state in this case the secretary has not paid the target amount defined by statute the target amount means the hospitals own actual operating costs and  that the secretary has just rates rather than waiting for that did this as a result of the secretary fail to produce budget neutrality your honor i think the question here is not so secretary did is she took reductions to rates rather than rates and when you start mixing different things it's hard to know exactly where it counts out but what the because the harm here is that the target now has been violated so the question is the statute said is it just the classification and waiting for doctors annually that's thirteen ninety five w the what we're saying is that it just ruins their pretty base year so we have the base year two thousand and six for this whole community hospitals when you adjust the rates down below asked it's harmless if it's after the base year because those are things that the hospitals are subject to the adjustments static her for example from two thousand and nine to two thousand t the cost below the cost in the base year and i think they're only example of page twenty eight shows that the example is the hospitals cost per patient in a vase year or five thousand and yet the payment rate being provided is forty nine hundred so it's just just from their own example i think that fact is clear but isn't that a result of the statutory requirement that applies to your clients as well as to all the other hospitals that there amount and i think the secretary doesn't claim to be paying the cost that the hospital incurred in the base year and that's the critical issue what what in the statute requires that the hospital be paid that costs that are actually operating costs of inpatient hospital services for the hospital and it's being a few words for the base hotshot reporting period that that's the key language and that is precisely what the statute defines it is the central protection the whole point of the soul community hospital program is this is the protection of their provided to insulate themselves against financial pressures that otherwise would eliminate the viability of a lot of these hospitals in the communities in which they operate the same thing for the medicare dependent submittals and i see that i now they don't they don't actually care how they get paid more because when when the secretary did it differently for the medicare dependent hospitals for several years she simply didn't apply the replace your budget neutrality adjustments she didn't change the way the weights or rates were handle so they can win without us having to do in the weights and i don't think they've actually care whether we do in the weights or the rates as long as they get paid more so i think the real dispute here is between whether the secretary is a allowed to they really i think is only one issue here and that's whether the statute permits a secretary to hear i really i i might i want to be strongly clear here which is that the secretary for twenty five years has been doing budget neutrality just the way she got this year and she does it in other parts of the medicare statute too so if we start messing around with the weights there's going to be repercussions throughout the entire in piece of perspective human system so what i'm what i'm suggesting is that the court could look at what the secretary did in fact do for the medicare dependent rural hospitals for several years which was which players were happy with because it did what stand now have meaning they represent a ratio of how much it costs to treat this patient as compared to the average patient if the secretary were to be required to put that two point two seven percent into the weight and every year it would be a different number and the weights would go back and forth and we wouldn't be able to tell anything about what the weighting factors met with respect to the ratio of treat th group thirty nine five if you foresee three well i think it means that you have to do it in a manner which means you can do some other things too but at the end of the day you've got to achieve budget neutrality which the secretary does  budget neutrality and to be clear it's budget neutrality with respect to the way he diagnosis related group waiting factors so what congress wanted to make sure didn't happen was when the secretary changed those to reflect  which i think we might very well do because now our weights would be all out which is sales screwy so that would actually make it come out secretary's way again but by you would have marked up your georgis and their utility for the kind of comparative  across time and then geography they're useful for the geology waiting factors are used throughout the entire inpatient perspective payment system so we don't know exactly what would happen if we had to change all the ways but we could see there would be repercussions there are other budget your priority requirements congress is it is concerned about that the aggregate payments don't pull up or down and that's exactly what the secretary has done and so i reached out he made in a manner to mean you could you could do and i was getting an example of  tarp for example so the secretary's i'm here she just put down a tarp so we normalise and then because congress is concerned about aggregate payments the secretary comes in with a supplemental budget metrology adjustment and that's as i said something that's been done for twenty or as a factor outside of the director j d just doesn't make a difference because they aren't there isn't this denominator when the d r g appears again and so tricks into congress might not be so focused on when they were writing this provision protection under the statute but beyond that i would add three additional points first they're not asking to not have it in the budget neutral d r g weights apply to them and bear the burden of budget neutrality so i want to be very clear that the only rate that matters to them is the hospital specific rate or the target amount of medicare dependent hospitals are paid the federal rate plus seventy five percent a difference so if the federal rate is also problematic it should be higher they would be affected by got they're not here complain about that because we agree that it's serious so this is not an issue of just trying to trying to take money that they're not entitled to what we're doing here is hospitals who have an interest in both rates even the small community hospitals many of them are and in in fact some of these hospitals may at some point have been paid based on the federal religious well they g based on costs in one thousand nine hundred one your high budget neutrality adjustments after that in fact their base year is nine hundred eighty one no problem it's harmless here that's why the medicare dependent hospitals for whom it's part of their formula is the federal rate are not complaining about that aspect similarly all the other provisions are that the budgeting trolley provision came into place after so many other base years recognize that there is complexity involved for administering this program easiest does not make it right especially when it's contrary to what the statute provides and the secretary has never said she couldn't  your position isn't just eaten up by the discretion that the secretary has under thirty ninety five w w eighty four to determine the hospital's costs and a base here i think even if you got the relief that you saw are that the secretary formula that does or doesn't include the d r g in a particular way right right it's determined using the cost the hospital actually saw merits in its cost report annually the discharges its cost forty annually and the puts those together and she has not claimed that this is being done because the cost to accurately reflect the hospital's costs in the base year that these adjustments are necessary that is not just conceptually why isn't it and they were in the denominator the rate would be higher that's not lower that's not our whole case that's part of our case so the thought of counting is actually reversed the rates have are really being reduced at some level because the weights were not made budget neutral that is the mathematical operation because they are in the denominator and now the secretary is coming back and loading an additional reduction on top of that so it's actually the reverse it's already reducing their rates and now there's another reduction that's in place and that fits in with the reason why i