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We explained that catastrophic events outside an ACO's control could increase the difficulty of coordinating care for patient populations and, due to the unpredictability of changes in utilization and cost of services furnished to beneficiaries, may have a significant impact on expenditures for the applicable performance year (85 FR 27577)

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Since intestinal metaplasia causes no direct symptoms and can only be diagnosed through testing, it’s impossible to know how common it is in the general population