- Kaiser Health News Original Stories 1
- Hospitals’ Struggles To Beat Back Familiar Infections Began Before Ebola Arrived
- Political Cartoon: Operative Theater?
- Health Law 3
- Report: Wide Variation In State Exchange Plans' Covered Benefits
- Employers Devise Strategies To Avoid Obamacare Fines
- Kasich's Public Medicaid Expansion Fracas Moves Into Its Second Day
- Capitol Hill Watch 2
- Poll: Most Likely Voters Expect The GOP To Win Control Of Senate
- Coburn Issues 'Wastebook' That Includes 'Unnecessary' Spending At NIH
- State Watch 1
- State Highlights: Health Care Takes Center Stage In Debates In Maine, Arizona, Missouri
From Kaiser Health News - Latest Stories:
Each year about 75,000 patients die from infections they caught in the hospital. A KHN analysis of federal data shows that nearly 700 hospitals have higher than expected rates of infection for at least one condition. (Jordan Rau, 10/21)
Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: Operative Theater?" by John Deering, Arkansas Democrat-Gazette.
Here's today's health policy haiku:
Ebola's the buzz...
But hospitals struggle with
less exotic bugs.
If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.
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Summaries Of The News:
University of Pennsylvania researchers find that the variations are significant. Other news about the online health marketplaces that open next month include Oregon's decision to ditch the old system for Medicaid enrollment, a review of navigators' roles in Georgia, and Maryland officials' assurances that their system will be ready.
Politico Pro: Wide State Differences Seen In Obamacare EHBs
ACA exchange enrollees in almost every state will find that chiropractic care is a covered benefit under their health plan, but they won’t have as much luck with acupuncture and weight loss programs, a new report from University of Pennsylvania researchers shows. The report, which was funded by the Robert Wood Johnson Foundation, finds that significant state variation exists in the ACA essential health benefits that insurers must cover to offer plans on the exchanges (Pradhan, 10/21).
Georgia Health News: Navigators Aided Consumers In Need, Report Shows
Consumers in Georgia and three other states who were helped by navigators for the 2014 insurance exchanges tended to be people of color who were not financially secure, a recently released report says. Navigators, who are specially trained in the provisions of the Affordable Care Act, provide face-to-face, in-person help for consumers seeking information about health insurance policies in the state exchanges, also called marketplaces (Miller, 10/21).
Denver Post: Disconnect For Health Consumers In Colorado Who Passed On Insurance Through State Exchange
A sign placed out on the 16th Street Mall beckoned people in late March to sign up for health insurance through the Affordable Care and Connect for Health Colorado. Colorado was one of 16 states that set up its own health insurance exchange under the Affordable Care Act and one of 27 states to expand Medicaid. Between the two, Colorado had enrolled more than 300,000 in one or the other by March 31. Among the state exchanges, Colorado had the fourth-highest number of people sign up for private insurance through its marketplace, Connect for Health Colorado. That was estimated to be 25 percent of eligible individuals. The Colorado Health Foundation hired the RAND Corporation to study why the rest hadn't signed up. The foundation released the report, "Barriers to Enrollment in Health Coverage in Colorado," in mid-October (Draper, 10/21).
Baltimore Sun: Md. Is In ‘Good Shape’ For Health Exchange, Official Says
Less than three weeks before uninsured Marylanders get their first look at health plans offered under the Affordable Care Act, officials say preparations are on track. The state's health exchange website crashed on its first day last year and tangled thousands in technological troubles for months. But in a briefing to members of the exchange board Tuesday, the site's top technical officer said it has been fully revamped and appears to be working properly. Though preparations continue, tests show it can handle thousands of users at a time and complex cases (Cohn, 10/21).
Kansas City Star: Coming Soon: Obamacare Take II
It was a near disaster last year when the Affordable Care Act’s health insurance plan marketplaces opened for business. The healthcare.gov website for online enrollment crashed on day one. Political opponents rose in a gleeful chorus of “I told you so.” The public was frustrated and confused. But ultimately, more than 7 million people enrolled in the ACA’s health insurance plans, meeting original predictions. Now, it’s time for round two. Open enrollment for the ACA’s 2015 marketplace insurance plans starts Nov. 15. And this time, the organizations promoting enrollment are optimistic it will go a lot more smoothly. The regional coalition of foundations, social service organizations and safety net clinics will try to better coordinate their work and focus on groups — African-Americans, Latinos, the LGBT community, rural residents — that have been hard to reach (Bavley, 10/21).
