High Cost Supply Research Articles

Signaling or not? The pricing strategy under fairness concerns and cost information asymmetry

Supply chain fairness issues have become crucial and prevalent recently, whereas the operational decisions in the fair chain are more and more challenging when involving information asymmetry. Considering the fact that the upstream supplier of a chain generally has private production cost information, this paper investigates how the supplier strategically makes pricing decisions under the own private information and the downstream fairness concerns. Based on inequity aversion theory, we set up a signaling game between the supplier and the retailer with two kinds of inequity aversion, disadvantageous inequity aversion and advantageous inequity aversion, respectively. Compared with the scenario of symmetric information, under asymmetric information, we find that: the high-cost supplier distorts the wholesale price upward to avoid the low-cost supplier's price mimicry when the retailer has disadvantageous inequity aversion and the cost difference between the two types of suppliers is small; the supply chain's expected profit and expected utility may increase due to the reason that the low-cost supplier distorts his wholesale price downward when the retailer has advantageous inequity aversion, which mitigates the double marginalization. Moreover, we extend the base model to the scenario of endogenous prior probability on supplier cost type and we show that when the retailer has disadvantageous inequity aversion, cost information asymmetry may improve the willingness of the high-cost supplier to become the low-cost supplier. Our results can provide some practical insights on managing cost information asymmetry from the perspectives of the supply chain and the industry.

On the trade-off between supplier diversity and cost-effective procurement

The COVID-19 pandemic has highlighted the need to rely on a diverse pool of suppliers, besides achieving cost effectiveness. Common wisdom, however, holds that these two aims are in conflict. We explore a model of dual sourcing and propose complementing a share auction with affirmative action to create an endogenous set-aside for a high-cost supplier. In our model more intensive affirmative action strengthens the targeted provider. This has the potential to level the playing field, inducing more competitive procurement overall. Our main result provides a condition under which the endogenous set-aside not only guarantees a very substantial share for the high-cost supplier, but also reduces the buyer's provision cost compared to a standard auction. We also illustrate how our approach can help reducing the severity and likelihood of health product shortages, such as those occurred during the COVID-19 outbreak.

Materials Design and System Innovation for Direct and Indirect Seawater Electrolysis.

Green hydrogen production from renewably powered water electrolysis is considered as an ideal approach to decarbonizing the energy and industry sectors. Given the high-cost supply of ultra-high-purity water, as well as the mismatched distribution of water sources and renewable energies, combining seawater electrolysis with coastal solar/offshore wind power is attracting increasing interest for large-scale green hydrogen production. However, various impurities in seawater lead to corrosive and toxic halides, hydroxide precipitation, and physical blocking, which will significantly degrade catalysts, electrodes, and membranes, thus shortening the stable service life of electrolyzers. To accelerate the development of seawater electrolysis, it is crucial to widen the working potential gap between oxygen evolution and chlorine evolution reactions and develop flexible and highly efficient seawater purification technologies. In this review, we comprehensively discuss present challenges, research efforts, and design principles for direct/indirect seawater electrolysis from the aspects of materials engineering and system innovation. Further opportunities in developing efficient and stable catalysts, advanced membranes, and integrated electrolyzers are highlighted for green hydrogen production from both seawater and low-grade water sources.

De novo biosynthesis of anticarcinogenic icariin in engineered yeast

Icariin (ICA) has wide applications in nutraceuticals and medicine with strong anticancer activities. However, the structural complexity and low abundance in plants of ICA lead to the unsustainable and high-cost supply from chemical synthesis and plant extraction. Here, the whole biosynthesis pathway of ICA was elucidated, then was constructed in Saccharomyces cerevisiae, including a 13-step heterologous ICA pathway from eleven kinds of plants as well as deletions or overexpression of ten yeast endogenous genes. Spatial regulation of 8-C-prenyltransferase to mitochondria and three-stage sequential control of 4’-O-methyltransferase, 3-OH rhamnosyltransferase, and 7-OH glycosyltransferase expression successfully achieved the de novo synthesis of ICA with a titer of 130 μg/L under shake-flask culture. The ICA synthesis from glucose represents the longest reconstructed pathway of flavonoid in microbe so far. This study provides a potential choice for the sustainable microbial production of number of complex flavonoids.

