no, no, I'm sorry for reimbursement. You mean. Yes. Oh, I'm sorry. No, they are not for that. Sorry. I apologize for the lack of clarity. Do you do that directly from Gifford with the carriers for reimbursement? Or do you have a in between company that helps you with that? Yeah, I knew it was going to point to me. Yes, we do use a third party firm in that negotiation process. That doesn't mean that we don't have a direct line of communication with the payers either. But we do use utilize a third party. Thank you. I had just a couple on the. The labor. The number of fte's went down pretty significantly to 87 down to 191. I assume that's mostly due to the provider transfers. And then the. The compensation per fte jumped up fairly significantly around the same time. And I was wondering if you could speak to that was that because of the types of. Providers that were transferring out or what else could you attribute that to. Or I think there are two issues. That are contributing to the opposing relationship that we're seeing here. One is that. We moved a considerable amount of fte's into our Gifford shared services division. Those were originally reported in GMC as well as our daycare. And so we did move those fte's out of what we report for just the hospital. And I think that's a little bit of the distortion there and why you're saying such a deep dive in that particular line. And then also, you know, I think it's important to from the salary line that, you know, staff vacancies would have an impact on this calculation. And also we report actual fte's in the calculation that we provide versus total position fte calculations. So if we do have a higher turnover, which we do here at Gifford in any of those mid to lower salary ranges, then that calculation of dollars on that upper line is actually going to look higher. So I think that's the reason we're seeing those that opposing relationship there. And then in terms of the anesthesiologists that you used, you currently employ directly any anesthesiologists and how has that number changed over the last few years. We, Dan, you'll have to correct me if I'm wrong. I want to say it was last year or the year before we are using a contracted service similar to as I mentioned that OB hospitalist service that we're using now. So we do not have any employed anesthesiologists any longer, although the anesthesiologists that we that were employed with Gifford did transition to that organization. And we've had some turnover with them over the last year or two. But in terms of us actually having that as an expense, it's in a purchase service line versus a salary line for the anesthesia service. And Dan, I don't know if you want to add anything to that. No, I think that answered it. I think it's been two years. Is that correct Rebecca? Yes, yes, so it's been two years and we've had that service. And I was curious how that has worked out from both, you know, availability of anesthesiologists when you need them and then in terms of the cost. Rebecca, do you want to jump in on the yes. So Rebecca oversees the contract and the staffing of that service. Yes. Thank you. So one of the big changes that was made over the course of time was we moved from an all MD service to a mixture of MD and CRNA, which has actually gone really well. As Jen said, we did transition all of the clinicians at the time over to the contracted service and over time we have replaced them with different folks as they've moved on to different places. Most of our anesthesia providers live right here in our community, even though they're contracted providers, they live close by or they stay in housing that we have here. And so they are still available immediately. You know, we have a 20 minute time for them to come in, but most of them are here within just a couple of minutes. So they're still 24 seven and they're still available with us. We've had a really great working relationship with the organization and we have a really nice open line of communication back and forth between them. And have you found this to be a cost savings with the complement of providers that Rebecca mentioned, going from an all MD model to a combination of MD and CRNA, we did have a cost savings there. It was don't hold me to this that it was in the ballpark in about a half a million dollars. And this third party. Is it just made up of anesthesiologists that used to work at Gifford or are there others. And then it's a compound question apologize, but then the second part of it is, are they working with other hospitals or just Gifford. We have a the group that's here with us now are not necessarily there. They're not all the folks who were here when we made the transition. And for the most part, the group that's here consistently only work here. We do have folks, which is the benefit of going with this organization, who float from other other local hospitals when we have someone out on vacation or, you know, some other type of leave. And can you speak at all to how many other hospitals they may be working with. I wouldn't have intimate knowledge of that for each one of them, but generally speaking, it's, it's 1 or 2. So they're here in there and they're somewhere else. But not they're not coming from all over the place. And but this particular group that we're contracted with works with a handful of other hospitals in Vermont and I'm sure. Can I just ask a follow up question because I think I'm a little confused by the word group, whether that means it sounded like Jill you were speaking about the people who come work at Gifford as opposed to the organization they work for. And then I think Dan was talking about and maybe Owen was asking about the group that the individuals work for so can I just get a little clarification there. So we we contract with a third party anesthesiology group. So it's a it's a private company that employees anesthesiologist and CRNA is that group then contracts with