‘The risks of late GI complications may change as therapy for childhood and adolescent malignancy proceeds to evolve and can require studies of recently treated patients,’ added Dr. Goldsby. Although various disease-specific combinations of chemotherapy, radiation and surgery have significantly improved survival, these treatment modalities have the potential to trigger significant GI problems. For example, abdominal radiation results in several acute toxicities often, including intestinal irritation and abnormal motion of the intestinal tract. Chemotherapy is connected with many acute GI toxicities, including nausea, vomiting, diarrhea, constipation and increased susceptibility to GI infections. Intra-abdominal surgery and subsequent GI complications are also contributors to GI toxicity of cancers therapy.Greater costs to Medicare because of longer hospital stays – Confusion about the restricted set of contracted house medical providers delayed hospital discharges and triggered unneeded emergency room visits.Non-local providers – Providers with no history of servicing a geographic area or zero operations in a bidding area had been awarded agreements. Inexperienced/unlicensed providers – Businesses were awarded Medicare contracts to provide equipment and services for which these were not licensed in their states and for which they had no previous experience offering. Desperation bidding – Structural flaws in the bidding program caused providers to send artificially low bids because these were confronted with the risk of shedding their businesses if not really awarded a contract.