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Commenters were also concerned that small practices and low-revenue ACOs, whose participants are drawn more heavily from small ambulatory, primary care practices and specialty practices will be the least likely to successfully adopt the eCQM collection type, and that adoption of the eCQM collection type contradicts the exception CMS granted to small practices and others with automatic reweighting of the Promoting Interoperability and CEHRT-use requirements in ACOs

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