{"id":37697,"date":"2016-10-27T16:58:29","date_gmt":"2016-10-27T15:58:29","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=37697"},"modified":"2016-10-28T09:34:11","modified_gmt":"2016-10-28T08:34:11","slug":"no-waiving-goodbye-to-medicaid-expansion","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2016\/10\/27\/no-waiving-goodbye-to-medicaid-expansion\/","title":{"rendered":"No waiving goodbye to Medicaid expansion: What does the rejection of Ohio\u2019s Medicaid waiver proposal mean for other states?"},"content":{"rendered":"

\"evan_goldstein\"Since the enactment of the Affordable Care Act (ACA, or Obamacare), the number of uninsured individuals in the United States\u00a0decreased from 49 million in 2010 to 29 million in 2015<\/a>. While the American press and political debate remain focused on the shortcomings of the ACA\u2019s Health Insurance Marketplace, relatively little attention is paid to the status of the expanded Medicaid program\u2014the ACA\u2019s mechanism for providing health insurance at no or little cost for Americans on low incomes.<\/p>\n

Such disregard is worrisome considering that, under the ACA, upwards of\u00a011-15 million <\/b>of the newly insured Americans have gained health insurance coverage through Medicaid expansion, even though only 31 states opted to expand it per the ACA.<\/p>\n

Even more worrisome,\u00a0the scent of political skullduggery is in the air. Despite the nascent successes of the expanded Medicaid program, several clever states headed by Republican governments<\/a> are contemplating how to reverse course via Section 1115 of the US Social Security Act, so that they can alter their Medicaid programs (known as a Medicaid demonstration waiver) and request monthly payments from most Medicaid beneficiaries whom otherwise receive healthcare at essentially no cost under the ACA model.<\/p>\n

Ohio is one such state. In June 2016, the state of Ohio submitted an\u00a0application<\/a> for a Section 1115 demonstration waiver program known as Healthy Ohio HSA<\/em> (Healthy Ohio) to the Centers for Medicare and Medicaid Services (CMS).<\/p>\n

The CMS denied the application proposal in September. For now, the state\u2019s traditional expanded Medicaid (Medicaid Expansion) program remains intact\u2014through which over\u00a0600 000 adults<\/a> have obtained coverage.<\/p>\n

The CMS\u2019s decision is significant not just on its own, but for the precedent it sets. The Healthy Ohio decision represents the first time that the CMS has reviewed (and the first time it’s rejected) an application from a state that has already implemented traditional Medicaid expansion pursuant to the rules of the ACA.<\/p>\n

Just as no two Medicaid programs are the same, no two 1115 demonstration waiver programs are alike. Yet\u00a0the CMS\u2019s decision about the fate of Healthy Ohio provides key insight into how the agency will react to pending and forthcoming 1115 demonstration waiver applications submitted by states (such as Kentucky and Arizona) that have already implemented Medicaid expansion.<\/p>\n

During the state\u2019s public commentary period, over 900 organizational stakeholders (for example, providers, hospitals, health plans, advocacy groups) provided feedback.<\/a>\u00a0Eighty four per cent of these 965 respondents<\/a>\u00a0identified potential patient related consequences of replacing ACA\u2019s Medicaid with an alternative program, arguing that Ohio\u2019s proposed new program would limit access or disrupt coverage for low income Ohioans.<\/p>\n

However, there was also a majority of respondents who made organization related appeals, regardless of concerns over access to care. Over 50% of respondents focused on how the proposed Medicaid program changes would be (a) administratively burdensome for providers and payers and (b) would interfere with continuity of care\u2014particularly for services that have required providers to address new organizational care coordination and integration arrangements under the ACA.<\/p>\n

Just two years into their implementation of the state\u2019s ACA Medicaid expansion, the majority of respondents expressed concern about the substantial logistical changes the Healthy Ohio program would provoke for organizations and institutions.<\/p>\n

But can organizational needs alone influence the CMS\u2019s decision making on a 1115 demonstration waiver outcome? \u00a0The specific criteria by which the CMS determines whether the objectives of Medicaid\/ the Children\u2019s Health Insurance Program (CHIP) would be satisfied by a waiver program like Healthy Ohio include: Does it<\/p>\n

    \n
  1. Increase and strengthen overall coverage of low income individuals in the state;<\/li>\n
  2. Increase access to, stabilize, and strengthen providers and provider networks available to serve Medicaid and low income populations in the state;<\/li>\n
  3. Improve health outcomes for Medicaid and other low income populations in the state; or<\/li>\n
  4. Increase the efficiency and quality of care for Medicaid and other low income populations through initiatives to transform service delivery networks.<\/li>\n<\/ol>\n

    Indeed,\u00a0criteria 2<\/em>\u00a0and\u00a04<\/em>\u00a0require the CMS to consider how proposed programs would affect providers, provider networks, and their subsequent ability to deliver an efficient and quality service. According to the 965 organizations who provided commentary on Ohio\u2019s 1115 demonstration waiver application, the proposed Healthy Ohio program would have not only decreased enrollment and access by those who receive coverage under the current Medicaid program, it would have also intentionally imposed inefficiencies and increased costs upon community healthcare providers and local health systems.<\/p>\n