Supply chain contracting with asymmetric cost information and behavioral preferences: Theory and experiment

We investigate a supply chain composed of a retailer who designs a contract with wholesale price and order quantity, and a supplier who has private information of low or high unit production cost. The standard benchmark predicts that in equilibrium, the optimal contract possesses a threshold dividing a cutoff condition and a non-cutoff condition for the retailer. Under the cutoff condition, retailers trade only with low-cost suppliers, while under the non-cutoff condition, retailers trade with both low-cost and high-cost suppliers. Suppliers accept the critical non-negative profit contracts. We incorporate behavioral factors of the retailer’s risk preference and the supplier’s fairness concern in view of the decision-making scenario. The behavioral model shows that the risk preference influences the threshold of the optimal contract design, while the fairness concern only affects the optimal wholesale price. We conduct a laboratory experiment to examine both parties’ decision behaviors and find that human retailers with risk-averse preference make local optimal strategies rather than global optimal strategies, which counter-intuitively improves the channel profit; and human suppliers with fairness concern enables human retailers to provide fair contracts, which increases the channel profit and balances the channel profit distribution. These findings imply that the behavior of retailers and suppliers plays an important role in mechanism design of supply chains.

Comparison of Post Transplant Outcomes between Refrigerated and Cryopreserved Autologous Hematopoietic Stem Cells in Patients with Multiple Myeloma

Introduction: Approximately 10% of individuals with hematological malignancies are diagnosed with Multiple Myeloma (MM); in addition, the incidence and prevalence of the disease have progressively increased in recent decades. Despite the recent remarkable advances in treatment, autologous hematopoietic stem cell transplantation (ASCT) is still a fundamental part of the therapeutic management of this population. Particularly in developing countries, ASCT is an underused tool. Social and economic issues play an essential role in accessing the procedure. Refrigerated hematopoietic stem cells (R-HSC) can be an attractive alternative to the traditional use of cryopreserved hematopoietic stem cells (C-HSC) since cryopreservation demands highly trained human resources, high-cost supplies, and sophisticated equipment. Aim: In order to compare the applicability, safety, and possible clinical and economic benefits of ASCT with different types of cell storage before infusion, we analyzed the medical records of patients diagnosed with MM who were transplanted using R-HSC or C-HSC. Methods: The study was approved by the local Research Ethics Committee. We analyzed charts of patients diagnosed with MM and submitted to ASCT at Erasto Gaertner Hospital between January 2017 and July 2021. R-HSC: Cells were stored immediately after leukapheresis, without any handling procedure, kept in a standard refrigerator at a temperature between 2-6oC, and infused within 48 hours after collection. C-HSC: Cells were collected by leukapheresis and submitted to cryopreservation within 12 hours after the procedure. As a cryoprotectant, a solution with dimethyl sulfoxide (DMSO) at a final concentration of 5.5% was used. The product's temperature was reduced under a controlled cooling rate and stored in a freezer at -80oC. All patients received a single intravenous dose of melphalan (200-100mg/m2) 24 hours before receiving the cells as conditioning regimen. In the group of patients who received R-HSC, the cells were removed from the refrigerator and immediately infused at a rate of 10 ml/minute. However, in patients who received C-HSC, the cells were removed from the freezer, thawed in a water bath at 37oC, and infused intravenously at a rate of 10 ml/minute. All patients received G-CSF from D+5 until neutrophilic engraftment. Results: We reviewed records of 170 patients. One hundred eight subjects received R-HSC and 62 C-HSC. Demographic characteristics, CD34+ cell dose received, melphalan dose, febrile neutropenia, and early mortality related to the procedure were similar between the two groups. There was a significant statistical difference in favor of the group utilizing R-HSC related to days until neutrophil engraftment (10 vs. 14 days p<0.0001), days until platelet engraftment (12 vs. 15 days p<0.0001), days of hospitalization (13 vs. 16 days p<0.0001) and infusion-related adverse reactions (10.1% vs. 33.8% p=0.003). There were no cases of graft failure in both groups. A reduction of 32.4% in the total cost per transplant was noticed in the R-HSC group. Conclusions: We demonstrated in this analysis that the use of stem cells stored in a standard refrigerator, with a temperature between 2-6oC for up to 48 hours after the collection is a safe and efficient approach. It was capable of simplifying the ASCT, preventing infusion-related adverse reactions, assuring an early neutrophil and platelet engraftment, and reducing hospitalization days. This strategy should be considered especially in resource constrained settings to avoid unnecessary expenses, increase the number of transplant centers, and expand access to the procedure.

