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well really up until about five years ago most of the post-acute reimbursement was based on a fee-for-service basis we got to decide how long a resident would stay in our building we got to decide what sort of therapy to provide them etc and although thats still the dominant model over the last five years theres been an increasing use of Medicare managed care accountable care organizations and dual demonstration projects which have shifted about forty percent of the payment away from P for service and more towards another model