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After transection of the esophagus, the proximal jejunum was anastomosed to the esophageal stump with a linear stapler

One commenter applauded this proposal and asserted that, in time-based billing scenarios, the need to ( maintain a certain rate of billable units across the patient population to keep the program financially tenable may directly or indirectly incentivize care managers to prioritize activities that fulfill billing requirements and deprioritize needed activities for patients who may need intervention but have already fulfilled the billing requirements or are unlikely to fulfill the billing requirements

Some of these commenters further explained that ACOs typically hear about confirmed fraud in their markets years after the performance period ended yet have no recourse for action, and as a result, ACOs are held accountable for patients' total cost of care but have no ability to stop instances of improper payments

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