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A much smaller percentage of people deficient in B12 have pernicious anemia which occurs more frequently in those over 60 accounting for 1-2% of all deficiencies

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[533] In addition, a recent study highlighted the resource intensity of quality reporting, underscoring the high cost of claims-based measures relative to others and recommended that policy makers shift to electronic metrics to optimize resources spent in the overall pursuit of higher quality. [534] For these reasons, and to continue encouraging ACOs on their progress to adopt digital quality measurement, we are not modifying the availability of eCQMs as a collection type for ACOs that reported the APP quality measure set by including eCQMs as a collection type in the APP Plus quality measure set in performance year 2025 and subsequent performance years