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These factors may act synergistically amplify peripheral itch perception and contribute to the persistence and exacerbation of chronic pruritus through multiple signaling cascades, as partially illustrated in Figure 4 and in greater detail in Figure 5

These included removing all topped out measures at the end of the topped out measure lifecycle, exempting all topped out measures in specialty measure sets from application of the 7-point cap, applying a denominator reduction for those scoring 7 out of 10 measure achievement points on topped out measures in specialty measure sets, and adopting a new reweighting policy for the quality performance category for clinicians impacted by limited measure choice that score below the performance threshold

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