Contract strategies in competitive supply chains subject to inventory inaccuracy

We use a newsvendor model to investigate equilibrium contracting strategies and their impact on the members in two competing supply chains that are subject to inventory inaccuracy. The suppliers are Stackelberg leaders and can choose either a wholesale-price contract or consignment contract. As a result, we analyze three cases: the wholesale price contract case, consignment contract case, and hybrid contract case. We first analytically derive the optimal outcomes of each case and then analyze the equilibrium behaviors of suppliers and retailers under both symmetric and asymmetric settings. Our results show that the consignment contract is no longer the dominant strategy for dominant suppliers when inventory inaccuracy is considered, even though it is considered as the channel-coordinating contract format in the traditional supply chain. Specifically, in the symmetric case, the wholesale price contract is the equilibrium contracting strategy when inventory inaccuracy is below a certain threshold. In the asymmetric case, the hybrid scenario occurs when the high-cost supplier chooses the wholesale price contract, and the low-cost supplier chooses the consignment contract when inventory inaccuracy is less than a certain value. Furthermore, our results demonstrate that the threshold point of inventory inaccuracy is interrelated with the channel cost-sharing rate and level of chain-to-chain competition between supply chains.

Private Information and Dynamic Bargaining in Supply Chains: An Experimental Study

Problem definition: We conduct a controlled human-subjects experiment in a two-tier supply chain where a supplier’s per-unit production cost may be private information while bargaining with a buyer. Academic/practical relevance: Academically, supply chain studies often assume full-information or highly structured bargaining. We consider private information with dynamic, unstructured bargaining. In practice, a buyer may not know its supplier’s cost exactly and interact with its supplier in a back-and-forth bargaining environment. Thus, understanding how a supplier’s private cost information affects both supply chain outcomes and bargaining is new to the literature and relevant to practice. Methodology: We employ insights from mechanism design to generate restrictions on the space of agreements and solve for a specific bargaining solution under private information to generate precise predictions. These predictions are then tested through a human-subjects experiment. Results: In our experiment, theory predicts that all supplier types should earn at least 50% of total profits when their cost information is private. However, we find that high-cost suppliers earn a disproportionately low share of total profits under private information, 20.16%. We show that this is because buyers, under private information, act as if they are bargaining with the lowest-cost supplier and suppliers do not appear to blame buyers for behaving this way. Based on these findings, we conduct an additional experiment where suppliers have the ability to communicate their private costs to buyers and observe that verifiable disclosure significantly increases profits for high-cost suppliers. Managerial implications: High-cost suppliers actually suffer from having their costs as private information, which runs counter to theory. However, if high-cost suppliers can credibly disclose their costs to buyers, they can significantly increase profits. Lastly, although private information does not lead to more disagreements, negotiations do take longer, which can be costly to firms.

Supplier Diversity Before the Time of Cholera

The current COVID-19 pandemic has highlighted the need to rely on a diverse poolof suppliers, besides achieving cost effectiveness. We propose complementing a shareauction for dual sourcing with affirmative action to create an endogenous set-asidefor a high-cost supplier. In our model more intensive affirmative action strengthensthe targeted provider. This has the potential to level the playing field, inducing morecompetitive procurement overall. Our main result provides a condition under whichthe endogenous set-aside not only guarantees a very substantial share for the high-costsupplier, but also reduces the buyer's provision cost compared to a standard auction.We also illustrate how our approach can help reducing the severity and likelihood ofhealth product shortages, such as those occurred during the recent COVID-19 outbreak.

Analytical evaluation of relation between alignment and performance in service triads – three differing contexts

Supply chain (SC) agility depends on organisational structure; customer satisfaction, and collaboration among SC actors. To understand these dimensions and their impact on supply chain performance, we have analysed three 'triadic' relationships. Examples in this research paper involve: 1) hospital buyers managing high-cost supplies with outside vendors, but influenced by its physicians; 2) specialised hospital outpatient units that need to coordinate patient flow with medical staff and attending physicians; 3) logistics service providers with assets managing its demand with external customer through an internal brokerage service. Specifically, we have analytically evaluated organisational – 'pressures' (hierarchical versus bureaucratic), 'practices' (scheduling, time-blocks) and 'structures' (captive versus autonomous) and how they influence alignment between interactions in the respective triads to ultimately affect performance, namely, lower supply expenses, balancing customer satisfaction and asset utilisation, and profitability.

