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CMS-1403-FC
conditions that are high cost, a high volume, or both. CMS
has identified several priority conditions that are high
cost, high volume, or both through an analysis of Medicare
FFS claims data. The reports disseminated in the Baltimore
and Boston program sites included the following conditions:
(i) congestive heart failure; (ii) chronic obstructive
pulmonary disorder; (iii) prostate cancer; (iv)
cholecystitis; (v) coronary artery disease with acute
myocardial infarction flare-up; (vi) hip fracture; (vii)
community-acquired pneumonia; and (viii) urinary tract
infections.
Under section 1848(n)(4) of the Act, we also are
permitted to focus the application as appropriate on
physician specialties that account for a certain percentage
of all spending for physicians’ services. Based upon the
high cost and high volume conditions selected above, CMS
identified the several medical specialties as being the
most relevant specialties for treating those conditions.
The RURs disseminated in the Baltimore and Boston program
sites included the following physician specialties:
internal medicine, cardiology, gastroenterology, general
practice, orthopedic surgery, medical oncology, urology,
pulmonology, family practice, and primary care. We are
implementing the focus of Phase I of the Program on the
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