    In a\u00a0letter to Ohio Medicaid Director John McCarthy<\/a>, the CMS encouraged Director McCarthy to continue upon the progress Ohio has made under the 2014 Medicaid expansion and the state\u2019s commitment to \u201cstrengthening delivery systems.\u201d In effect, the CMS\u2019s ruling perhaps signals that it will reject any Medicaid waiver applications that create burdens on program beneficiaries and\/or providers, which in turn create barriers to patients accessing care. As such, states should anticipate the rejection of any proposal calling for underserved beneficiaries to put more financial “skin in the game.”<\/p>\n

    The CMS\u2019s rejection of Healthy Ohio may further set the precedent that evidence of clear, convincing, and widespread burden to organizations alone (even without harm to those accessing care) may be grounds for rejecting an 1115 waiver proposal.<\/p>\n

    Evan Goldstein<\/strong> is a health services management and policy doctoral student at the Ohio State University in Columbus, Ohio, US. He\u00a0completed his MPhil, public policy, at the University of Cambridge where he was a Cambridge Trust Scholar. Before\u00a0returning to the US, Evan conducted global health advocacy strategy evaluation for the prevention of noncommunicable diseases department at the World Health Organization.<\/em><\/p>\n

    Competing interests:<\/strong> I have read and understood BMJ policy on declaration of interests and declare the following interests: None.<\/p>\n","protected":false},"excerpt":{"rendered":"

    Since the enactment of the Affordable Care Act (ACA, or Obamacare), the number of uninsured individuals in the United States\u00a0decreased from 49 million in 2010 to 29 million in 2015. […]<\/p>\n