Analytical evaluation of relation between alignment and performance in service triads – three differing contexts

Supply chain (SC) agility depends on organisational structure; customer satisfaction, and collaboration among SC actors. To understand these dimensions and their impact on supply chain performance, we have analysed three 'triadic' relationships. Examples in this research paper involve: 1) hospital buyers managing high-cost supplies with outside vendors, but influenced by its physicians; 2) specialised hospital outpatient units that need to coordinate patient flow with medical staff and attending physicians; 3) logistics service providers with assets managing its demand with external customer through an internal brokerage service. Specifically, we have analytically evaluated organisational – 'pressures' (hierarchical versus bureaucratic), 'practices' (scheduling, time-blocks) and 'structures' (captive versus autonomous) and how they influence alignment between interactions in the respective triads to ultimately affect performance, namely, lower supply expenses, balancing customer satisfaction and asset utilisation, and profitability.

Analysis for the implementation of a system for natural gas liquids removal and recovery at the gas processing plant El Centro in Santander, Colombia

The present work carried out the analysis of seven natural gas liquids removal and recovery technologies, evaluating ten decision criteria to identify the technology with the highest technical and economic potential to be implemented at the gas plant “El Centro”, Colombia. The technical criteria evaluated took into account: the chemical composition of the natural gas processed; the flow, pressure and temperature of the system; the efficiency in the removal of natural gas liquids and the technology adaptability against fluctuations that may occur in the operating conditions. On the other hand, the economic criteria evaluated included the purchase of high–cost supplies and equipment, as well as space and maintenance requirements for their implementation. Based on the analysis, the triethylene glycol improved absorption process was established as the technology with the greatest potential to be implemented at the gas plant “El Centro”, Colombia, so it was evaluated in a pilot test where a reduction of 30 °F on the cricondentherm point was observed, associated to the removal of higher molecular weight hydrocarbons from the natural gas stream.

Dual Sourcing Strategy for High-Tech Manufacturer Under Supply Risk and Capacity Constraint

High-tech manufacturers frequently suffer from supply risk and capacity constraint. This paper considers a manufacturer who procures a type of high-tech component from two suppliers with asymmetric costs, capacities, and reliabilities, where the low-cost supplier has low reliability. One supplier is selected as a primary supplier and another as a backup supplier. The manufacturer places regular order to the primary supplier and determines backup order quantity from the backup supplier after random yield realization of the primary supplier. By developing a dynamic game-theoretical model, we obtain the optimal wholesale prices for the primary supplier and backup supplier, the optimal order quantity and supplier arrangement decisions for the manufacturer. We show that the manufacturer selects the low-cost supplier as a primary supplier and the high-cost supplier as a backup supplier (namely, LH policy) when the reliabilities of the two suppliers are close. When these reliabilities are not so close, the manufacturer chooses the high-cost supplier as a primary supplier and the low-cost supplier as a backup supplier (namely, HL policy). In addition, the manufacturer in the industry with scale diseconomies is more likely to select HL policy than that in the industry with scale economies. Compared with centralized decision making scheme, decentralized scheme induces the manufacturer more likely to select HL policy in the industry without scale economies, whereas in the industry with scale economies, decentralized scheme induces the manufacturer more likely to choose either HL policy when the capacity advantage of the low-cost supplier is weak, or LH policy when this advantage is significant.

Private Information and Endogenous Matching in Supply Chains: Theory and Experiments

We investigate a supply chain setting where a supplier's cost information may be private information (and they have the ability to disclose it) and buyers and suppliers may endogenously match into pairs. After forming pairs, the two parties interact in a dynamic back-and-forth bargaining environment. We first derive theoretical predictions depending on whether the supplier's cost information is private or not, and the matching protocol type. We then test these predictions through a human-subject experiment, which yields a number of insights. A key one is that suppliers always make less than the normative theory predicts, whether their cost information is known or private information. This effect is especially pronounced under private information for high cost suppliers, because buyers make more aggressive bargaining offers in such a setting. Thus, contrary to theory, a second result is that higher cost suppliers actually benefit from disclosing their private costs, in an effort to achieve a more favorable outcome while bargaining. A third important result is that endogenous matching leads to a higher variance of profits, compared to an exogenous matching protocol. This is due to the ability of higher quality buyers to choose to contract with higher quality suppliers and vice-versa.

