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These commenters encouraged CMS to incorporate robust risk adjustment to account for patient case mix and volumes and the availability of post-acute care services within a hospital's service area

doi:10.21037/tau.2018.06.20

Fourman et al

And the thing thats important here is it is ceruloplasmin, which is a copper containing protein made in the liver that converts the storage iron into the active form

A few commenters recommended pilot testing in diverse settings and populations to ensure reliability, practicality, and applicability of new measures before full implementation