hospitals to provide that service at their hospitals. And that that company that anesthesiology group works with a handful of hospitals. Within the, you know, within the region close to us in Vermont and New Hampshire, Rebecca was noting that the individual doctor. Anesthesiologist and CRNA is that work at Gifford may also work at one or two of those other hospitals that their company contracts with and it just varies by their personal preference. But that did I did I get it. Yes, thank you. Okay, that's what I thought I heard, but I just wanted to clarify so that it was a little clear. Business is confusing. I want to follow up on some of what others had asked about this retroactive adjustment to the charge master. Is it accurate that Gifford has not increased the gross charge on any of the services in three years? Is it three years? Two 20 is starting in FY 2022. We were not able to implement that increase. We were hoping that we could implement that increase. We were originally supposed to go live with our EMR in July of this fiscal year in 2023. So we were hoping that we may and we mentioned this in our hearing last year that that was our hope. Unfortunately, we did have to postpone our go live to October. So now we're two years of those increases. We've not been able to implement. Any of them. Any of them. On any service line. Right, right, right. And just so I'm clear, the issue exactly was why couldn't you. So there were two things that were creating this particular issue. One was we needed to completely rebuild our charge master. There was a lot of revenue code changes that needed to be implemented location of service lines and things of that nature. So we've completely rebuilt that and we're prepared to go live with that obviously with the new EMR. And also we needed to implement or not even implement, but undergo a price analysis and a price study of our current pricing structure. And we've also done that in tandem as we've been getting up for our go live. And so those two things really have prevented us from implementing those price increases. We certainly don't want to, you know, some prices go up, some prices go down when you do a price analysis. And I certainly wouldn't want to put that additional percentage on prices that we needed to reduce. So those two things were really why we were not able to do that. Okay. And, you know, maybe somebody asked this, but what happens if the insurance companies don't agree to these increases? Well, there's always a negotiation obviously between us and the payers. You know, we do without getting too much in the weeds of our contracts. There is language in our contracts that point to the approvals by Green Mountain Care Board. We have, in the last two years as well as this year, have sought quite low price increase requests. So we are hoping that our negotiation with them will take that into account. I don't know if you saw, but I just point out for your awareness that the care board issued rate review decisions this year that said that the rate increases we allow in our hospital budget decisions are not an entitlement and that insurers are required to negotiate based on affordability, access, and quality. Anyway, last question. Sorry, I think if I could share a posture. I do, you know, those two years they were approved obviously by the board and we want to be transparent in our budget and share with you that that's what we were doing. And, you know, it is a negotiation between the commercial payers and us. And so, you know, that is what we are seeking from them. But I understand what you're saying. I appreciate that. And thank you for the transparency. I think it's really, it's really critical. And I want to point out that I really do appreciate the fact that you guys had guidance three years in a row, which I don't know how many hospitals have done that, but that makes this job a little bit easier for us. The last question I had was about how physicians are generally compensated. And if you could speak to just the general methodology for compensating physicians. And one of the things I'm trying to understand is whether or not physicians are rewarded or incentivized for increasing revenue, either through increased volumes or increased procedures or which types of procedures. So, we compensate again, we're speaking about the specifically about the hospital. We compensate our physicians based on salary. So we derive a salary utilizing national surveys and then we evaluate them. We've evaluated our compensation salary portion of the compensation based on the national surveys. In addition to that, we do have incentive programs. And there's two components to that. The first one is based on a, again, looking at national surveys, looking at work RBU. So that is a productivity standard. And so that's a component of the incentive. The second component of the set of the incentive is what we call citizenship. And that incentivizes activities that where our providers are doing community outreach activities where they are participating in medical staff quality type activities. Things that promote the practices things that promote a community health, those sort of things. And for both the salary component and the work RBU component, we target the the median on the surveys. And Mr. Bennett, is there a set split between the work RBU and the citizenship component of the incentive cop or can that vary? For the most part, there is a dollar, there is a dollar limit on how much we pay out on that. But I'm trying to understand it. So it's about so it's about half and half. In terms of those incentives would typically be about equal the amount that they were able to earn through that. Right. Okay. So the incentive cop, the median of the surveys you look at is $100 and a position hits it 100%. 