; and (2) in clause (v), by adding at the end the following new subclause: (XII) Reductions attributable to an adjustment correction For an adjustment correction period, reduced expenditures attributable to application of clause (vii)(I)(bb) with respect to such period. . 4. Timely updates to direct costs used to calculate practice expense RVUs Section 1848(c)(2)(B) of the Social Security Act ( 42 U.S.C. 1395w–4(c)(2)(B) ), as amended by section 3, is further amended by adding at the end the following new clause: (viii) Timely updates to direct costs used to calculate practice expense relative value units (I) Simultaneous updates to direct cost inputs at least once every 5 years The Secretary shall, not less often than every 5 years, update the prices and rates, as applicable, for each of the direct costs inputs described in subclause (II) used in the methodology for calculating the practice expense relative value units under this subsection for physicians’ services. Updates made pursuant to the previous sentence shall be made in the same year for all direct cost inputs described in such subclause. (II) Direct costs input categories described For purposes of this clause, the direct costs inputs described in this subclause are clinical staff wage rates, prices of medical supplies, and prices of equipment. (III) Consultation In making the updates under this clause, the Secretary shall consult with relevant stakeholders, including physician specialty societies. . 5. Limitation on year-to-year conversion factor variance Section 1848(c)(2)(B) of the Social Security Act ( 42 U.S.C. 1395w–4(c)(2)(B) ), as amended by sections 3 and 4, is further amended— by adding at the end the following new clause: (ix) Limitation on conversion factor variance (I) In general In the case that application of clause (ii)(II) for a year (beginning with 2025) would result in a conversion factor established under subsection (d) for such year, not taking into account any adjustment provided under such subsection, to vary by more than 2.5