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This is so because of our QP determination rule for participation in an Advanced APM as specified at 42 CFR 414.1425(b)(1) provides that eligible clinicians are assessed at the APM Entity level when a Participation List is used to identify eligible clinicians that participate with the APM Entity, as is the case with the Shared Savings Program and because the Shared Savings Program requires all participating ACOs to report and be scored on the quality measures in the APP quality measure set at the APM Entity level to evaluate quality performance, regardless of whether an ACO's eligible clinicians otherwise achieve QP status for a year through a track that qualifies as an Advanced APM

During the early low-dose phases, one 5mg vial contains many more doses than you can use within 28 days, so some waste is inevitable