50% would be due to their RBU performance and 50% would be due to the assessment of their citizenship. So let me let me just let me let me take that example and come back and try to explain it. So if the median is $100. You know, we would pay them somewhere in the range of $80 on a salary. And then they would have the opportunity to earn $10 for citizenship and $10 for work RBU. I get it. To get to that median. If 100 is the median. Understood. That helps. Thank you. I should have started with that. Sorry, that would have been. Oh, as I misunderstood, that was great. I don't have any other questions. Mr. Sutter or director Lindberg, do you guys have any follow up or you guys all set. We're set just again, testament to this being the second of two hospitals under benchmark and just shouts outs. But the advocate may have some questions as I see Eric has arrived. Great. All right, I will turn to the healthcare advocate. Thank you so much and apologies for the sound if you can hear heavy machinery in the background my neighbor has decided to restart construction and in an odd coincidence, they work at Gifford. Which made me laugh very hard this morning. And they're wonderful. So I just want to point out that that that we had nothing to do with that. I didn't think you did. It's supply chains fall to the fact that they didn't have windows. So again, I want to echo Sarah's comment that you deserve to be applauded for coming at or under guidance for now years. And that is a level I think the level of commitment to your patients and their pocketbooks that honestly is good to see and perhaps should be heard across more of the system. So my questions are going to be for Jen and it's really I'm trying to understand. And member launch asked about this a bit but I'm trying to understand the change in booking of a GB discounts to bad that and I think what's so correct me Jen or chime in I think what's so I think you're saying that you had a self pay person who was going to charge a GB for a service to say that services is 200 on the charge master and a GB is 100 that then they come in and regardless and they owe 100 regardless if they pay that amount or not that the difference in the charge master and a GB so that added hundred gets booked as bad debt. And I know like this doesn't actually have an impact on the bottom line I'm just trying. It's important to me just I'm trying to understand how to use free care and bad debt. Right so like I'm not working at the bottom line level I'm kind of in the middle of it but I don't want to make false conclusions. Let's see if I can kind of use your example Eric kind of adjudicate this the way we normally would an organization. So taking that $200. Let me back up to the bad debt versus contractual that I mentioned earlier. So we do automatically out of the gate and give a 50% discount for self pay patients on that $200 charge so that hundred initial dollars used to go to the bad debt line. We now change that net we consider as a contractual adjustment right off of the the charge. So that remaining $100 if the patient for example qualified for some free care. Let's say they qualified for 50% of that $100. So then reduce their portion, their obligation to $50. If they were not able to pay that $50 of their obligation after 120 days and conversations trying to get them on payment then that $50 we would transfer to bad debt. Okay. Does that help clarify it? There's resources and things that we do from an accounting standpoint but that's really the gist of how you're to kind of adjudicate that example you gave me. And with that switch due to the change in GAAP accounting standards so that you know where they were trying not to have so many ways of booking things by industry type or was that something you guys took on or a mix of the two? It's a mix of the two from the revenue recognition versus how we should be classifying that initial discount. Okay. And so I understood Jen like this idea of the problems of looking at like looking longitudinally at bad debt because of this change. Now, but I'm wondering like if we look out, if we look at the system as a whole, so not just, you know, Gifford, right? Like could we, is it reasonable to expect that we're seeing similar, like similar changes in accounting across time amongst internal to each of the individual hospitals? Like that it's kind of difficult to compare or cross hospitals to likely? I don't want to speak for others but I think it's fine that perhaps the majority of the hospitals probably classified the way I was describing but I don't want to speak for them obviously. You know, there might be a couple that here and there that are putting that to the bad debt portion versus the contractual line. But I can only say my experience, but obviously, you know, I just don't want to speak for them but I would presume that that's the same structure that they adopted. Okay. Okay, that makes sense and it's helpful and then just one last thing for me when you're talking about the 2024 budget and you're looking at free care and you're saying you're aligning that. You're aligning that with historical trends from before and after or during continuous coverage, not after because that's right now. I'm wondering had you thought about or had you included in that like what the effect of the implementation of Act 119 will be and if your free care policies become more generous due to that because that's like a quarter worth of impact right July 1 July, August, yeah. Correct. We're moving in that direction now to adopt what is stipulated in the Act 119. It will have an impact because it does change that threshold because currently we're at 300% of care. So that is going to change that bit of obviously we're we're going to adopt that we're going to be looking at that because we've been waiting for our go live. And then really start to adopt that obviously we'll meet the deadline. But it to answer your question it certainly will have an impact on the amount that you see in those two two lines just because currently it's under that threshold is