Preparing for bundled payments in urology: Defining episodes, evaluating variations in care, and demonstrating improved value.

11 Background: As payors introduce APMs, there is little guidance on how episodes will be defined in subspecialty areas. We set out to define clinically relevant episodes of care, develop standardized approachs toward reducing variations in care, and implement evidence-based standardized care pathways. We chose two urologic cancer procedures- Radical Cystectomy and Robotic Radical Prostatectomy. Methods: Episode timeframes were defined: Radical Cystectomy (14 days prior, index hospitalization, 90 days post) and RALP (30 days prior, index hospitalization, 30 days post). To identify variations in care, we compared evidence-based guidelines with practice patterns, analyzed episode and index hospitalization direct costs for various surgeons, and reviewed the utilization of high cost supplies and drugs. Length of stay (LOS), readmissions, complications, and acuity were benchmarked against comparable academic medical centers. Faculty, trainees, APPs, and staff collaborated to develop care pathways, modify workflows and EPIC order sets to reduce variation, improve outcomes, and increase efficiency. Results: Variation in care was reflected in wide standard deviations in episode direct costs. Six months after implementing care pathways, we achieved the following: RALP average cost per episode decreased by 15%. Standard deviation in episode direct costs decreased by 77%. The percentage of patients with 1-day LOS increased from 21% to 67%. The medical surgical supply costs during hospitalization decreased by 22.5%. Standard deviation in episode direct costs for Radical Cystectomy decreased by 27%. Readmissions to SHC decreased from 15.6% to 12.5%. The percentage of patients with less than 6-day LOS increased from 46% to 66%. Conclusions: Across two episodes, our care redesign efforts had actualized direct cost savings of $692,000 annually. As we prepare for future APMs, similar multidisciplinary approaches can be applied to other areas to reduce costs and improve quality of care.

Predictors of micro-costing components in liver transplantation

OBJECTIVES:Although liver transplantation procedures are common and highly expensive, their cost structure is still poorly understood. This study aimed to develop models of micro-costs among patients undergoing liver transplantation procedures while comparing the role of individual clinical predictors using tree regression models.METHODS:We prospectively collected micro-cost data from patients undergoing liver transplantation in a tertiary academic center. Data collection was conducted using an Intranet registry integrated into the institution’s database for the storing of financial and clinical data for transplantation cases.RESULTS:A total of 278 patients were included and accounted for 300 procedures. When evaluating specific costs for the operating room, intensive care unit and ward, we found that in all of the sectors but the ward, human resources were responsible for the highest costs. High cost supplies were important drivers for the operating room, whereas drugs were among the top four drivers for all sectors. When evaluating the predictors of total cost, a MELD score greater than 30 was the most important predictor of high cost, followed by a Donor Risk Index greater than 1.8.CONCLUSION:By focusing on the highest cost drivers and predictors, hospitals can initiate programs to reduce cost while maintaining high quality care standards.

Information acquisition and transparency in a supply chain with asymmetric production cost information

This paper studies a retailer outsourcing the production to a supplier who can improve the quality of the production cost information by exerting costly forecasting effort. The outcome of the supplier's information acquisition may turn out to be either successful, with the supplier becoming informed, or unsuccessful, with the supplier remaining uninformed. Once the outcome of the forecasting is resolved, the supplier knows the information status (informed or uninformed) and content (high type or low type). We consider two-layer information asymmetry and analyze three different scenarios: no forecasting, forecasting with transparent information acquisition (disclosing information status) and forecasting with nontransparent information acquisition (hiding information status). We study both the retailer's contract design and the supplier's information disclosure decision. We obtain some interesting observations. First, the retailer's incentive for the supplier's forecasting is a threshold policy: If the forecasting cost is low, then the retailer will prefer the supplier to forecast, otherwise, the retailer will prefer the supplier not to forecast. Second, when the forecasting cost is high and the production cost variance is small, under transparent information acquisition, the high cost supplier's production quantity may be either upward or downward distorted; while under nontransparent information acquisition, the uninformed supplier's production quantity is either upward or downward distorted, and the high cost supplier's production quantity is always downward distorted. At last, the supplier can benefit from transparency only under some specific conditions, and when the production cost variance is extremely large, nontransparent information acquisition is always the supplier's first choice.

