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CGT our stands for comprehensive care for joint replacement and we got involved early on in the process and its going on two years now its been amazing the initial thought was to save money for the system in terms of Medicare and eventually private insurers but really its much bigger than that in terms of were taking better care of patients the outcomes are better our remission rates are lower the complications are lower its just been a huge benefit the patient really the secondary gain is the financial gain which you know was initial intent but really now its turned out to be the best thing for the patient its pretty much all about rapid recovery and we have found out from the programs that start this whole process that the faster the patient get back to their normal life the better off they are in terms of reducing complications so therapies involve the hospitals involved and the real focus is in the patient the family and outpatient therapy so the first year in the program Ba