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A few commenters expressed concern that this approach could distort results, limit the value of the ratings for patients, and fail to drive meaningful performance improvement, particularly given that many hospitals already receive two- or three-star ratings that signal a need for improvement in multiple respects

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While vitamin B12 deficiency is rare and most people get enough B12 from their diets, some people may be at greater risk of low B12 levels, including vegetarians and vegans, older adults and people with digestive system conditions, such as Crohn's disease and celiac disease

In addition, the Supporting Factors such as sleep and hydration will materially affect results