Donald W. Fisher, Ph.D., CAE, Chief and President Executive Officer of AMGA, stated While we were pleased to find that CMS is normally continuing in lots of ways to take the steps needed to improve the Medicare Shared Cost savings System, we still recognize that extending various waivers to all ACOs would be a substantial move toward completely establishing ACOs simply because a vehicle to boost quality and coordination of care while reducing costs. We remain hopeful that CMS will use this opportunity to both reinforce the viability of ACOs as the harbingers of change for the health care delivery system and extend every advantageous design changes to all Medicare beneficiaries. .. AMGA submits comment letter to CMS regarding proposed guideline on Medicare Shared Savings Program On Friday, the American Medical Group Association drafted and submitted a comment letter to the Centers for Medicare and Medicaid Providers regarding the proposed guideline on refinements to the current framework of the Medicare Shared Cost savings Program.Randomization was performed after intraoperative transesophageal echocardiography verified the lack of a left atrial thrombus. Randomization was stratified regarding to center. All patients also underwent closure of the remaining atrial appendage to lessen the risk of formation of a still left atrial thrombus. The surgical-ablation procedures and postoperative management are described in the Supplementary Appendix, including Fig.