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A 2003 J Natl Cancer Inst paper by Cha et al

These effects can be troublesome and may require dose adjustments or treatment discontinuation

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Although a number of possible circumstances could cause an ACO's assigned beneficiary population in the benchmark years to fall below 5,000 assigned beneficiaries during its agreement period, the proposal to apply alternative performance payment and loss recoupment limits for ACOs with less than 5,000 assigned beneficiaries in any BY is one of several safeguards we believe is necessary to address risk to the program that result from the proposed changes to the eligibility requirements to allow for participation by ACOs that have fewer than 5,000 assigned beneficiaries in BY1, BY2, or both, which we are finalizing with this final rule (see section III.F.4.b.(2)(a) of this final rule)