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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

As humans, we need our tribe, you know? I kept thinking about how our species has long been more easily persuaded by a good story than hard evidence, that opting in has been more evolutionarily advantageous than opting out

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