Salem Ore. Statesman Journal: Oregon Seeking To Use Different State's Medicaid System
The state has cut its final ties between Cover Oregon and Oracle, the company that was hired to build Oregon's state health insurance exchange. After the two entities failed to launch a working insurance marketplace, the state distanced itself from Oracle and instead piggy-backed on the federal health care exchange for private insurance. Oregon officials had hoped to build on existing work of Oracle's to create an automated system for Medicaid enrollments, but continued disagreements have led to the state giving up on any plans involving the corporation. ... A list of criteria are being developed to help guide the decision on which state Medicaid system to use (Yoo, 10/21).
The Oregonian: Oregon Gives Up On Oracle Technology, Will Use Another State's Medicaid System
State officials have given up on trying to salvage a portion of the troubled Cover Oregon technology project, essentially abandoning all hope of getting any lasting benefit from the $240 million paid Oracle America on the health insurance exchange and related work. ... The state had been planning to use salvaged Oracle technology for enrollment in the Oregon Health Plan, but has now halted that effort (Budnick, 10/21).
The Washington Post: Obamacare’s Small-Business Exchanges To See Major Changes In The Coming Months
One year in, the new small-business insurance marketplaces born out of the new federal health-care law have fallen short of their promise in nearly every state, both in terms of functionality and enrollment. However, many are scheduled to see some important updates heading into year two — ones that health officials say should make them much more useful and appealing to small employers and their workers (Harrison, 10/20).
With large companies facing potential fines next year for not offering health insurance, some are looking at approaches such as enrolling employees in Medicaid, reports The Wall Street Journal. Meanwhile, the federal government posts a notice Tuesday saying that it will continue to fund an optional health insurance program for the working poor in 2016.
The Wall Street Journal: Companies Try To Escape Health Law’s Penalties
With companies set to face fines next year for not complying with the new mandate to offer health insurance, some are pursuing strategies like enrolling employees in Medicaid to avoid penalties and hold down costs. The health law’s penalties, which can amount to about $2,000 per employee, were supposed to start this year, but the Obama administration delayed them until 2015, when they take effect for firms that employ at least 100 people (Wilde Mathews and Jargon, 10/21).
Modern Healthcare: Feds Outline Plan To Pay States For Basic Health Program In 2016
The federal government will continue to fund an optional health insurance program for the working poor in 2016 with the methodology it used for 2015, according to a proposed notice from the CMS. The Patient Protection and Affordable Care Act established the Basic Health Program. The initiative is a form of managed care that gives people younger than 65 who earn between 138% and 200% of the federal poverty level and are not otherwise eligible for Medicaid a chance to obtain affordable health coverage. The Basic Health Program is voluntary, and it's an alternative to the widely followed insurance marketplaces. States that move forward with the Basic Health Program must offer plans that at least cover the 10 essential health benefits required by the healthcare law, such as hospitalization, lab tests and mental health services (Herman, 10/21).
The Ohio governor is engaged in a spat with The Associated Press after the news outlet published comments in which he said he didn't think the health law would be repealed. He has since offered further explanation, saying that he doesn't think the Medicaid expansion -- which he views as separate from the overhaul -- should be undone.
Politico: Gov. John Kasich’s View On Medicaid Fuels Two-Day Spat With AP
What, exactly, is Obamacare? According to Ohio Gov. John Kasich, it doesn’t include Medicaid expansion, a major facet of the law. It’s a view held by virtually no one else. Kasich’s unorthodox view of the Affordable Care Act — and the hunger the Republican base has for the health law’s repeal — are behind a two-day public spat between the possible 2016 contender and The Associated Press (Wheaton, 10/21).
Meanwhile, in Tennessee, health advocates press for expanding Medicaid -
The Associated Press: Advocates Continue Call For Medicaid Expansion
Members of the state chapter of the NAACP and other health care advocates held a mock funeral across from the state Capitol on Tuesday to characterize lives they say will be lost if Medicaid is not expanded in Tennessee. About 100 people attended the event, which included a processional with a casket. Organizers say many people have died because they don't have health care and that there will be more deaths if Medicaid is not expanded. "The suffering is profound," said Margaret Ecker, an outreach coordinator with the Tennessee Justice Center, a leading advocate for enrollees in TennCare, Tennessee's version of Medicaid. "These are human beings who will all care for. It's about doing the right thing." Gov. Bill Haslam, a Republican, has been criticized by Democrats for refusing last year to agree to $1.4 billion in federal funds to cover about 180,000 uninsured Tennesseans under the terms the money was offered (Johnson, 10/21).
