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Commenters expressed concerns that the productivity adjustment, which reflects the private nonfarm business total factor productivity, are not achieved by hospitals and the health care field

In the proposed rule (90 FR 33758), we acknowledged that updating EHRs with new measures requires some initial investment from hospitals, but in the long-term it would automate timely collection of more granular quality information

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Andji G, Baumgartner-Mora C, Baumgartner P (2016) An upper Paleogene shallowing-upward sequence in the southern Sandino Forearc Basin (NW Costa Rica): response to tectonic uplift