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A hiatus hernia involves a part of your upper stomach penetrating through the diaphragm (the layer of muscle separating your chest from your stomach)

Unlike the other five new measures we are proposing, this measure did not undergo further development as part of Wave 5

Therefore, they are averages and may not necessarily represent what is happening to the particular services furnished by a single practitioner within any given specialty

Topped out measures are measures for which measure performance is considered so high and unvarying that meaningful distinctions and improvements in performance can no longer be made (81 FR 77136)