Health care continues to be a big issue, though not as important as the economy.
The Associated Post: AP-GfK Poll: Most Expect GOP Victory In November
But the survey suggests many will cringe when they cast those ballots. Most likely voters have a negative impression of the Republican Party, and 7 in 10 are dissatisfied by its leaders in Congress. … What’s deeply important to likely voters after the economy? About three-quarters say health care, terrorism, the threat posed by the Islamic State group and Ebola (10/21).
Meanwhile, MPR examines the ideas for replacing the health care law put forward by Republican Senate candidate Mike McFadden -
Minnesota Public Radio: Experts Say McFadden’s Health Insurance Ideas Don’t Hold Up
Republican Senate candidate Mike McFadden takes advantage of every opportunity to slam the Affordable Care Act as bad for the nation. In advocating for a replacement for the federal health care law, McFadden opposes a national solution. He would leave most of the decisions up to states, including whether to require people to buy health insurance. But McFadden would force states to keep some of the most popular benefits of the heath care law. ... Experts, however, say much of what McFadden proposes has been tried before and left millions of Americans without health insurance (Zdechlik, 10/22).
Oklahoma Republican Sen. Tom Coburn's list includes various programs that continue to receive funding even as National Institutes of Health officials express concern about the slowing of disease research.
Politico: Tom Coburn Skewers NIH In Final 'Wastebook'
This particular study on rodent rubdowns cost $387,000 -- a tiny fraction of the National Institute of Allergy and Infectious Diseases’ more than $4 billion budget. But the ranking member of the Senate’s Homeland Security and Governmental Affairs Committee cites many “unnecessary” spending programs that continue while NIH officials argue that important disease research has slowed (Everett, 10/22).
Also in the news, another congressional committee is examining possible waste in the Medicare Advantage program --
Center for Public Integrity: GAO Takes On Medicare Advantage Spending
A Congressional committee has taken aim at waste in the popular Medicare Advantage health insurance program for seniors, ordering an extensive audit of billing errors and overcharges by insurers -- mistakes estimated to cost taxpayers billions of dollars every year. The Government Accountability Office, the watchdog arm of Congress, is conducting the probe at the request of the House Ways and Means Committee. Results are due next spring (Schulte, 10/20).
Hospital ownership of physician groups increased patient care costs by as much as 20 percent, according to the UC Berkeley study. Meanwhile, another study by Harvard researchers finds that switching to for-profit status may boost hospitals' financial health but has no effect on quality of care.
Los Angeles Times: Medical Costs Up To 20% Higher At Hospital-Owned Physician Groups, Study Finds
Raising fresh questions about healthcare consolidation, a new study shows hospital ownership of physician groups in California led to 10% to 20% higher costs overall for patient care. The UC Berkeley research, published Tuesday in the Journal of the American Medical Association, illustrates the financial risks for employers, consumers and taxpayers as hospital systems nationwide acquire more physician practices (Terhune, 10/21).
Modern Healthcare: Hospitals Switching To For-Profit See No Drop In Quality
Switching to for-profit status generally boosts hospitals financial health and has no effect—good or bad—on the quality of care they deliver, according to a new analysis of what happened in the years after more than 200 conversions. “For-profit hospitals have often argued that conversion will provide resources that will lead to better care,” wrote Harvard University researchers Dr. Karen Joynt, Dr. Ashish Jha and John Orav in a study published in JAMA. “Our study failed to find any evidence to support this notion,” they concluded. ... Some states have limited the entry of for-profit hospital operators out of fear that the profit motive would undermine hospitals' quality and their commitment to serving the uninsured and patients covered by Medicare and Medicaid (Rice, 10/21).