Sequential unreliable newsboy ordering policies

In this paper, we show how ordering time can be used as a mechanism to mitigate the supply risks of the unreliable newsboy. We consider the situation where a firm has an option of placing a series of sequential orders such that a new order is placed only after the yield from the previous order is known and derive an optimal order quantity for each ordering stage. The effectiveness of our approach is assessed by comparing its expected cost with the expected cost of the conventional reliable newsboy problem. It is demonstrated that the adverse effect of supply side risks can be almost completely negated by adopting our approach when the combined purchasing and holding costs for a low cost supplier at an earlier stage are equal to those of a high cost supplier at the next stage. Computational experiments suggest that the sequential ordering policy performs better than a simultaneous ordering strategy when customer service level norms become stringent and inventory holding costs decrease.

Supply diversification with isoelastic demand

We study a firm׳s sourcing strategy when facing two unreliable suppliers and a price-dependent isoelastic demand. At optimality, the firm always orders at least from the low-cost supplier. The firm also orders from the high-cost supplier if and only if the effective purchase cost from the low-cost supplier is greater than the actual purchase cost from the high-cost supplier. We also find that when the firm orders from both suppliers, the total order quantity decreases as the correlation between the suppliers׳ capacities increases.

The SGR Patch Has Fine Print That Also Affects Doctors

On April 1, President Obama ­officially halted the 24% Medicare physician pay cut when he signed into law a bill that provides a 12-month pay patch. The legislation replaces the scheduled fee cut with a 0.5% pay increase through the end of 2014. It then freezes payment levels for the first 3 months of 2015, giving Congress another year to figure out if it can pass legislation to permanently repeal Medicare's Sustainable Growth Rate (SGR) formula. The good news, said Reid Blackwelder, MD, president of the American Academy of Family Physicians (AAFP), is that lawmakers have already made a lot of progress toward a permanent repeal of the SGR. But the 1-year patch may give Congress only a few months to work out its disagreements, he said, because the midterm elections are likely to disrupt the process and bring in new faces unfamiliar with the work that's already been done. “There are likely to be changes in the Congress itself, which creates some worry,” he said. But the 45-page bill did a lot more than just put a Band-Aid on the problem of the SGR. The biggest policy change is the 1-year delay of the implementation of the ICD-10 coding sets, which had been scheduled to go into effect on Oct. 1, 2014. Under the recently passed law, the Department of Health & Human Services (HHS) is barred from implementing the new coding sets until at least Oct. 1, 2015. The delay was greeted with relief from most physician groups, which had already warned the government that many physicians, especially those in small practices, weren't ready to make the switch. But a coalition that includes health information technology companies, health plans, and the American Hospital Association decried the delay. The industry has already invested time and money in the switch, and a delay will only cause disruption, according to the Coalition for ICD-10. Enforcement of the controversial policy by Recovery Audit Contractors (RACs) had already been delayed until Oct. 1, 2014. Under H.R. 4302, most postpayment claims audits by RACs are now delayed until March 31, 2015. However, RACs are allowed to perform audits in cases where there is evidence of systematic gaming, fraud, abuse, or delays in delivering care, according to the legislation. The bill also includes a provision to more aggressively target potentially misvalued codes. For instance, it directs HHS to examine codes that: ▸have experienced the fastest growth.▸have undergone substantial changes in practice expenses.▸describe new technologies.▸account for the majority of spending under the Physician Fee Schedule.▸have high-cost supplies. The bill sets a target for reducing misvalued services from 2017 through 2020 (0.5% of the estimated amount of the fee schedule spending). If the target is met, the savings are redistributed to other services in the fee schedule. However, if the target is not met, payments are reduced. Cuts of 20% or more in a year will be phased in over a 2-year period, according to the legislation. While primary care groups have been urging the government to shift payments toward cognitive services and away from procedural work for years, they said the bill's misvalued code provision is probably bad news for physicians. The problem, said Norman E. Vinn, DO, president of the American Osteopathic Association, is that it doesn't just redirect payments from one area to another but instead appears to cut payments to physicians across the board. But physicians praised the bill's increased funding for mental health services. The bill funds a 2-year pilot project aimed at improving community mental health services and a grant program for assisted outpatient treatment for people with serious mental illness. Under the 4-year grant program, HHS will award up to $1 million each to no more than 50 institutions providing outpatient care to individuals with serious mental illness who have been ordered by a court to seek treatment.