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First, the projections are anchored in the most recently available public information on Advanced APMs

in 2016, a reported 3.4% of adults aged 18-plus used smokeless tobacco

IARC Monographs on the Evaluation of Carcinogenic Risks to Humans - Smokeless Tobacco and some Tobacco-speicific N-Nitrosamines

Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case-control study

CMS then applies the MIPS payment adjustment factor to amounts otherwise paid under Part B with respect to covered professional services for the MIPS eligible clinician for the applicable MIPS payment year such that their payments for such covered professional services are increased, decreased, or not adjusted based on the MIPS eligible clinician's final score relative to the performance threshold