In other hospital news -
Kaiser Health News: Hospitals’ Struggles To Beat Back Familiar Infections Began Before Ebola Arrived
While Ebola stokes public anxiety, more than one in six hospitals — including some top medical centers — are having trouble stamping out less exotic but sometimes deadly infections, federal records show. Nationally, about one in every 25 hospitalized patients gets an infection, and 75,000 people die each year from them—more than from car crashes and gun shots combined. A Kaiser Health News analysis found 695 hospitals with higher than expected rates for at least one of the six types of infections tracked by the federal Centers for Disease Control and Prevention. In 13 states and the District of Columbia, a quarter or more of hospitals that the government evaluated were rated worse than average for at least one infection category, the KHN analysis found (Rau, 10/21).
A Pew Research Center survey finds 41 percent of Americans say they worry they or someone in their families will be "exposed" to the Ebola virus, up from 32 percent two weeks ago. Public confidence in the government's ability to combat the disease has also dropped, finds a Gallup poll. Meanwhile, GOP doctors in the House of Representatives seek a temporary travel ban for West African countries affected by Ebola.
Los Angeles Times: Public Concerns About Ebola Increase Faster Than Cases
Public concerns about Ebola have grown much faster than the actual number of cases of the illness in the U.S. A Pew Research Center survey released Tuesday found that 41% of Americans said they worried that they or someone in their families would be "exposed" to the Ebola virus, up from 32% two weeks ago (Lauter, 10/21).
Politico: Poll: Drop In Faith In Government On Ebola
Americans have become less confident in recent weeks in the federal government’s ability to fight Ebola in the United States, according to a new poll. According to the Gallup poll, 52 percent of Americans said that they were “very” or “somewhat confident” in the government’s ability to handle the virus. That’s down nine percent from Oct. 5, when 61 percent of Americans expressed confidence, and Oct. 12, when Gallup found that 60 percent of Americans were confident in government to handle the situation (Breitman, 10/22).
Politico: GOP Doctors In House Seek Travel Ban
The Republican Doctors Caucus is calling on the White House to put in place a temporary travel ban for West African countries affected by Ebola. The letter, sent Tuesday to President Barack Obama, was signed by 16 members of the group, including co-chairs Reps. Phil Gingrey of Georgia and Phil Roe of Tennessee (Topaz, 10/22).
USA Today: West Africa Travelers Must Go To 1 Of 5 Airports
The Department of Homeland Security announced Tuesday that all travelers from Ebola outbreak countries in West Africa will be funneled through one of five U.S. airports with enhanced screening starting Wednesday. Customs and Border Protection within the department began enhanced screening — checking the traveler's temperature and asking about possible exposure to Ebola — at New York's John F. Kennedy International Airport on Oct. 11 (Jansen, 10/21).
A selection of health policy stories from Maine, Arizona, Missouri, Oregon, California, Florida, Pennsylvania, New Jersey, Kentucky and Connecticut.
The Associated Press: Sparks Fly Throughout Last Maine Governor Debate
The three candidates for governor clashed Tuesday in their final debate, highlighting their differences on a wide range of issues, including health care and welfare. Partisan sparks flew early and often between Republican Gov. Paul LePage and Democratic U.S. Rep. Mike Michaud, who are running in a dead heat in the race, far ahead of independent Eliot Cutler, two weeks before Maine residents go to the polls (10/21).
Arizona Central-Republic: Ducey, DuVal On Health Care
The two major candidates for governor, Democrat Fred DuVal and Republican Doug Ducey, are answering questions about issues explored in The Arizona Republic's "New Arizona" project. The project identified key issues in building a better Arizona. Today, the fourth in the occasional series, we focus on biotech and health care (10/21).
Kansas City Star: Missouri Senate: Two Doctors, Two Different Views On Medicaid Expansion
The two men running for the Missouri Senate in the 34th District are both doctors. Both cited experiences they had as physicians as motivation to run. But they come down on very different sides of a medically focused debate in Missouri: whether the state should expand Medicaid as envisioned in the federal Affordable Care Act. Rob Schaaf, the incumbent in the 34th District, which includes Platte County, said that expanding Medicaid in Missouri would be too expensive for the state. Robert Stuber said that expanding Medicaid is one of his top priorities. Doing so, he said, would create more jobs and salaries, which would increase state tax revenue. Refusing to expand Medicaid, he said, puts rural health care systems at risk for a hefty financial burden as federal subsidies to rural hospitals decrease (Pointer, 10/21).
