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Commenters discussed the statutory requirements that CMS assign to each MS-DRG an appropriate weighting factor which reflects the relative hospital resources used. They stated that the negotiated rates are influenced by many factors, including bargaining leverage, patient populations, network needs, utilization management practices, local market concentration, out-of-network Medicare payment requirements, quality and value initiatives, episodes of care, and other contract and pricing dynamics rather than relative hospital resource use at the MS-DRG level

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