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Since red blood cells are being produced at a slower rate, the old blood cells hang around and grow, leading to a condition known as macrocytic anemia (low blood cell count, but large blood cells)

Beginning with the 2026 payment year, which relates to the 2024 QP Performance Period, section 1848(d)(1)(A) of the Act specifies that there shall be two separate PFS conversion factors, one for items and services furnished by an eligible clinician who is a QP for the year (the qualifying APM conversion factor), and the other for other items and services not furnished by a QP (the non-qualifying APM conversion factor)

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acknowledging this, and consequently adapting to the right phase can make the "way down" prosperous (Odum & Odum, 2011)