Oregonian: State Announced $150,000 Contract To Wife Of Key Kitzhaber Adviser Before Competitive Bidding
Oregon Health Authority officials announced the selection of the wife of a former top aide to Gov. John Kitzhaber for a $150,000 contract before any formal bidding took place, The Oregonian has learned. A state manager internally announced the hiring of Kate Raphael to produce videos about the governor's health reforms on July 31, documents show. That was eight days before a formal competitive-bidding solicitation was issued, and nearly a month before a contract was signed (Budnick, 10/21).
Los Angeles Times: Lawyers Versus Doctors In Costly Prop. 46 Campaign Wars
A ballot initiative that pits lawyers against doctors has set off one of this year's fiercest campaign wars, a costly clash over increasing state limits on malpractice damages and imposing drug testing on physicians. Proposition 46 would raise the cap on pain-and-suffering awards in malpractice lawsuits and require that hospitals randomly test their doctors for drug and alcohol use. Backers say the measure would rein in negligent doctors; opponents charge that it's a money grab by the lawyers who helped put it on the ballot (Mason, 10/21).
Miami Herald: Miami Physician Assistant Gets 15 Years For Nation’s Biggest Medicare Therapy Scam
A Miami physician's assistant who was described by his lawyer as a “bit player” in a nearly $200 million mental health scheme to swindle Medicare was sentenced to 15 years in prison on Tuesday. But it could have been worse for Roger Bergman, 65, of Miami, who was facing up to 25 years under federal sentencing guidelines for his supporting role in the biggest mental-health clinic scam ever orchestrated against the taxpayer-funded Medicare program. Bergman, convicted in July of a fraud conspiracy, conducted bogus evaluations of hundreds of patients and falsified their records to dupe Medicare into believing they needed the costly therapy services, according to trial evidence (Weaver, 10/21).
Philadelphia Inquirer: Overdose Deaths Rise In Pa., N.J.
Because of that surge, New Jersey's ranking in drug-death rates soared from 41st in 2010 to 18th. The new statistics predate New Jersey's most recent moves to attack the problem. Several months ago, it changed state law to encourage people who witness an overdose to call 911 without fear of arrest. It also permitted first responders, family, and friends to carry medication that can quickly reverse an overdose due to heroin or opioid prescription painkillers. Families and police around the state have since reported more than 230 "saves," according to the Drug Policy Alliance, including 47 in Camden (Sapatkin, 10/21).
Modern Healthcare: Ky. Cardiologists Settle False Claims Allegations
Two Kentucky cardiologists have agreed to pay $380,000 to settle allegations that they violated the False Claims Act by entering into bogus management agreements with an area hospital in exchange for referring their patients to that hospital, the Department of Justice announced Tuesday. The government alleged that Drs. Satyabrata Chatterjee and Ashwini Anand, who owned cardiology physician group Cumberland Clinic, London, Ky., entered into sham management agreements with Saint Joseph Hospital. The two were paid to provide management services but never actually provided them, according to the government. Instead, they allegedly agreed to refer their clinic's patients to the hospital for cardiology and other services in violation of the Stark Law and the anti-kickback statute, according to a Department of Justice news release (Schencker, 10/21).
Connecticut Mirror: Public Gets First Look At Health Industry Payments To Doctors
Pharmaceutical companies and medical-device manufacturers paid more than $6 million to about 5,400 Connecticut doctors for various services during the last five months of 2013, a Connecticut Mirror examination of a newly released federal database shows. The information was collected under a provision of the Affordable Care Act that is designed to help consumers understand the financial relationships between the health care industry and the nation’s physicians. Though only a five-month snapshot, the new data provides the public with the ability to search actual payments to their own doctors for the first time (Radelat, 10/22).
Los Angeles Times: Children's Health Insurance Program Deserves Funding
In what may be a hopelessly quixotic effort, supporters of the federal Children's Health Insurance Program are trying to persuade Congress to renew its funding almost a year in advance — and in a lame-duck session. Nevertheless, lawmakers ought to heed that call. The program plugs a troubling gap between Medicaid and the Affordable Care Act's subsidized plans, and states need to know whether they can count on federal funding or whether they will have to spend far more dollars of their own (10/21).
The New York Times: The Democratic Panic
But one of the reasons for [President Obama's] unpopularity is that nervous members of his own party have done a poor job of defending his policies over the nearly six years of his presidency, allowing a Republican narrative of failure to take hold. … Similarly, the Affordable Care Act, one of the most far-reaching and beneficial laws to have been passed by Congress in years, gets little respect even among the Democratic candidates who voted for it. Though none support the Republican position of repeal, most talk about the need to “fix” the health law, as if it were a wreck alongside the road rather than a vehicle providing millions of people with health coverage (10/21).
