Thank you for your question about CMS 1028/PC-07 Severe Obstetric Complications. In the current annual update process - effective reporting year 2025, the case for placenta percreta and placenta increta will not be in the numerator if hysterectomy is the only Severe Maternal Morbidity. Since all the placenta accreta spectrum disorders can impact other morbidities, they will also remain in the risk adjustment. As for having higher rates, it may be helpful to know that the goal of risk adjustment is to account for patient characteristics and/or comorbidities associated with the measure outcome that are reasonably beyond the control of the hospital. The aim of risk adjustment is to isolate the assessment of quality of care. Risk adjustment accounts for case mix differences between hospitals and “levels the playing field,” allowing for better comparisons between hospitals on the care patients receive at the hospital.