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10.1371/journal.pone.0055382 150 WeiJ

The additional marginal effect of the 1-star reduction is fairly minimal in the scope of ordinary year-on-year changes and is likely less than the one-time impact of other significant methodological changes in past years (most significantly the switch from latent variable modeling to explicit average measure group scoring and the introduction of peer grouping) (85 FR 86193)

They also said they anticipate the deals to be cost-neutral over time, using the cost savings from lower negotiated prices to cover the increasing coverage

A vial that freezes in the cargo hold is destroyed