Bloomberg: Republicans Who Secretly Love Obamacare
Here's a conundrum for Republicans this year: The Affordable Care Act remains unpopular, especially with the Republican base, but as the law has taken effect a number of provisions are embraced by voters. Republican candidates across the country, facing this contradiction, have a solution: repeal Obamacare, but keep the popular parts. Never mind this isn't possible; if you get rid of the whole the parts go, too, and few political opponents have proposed an alternative (Albert R. Hunt, 10/21).
The Washington Post’s Right Turn: GOP 2016 Contenders: Repeal Obamacare, Reform Medicaid
[Ohio Gov. John] Kasich, however, is correct that one can be for repealing Obamacare and still support states’ expansion of Medicaid. But other governors should be forewarned: You better be crystal clear about what you want to do (Jennifer Rubin, 10/21).
USA Today: In Ebola Outbreak, Worry About The Right Things
If you spend enough of your day watching certain cable news outlets without an appropriate degree of skepticism, you easily could become convinced that an Ebola epidemic is imminent, that we are all at tremendous risk of infection. This is extremely unlikely to be true, but while we should not be panicking about the threat of Ebola, we should be panicking about the apparent inability of our institutions to respond appropriately to a genuine public health problem (Duncan Black, 10/21).
Politico: The Hottest Zone: How The Media Stoked The U.S. Ebola Panic.
The irony, at least for Americans, is that only two people have become infected on U.S. soil, and only one of all those treated here has died, while the list of Americans affected by other (more mundane) major health threats is much longer. The press, however, has turned Ebola coverage into a self-perpetuating frenzy. The media keeps making waves and then surfs them in every direction. No question there’s an overwrought panic over Ebola in the United States, and no question the media has played a major role in generating that panic (Tara Haelle, 10/21).
Politico: Are Hospitals More Deadly Than Ebola?
We’ve all been horrified by the medical blunders made in dealing with Ebola in the United States—from sending home a patient who was showing symptoms and had recently travelled to West Africa to relying on inadequate protocols or protection that led to the infection of two of his nurses. It’s awful, but we shouldn’t be surprised. These types of hospital mistakes—caused by knowledge gaps, carelessness, unpreparedness or a combination of all—by my estimate kill between 210,000 and 440,000 people in the United States every year (John T. James, 10/21).
Bloomberg: Let People Shop For Health Care
If people knew the prices of medical treatments, and if they paid partly from their own pockets, they might shop around and save money. This stands to reason, and a new study in the Journal of the American Medical Association shows it's true. This comes as very encouraging news for the wider effort to keep going the profound deceleration in health costs we've seen over the past several years (Peter R. Orszag, 10/21).
Health Affairs: The $500 Billion Medicare Slowdown: A Story About Part D
A great deal of analysis has been published on the causes of the health care spending slowdown system-wide — including in the pages of Health Affairs. Much attention in particular has focused on the remarkable slowdown in Medicare spending over the past few years, and rightfully so: Spending per beneficiary actually shrank (!) by one percent this year (or grew only one percent if one removes the effects of temporary policy changes). Yet the disproportionate role played by prescription drug spending (or Part D) has seemingly escaped notice. Despite constituting barely more than 10 percent of Medicare spending, our analysis shows that Part D has accounted for over 60 percent of the slowdown in Medicare benefits since 2011 (beyond the sequestration contained in the 2011 Budget Control Act). (Loren Adler and Adam Rosenberg, 10/21).
JAMA Internal Medicine: Lowering Medical Costs Through The Sharing Of Savings By Physicians And Patients
Current approaches to controlling health care costs have strengths and weaknesses. We propose an alternative, "inclusive shared savings," that aims to lower medical costs through savings that are shared by physicians and patients. Inclusive shared savings may be particularly attractive in situations in which treatments, such as those for gastric cancer, are similar in clinical effectiveness and have modest differences in convenience but substantially differ in cost. Inclusive shared savings incorporates features of typical insurance coverage, shared savings, and value-based insurance design (Harald Schmidt and Ezekiel J. Emanuel, 10/20).