Well see the note to Fred . Dialysis centers are penalized if pho levels aren't controlled...and MOST ( not many ) dialysis patients have poorly controlled pho levels . Why ? Because most hate the pho meds they are given . Theres a 6 mth delay on CMS checking cost to the clinic ....so clinic could save $ ...BUT also be penalized for high rate of poorly controlled patient pho levels if they've kept their patients on the generics