stipulated. Okay. Yeah, I think you know what's what's interesting and I don't I haven't looked at Giffords FAP in a while, but it seems like you probably also in addition to the FL changes the limits the actually. I mean it may not affect Gifford as much but for some hospitals, the statewide criteria instead of being put at the limited to the service area is a, it's going to be a really big impact for some hospitals. I don't know if that works out for Gifford but that's kind of there's some things that are kind of way deep inside of Act 119. So I think it's going to have a bigger impact and I think, you know, we should talk or I think might probably send you a letter Jen and we'll be rolling out a bunch of stuff going forward. But yeah, Act 119, it's weird how that played out. So I had a look at it with a magnified glass. I mean, I've read through it a few times to Eric and we're happy to work with healthcare advocate on, you know, the changes that we're implementing or or some as you mentioned that we already have in place. So in terms of providing free care statewide, and not just within our health service area. Thank you so much, Jen. And again, thank you for coming in in a way that conforms with the guidance. Can I just ask a quick follow up question on on Eric's question. I'm sorry I missed in the initial the $200 charge that you give the 50% discount upfront. Where do you where did you say you put that in accounting. How does that. It goes in our contractual allowance line. And is that reflected in the exhibit dying in the in the budget submission. Yes, that would flow through our contractual and the two lines that we entered at the very bottom we added the bad debt and free care that would be net of that discount but the contractual line would contain that discount. So, so that first $100 deduction would go under free care. That first hundred line would go under contractual allowances. Okay, because there's I'm just trying to fit there's not a contractual allowances on exhibit nine I'm just trying to figure out which one. Oh, is that I believe that might be the one that is just gross and net Sarah if I recall. Okay, so. Our detail. If you look at our income statements, there's a contractual allowance line. That's a negative number. And that will reflect where that is hitting on the income. All right, I'll read through that. Thank you. I had a quick follow up on the third party that negotiates the rates with the insurance companies. Is that Helms and co. Yes. And if it's in the contract that the insurance companies have to pay the amount approved by the GMC be. Why do you have to pay a third party to negotiate. Not all of the contracts have that in there and that's not the only thing that we utilize Helms for we work with them to build. What we call a matrix so that we almost have a contract management type of methodology so we can look at inpatient versus outpatient versus professional how much we should be getting from each of those contracts. So they don't only do the negotiation, but they also assist us in creating the different amount of reimbursement by each service by each pair. The other thing that Helms and company also assist us with is anytime a pair makes a change to their policies. We do ask Helms to alert us of those pair policy changes. If we also notice that our claims may not be adjudicating in accordance with those contracts, we work with Helms to decipher, you know, that delta that we might be experiencing and have that conversation with the partners as well so that we can ensure we're getting reimbursed at the rate that we were contracted. So there's, there's other functions that that particular third party does versus just the negotiation. I hope that helps. Yeah. I'm sure I would just add to that that is a small organization like Gifford and I assume that, you know, the majority of the hospitals in for monitor in somewhat the same boat there's only so much bandwidth we can that that we have to do some of these more technical activities so it is more efficient and in some case we don't have a lot of other options, but to work with some people who do this on a full time basis. And if I could, it's it's much more cost effective than it would be hiring an FTE for that additional set of services. No, I understood. Yeah, no, appreciate that very much. Okay, I have nothing else. I will open it up to public comment. Yeah, and I have to say, I've done a fair number of hearings now at the care board and the only hearings I've never had a public comment on our hospital budgets, which I find so surprising. Every other hearing we have there's so many public comments. We'll probably get some Wednesday. All right. Well, yeah. Okay. Well, be that as a may, I will turn it back to you guys for your closing statements and thank you very much for your presentation and for observing the budget guidance. Well, thank you, Chair Foster. I appreciate the opportunity to talk with you all today. And again, thank you all from your team for the work that you've put into this as well. So, I would just conclude by stating that, you know, given my opening comments, we wanted to stress the level to which different is a community focused organization. We do work with very closely with with our community members to assess what the needs are in the community and then with our leadership and our board and our medical staff and others to ensure that we are organizing our services in a way that that can meet those needs. And we do leverage the relationships both local and from a wider region to meet those needs. As you've heard about both in my comments earlier and then obviously with some of the other services that we that we contract and work with. I just want to again thank you for the opportunity today. And as always, please feel free to reach out to us if you have any follow up questions and have a great weekend. Great. Thank you all very much. We will adjourn until 10am.