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of this proposed rule for our discussion of budget neutrality adjustments

If CEHRT is utilized as required to collect and report measure data and submit attestation statements and other requirements, it would generally result in only complete submissions for the Promoting Interoperability performance category

To accommodate for this limited measure choice and the rising performance threshold, we are proposing to remove the 7-point topped out measure score cap for clinicians reporting measures included in certain specialty measures and implement a benchmarking strategy for affected measures that would ensure clinicians with limited measure choice are not unfairly penalized

& Fariss, M

In the November 2011 final rule (76 FR 67920 through 67922), we adopted an alternate payment methodology that excluded Indirect Medical Education (IME) and Disproportionate Share Hospital (DSH) payments from ACO benchmark and performance year expenditures due to concerns that the inclusion of these amounts would incentivize ACOs to avoid referring patients to the types of providers that receive these payments