    More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1357],"tags":[],"class_list":["post-37697","post","type-post","status-publish","format-standard","hentry","category-us-health-care"],"yoast_head":"\nNo waiving goodbye to Medicaid expansion: What does the rejection of Ohio\u2019s Medicaid waiver proposal mean for other states? - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/10\/27\/no-waiving-goodbye-to-medicaid-expansion\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"No waiving goodbye to Medicaid expansion: What does the rejection of Ohio\u2019s Medicaid waiver proposal mean for other states? - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Since the enactment of the Affordable Care Act (ACA, or Obamacare), the number of uninsured individuals in the United States\u00a0decreased from 49 million in 2010 to 29 million in 2015. [...]More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bmj\/2016\/10\/27\/no-waiving-goodbye-to-medicaid-expansion\/\" \/>\n<meta property=\"og:site_name\" content=\"The BMJ\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/bmjdotcom\/\" \/>\n<meta property=\"article:published_time\" content=\"2016-10-27T15:58:29+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2016-10-28T08:34:11+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/bmj\/files\/2016\/10\/Evan_Goldstein-300x281.jpg\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:site\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/10\\\/27\\\/no-waiving-goodbye-to-medicaid-expansion\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/10\\\/27\\\/no-waiving-goodbye-to-medicaid-expansion\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"No waiving goodbye to Medicaid expansion: What does the rejection of Ohio\u2019s Medicaid waiver proposal mean for other states?\",\"datePublished\":\"2016-10-27T15:58:29+00:00\",\"dateModified\":\"2016-10-28T08:34:11+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/10\\\/27\\\/no-waiving-goodbye-to-medicaid-expansion\\\/\"},\"wordCount\":954,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/10\\\/27\\\/no-waiving-goodbye-to-medicaid-expansion\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2016\\\/10\\\/Evan_Goldstein-300x281.jpg\",\"articleSection\":[\"US healthcare\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/10\\\/27\\\/no-waiving-goodbye-to-medicaid-expansion\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/10\\\/27\\\/no-waiving-goodbye-to-medicaid-expansion\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/10\\\/27\\\/no-waiving-goodbye-to-medicaid-expansion\\\/\",\"name\":\"No waiving goodbye to Medicaid expansion: What does the rejection of Ohio\u2019s Medicaid waiver proposal mean for other states? - The BMJ\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/10\\\/27\\\/no-waiving-goodbye-to-medicaid-expansion\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/10\\\/27\\\/no-waiving-goodbye-to-medicaid-expansion\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2016\\\/10\\\/Evan_Goldstein-300x281.jpg\",\"datePublished\":\"2016-10-27T15:58:29+00:00\",\"dateModified\":\"2016-10-28T08:34:11+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/10\\\/27\\\/no-waiving-goodbye-to-medicaid-expansion\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/10\\\/27\\\/no-waiving-goodbye-to-medicaid-expansion\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/10\\\/27\\\/no-waiving-goodbye-to-medicaid-expansion\\\/#primaryimage\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2016\\\/10\\\/Evan_Goldstein.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2016\\\/10\\\/Evan_Goldstein.jpg\",\"width\":660,\"height\":618},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2016\\\/10\\\/27\\\/no-waiving-goodbye-to-medicaid-expansion\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"No waiving goodbye to Medicaid expansion: What does the rejection of Ohio\u2019s Medicaid waiver proposal mean for other states?\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"name\":\"The BMJ\",\"description\":\"Helping doctors make better decisions.\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\",\"name\":\"The BMJ\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"width\":852,\"height\":568,\"caption\":\"The BMJ\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/bmjdotcom\\\/\",\"https:\\\/\\\/x.com\\\/bmj_latest\"]},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\",\"name\":\"BMJ\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"caption\":\"BMJ\"},\"sameAs\":[\"https:\\\/\\\/blogs.bmj.com\\\/\"],\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/author\\\/admin\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"No waiving goodbye to Medicaid expansion: What does the rejection of Ohio\u2019s Medicaid waiver proposal mean for other states? - The BMJ","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/bmj\/2016\/10\/27\/no-waiving-goodbye-to-medicaid-expansion\/","og_locale":"en_US","og_type":"article","og_title":"No waiving goodbye to Medicaid expansion: What does the rejection of Ohio\u2019s Medicaid waiver proposal mean for other states? - The BMJ","og_description":"Since the enactment of the Affordable Care Act (ACA, or Obamacare), the number of uninsured individuals in the United States\u00a0decreased from 49 million in 2010 to 29 million in 2015. [...]More...","og_url":"https:\/\/blogs.bmj.com\/bmj\/2016\/10\/27\/no-waiving-goodbye-to-medicaid-expansion\/","og_site_name":"The BMJ","article_publisher":"https:\/\/www.facebook.com\/bmjdotcom\/","article_published_time":"2016-10-27T15:58:29+00:00","article_modified_time":"2016-10-28T08:34:11+00:00","og_image":[{"url":"https:\/\/blogs.bmj.com\/bmj\/files\/2016\/10\/Evan_Goldstein-300x281.jpg","type":"","width":"","height":""}],"author":"BMJ","twitter_card":"summary_large_image","twitter_creator":"@bmj_latest","twitter_site":"@bmj_latest","twitter_misc":{"Written by":"BMJ","Est. reading time":"5 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/10\/27\/no-waiving-goodbye-to-medicaid-expansion\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/10\/27\/no-waiving-goodbye-to-medicaid-expansion\/"},"author":{"name":"BMJ","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe"},"headline":"No waiving goodbye to Medicaid expansion: What does the rejection of Ohio\u2019s Medicaid waiver proposal mean for other states?","datePublished":"2016-10-27T15:58:29+00:00","dateModified":"2016-10-28T08:34:11+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/10\/27\/no-waiving-goodbye-to-medicaid-expansion\/"},"wordCount":954,"commentCount":0,"publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/10\/27\/no-waiving-goodbye-to-medicaid-expansion\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2016\/10\/Evan_Goldstein-300x281.jpg","articleSection":["US healthcare"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/bmj\/2016\/10\/27\/no-waiving-goodbye-to-medicaid-expansion\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/10\/27\/no-waiving-goodbye-to-medicaid-expansion\/","url":"https:\/\/blogs.bmj.com\/bmj\/2016\/10\/27\/no-waiving-goodbye-to-medicaid-expansion\/","name":"No waiving goodbye to Medicaid expansion: What does the rejection of Ohio\u2019s Medicaid waiver proposal mean for other states? - The BMJ","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#website"},"primaryImageOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/10\/27\/no-waiving-goodbye-to-medicaid-expansion\/#primaryimage"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/10\/27\/no-waiving-goodbye-to-medicaid-expansion\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2016\/10\/Evan_Goldstein-300x281.jpg","datePublished":"2016-10-27T15:58:29+00:00","dateModified":"2016-10-28T08:34:11+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/10\/27\/no-waiving-goodbye-to-medicaid-expansion\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/bmj\/2016\/10\/27\/no-waiving-goodbye-to-medicaid-expansion\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/10\/27\/no-waiving-goodbye-to-medicaid-expansion\/#primaryimage","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2016\/10\/Evan_Goldstein.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2016\/10\/Evan_Goldstein.jpg","width":660,"height":618},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/bmj\/2016\/10\/27\/no-waiving-goodbye-to-medicaid-expansion\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/bmj\/"},{"@type":"ListItem","position":2,"name":"No waiving goodbye to Medicaid expansion: What does the rejection of Ohio\u2019s Medicaid waiver proposal mean for other states?"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/bmj\/#website","url":"https:\/\/blogs.bmj.com\/bmj\/","name":"The BMJ","description":"Helping doctors make better decisions.","publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/bmj\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/bmj\/#organization","name":"The BMJ","url":"https:\/\/blogs.bmj.com\/bmj\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","width":852,"height":568,"caption":"The BMJ"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/bmjdotcom\/","https:\/\/x.com\/bmj_latest"]},{"@type":"Person","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe","name":"BMJ","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","caption":"BMJ"},"sameAs":["https:\/\/blogs.bmj.com\/"],"url":"https:\/\/blogs.bmj.com\/bmj\/author\/admin\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/37697","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/comments?post=37697"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/37697\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media?parent=37697"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/categories?post=37697"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/tags?post=37697"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}