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weamp;#39;re going to talk about outpatient joints i think this is the whole session is talking about ascs and really the paradigm shift that is happening and will happen and continue to happen with ascs so letamp;#39;s look at ascs and whatamp;#39;s changed in the last few years in ascs so in 2014 there are 25 centers in the country that performed at least one total joint arthroplasty in 2017 that number rose to over 200 and in 2019 the estimate is over 500 ascs in this country are doing outpatient joints in an asc thatamp;#39;s a big number and a big jump so clearly weamp;#39;re at a tipping point and itamp;#39;s deemed the new reality in some respects obviously we have to do this safely thatamp;#39;s paramount on all of our minds transitioning to the asc is all about the three ps prepare your patience thatamp;#39;s the first p number two p is practice in the hospital and number three is modify your protocol so those are the three pamp;#39;s weamp;#39;re going to go through