KANSAS CITY, Kan. (AP) — There is now a $1,000 award being offered for anyone who comes forward with information that leads to the return of the University of Kansas Cancer Center’s giant inflatable colon.

The American Society of Gastroenterology donated the reward money in hopes of returning the stolen colon.

The 10-foot long, 150 pound inflatable was stolen earlier this month from the back of a pickup truck in Brookside. It’s valued at $4,000 and is owned by the Cancer Coalition, which hosts walking and running events under a campaign called “Get Your Rear In Gear.”

The Cancer Coalition ships the inflatable colon across the country to help see in a unique way the progression of colon cancer.

PITTSBURGH (AP) — A shooter opened fire during a baby naming ceremony at a Pittsburgh synagogue on Saturday, killing 11 people.

At least six other people were wounded, including four police officers who dashed to the scene, authorities said.

Police said a suspect was in custody after the attack at the Tree of Life Congregation in Pittsburgh’s Squirrel Hill neighborhood. A law enforcement official identified the suspect as Robert Bowers and said he is in his 40s. The official wasn’t authorized to discuss an ongoing investigation and spoke to The Associated Press on condition of anonymity.

Families of shooting victims can call 412-432-4400 for news of their loved ones. A Victims Assistance Center has been set up at Chatham University, Berry Hall, 106 Berry Street.

— Pgh Public Safety (@PghPublicSafety) October 27, 2018

Bob Jones, the special agent in charge of the FBI’s office in Pittsburgh, said investigators Bowers was not known to law enforcement and that they believe he was acting alone. He said Bowers’ full motive still isn’t known.

The social media site Gab.com said the alleged shooter had a profile on its website, which is popular with far-right extremists. The company said the account was verified after the shooting and matched the name of the gunman.

A man with the same name posted on Gab before the shooting that “HIAS likes to bring invaders in that kill our people. I can’t sit by and watch my people get slaughtered. Screw your optics, I’m going in.”

HIAS is a nonprofit group that helps refugees around the world find safety and freedom. The organization says it is guided by Jewish values and history.

Bowers also recently posted a photo of a collection of three semi-automatic handguns he titled “my glock family,” a reference to the firearms manufacturer. He also posted photos of bullet holes in person-sized targets at a firing range, touting the “amazing trigger” on a handgun he was offering for sale.

FBI Pittsburgh and other law enforcement agencies providing an update on the shooting at the synagogue. There were 11 fatalities. pic.twitter.com/q2NMkcjt5X

— FBI Pittsburgh (@FBIPittsburgh) October 27, 2018

City officials said the shooting was being investigated as a federal hate crime. It comes amid a rash of high-profile attacks in an increasingly divided country, including the series of pipe bombs mailed over the past week to prominent Democrats and former officials.

The shooting also immediately reignited the longstanding national debate about guns: President Donald Trump said the outcome might have been different if the synagogue “had some kind of protection” from an armed guard, while Pennsylvania’s Democratic Gov. Tom Wolf noted that once again “dangerous weapons are putting our citizens in harm’s way.”

The people who provided the death toll spoke to The Associated Press anonymously because they were not authorized to speak publicly about the shooting.

The attack took place during a baby naming ceremony, according to Pennsylvania Attorney General Josh Shapiro. It was unknown whether the baby was harmed.

“It is a very horrific crime scene. It’s one of the worst that I’ve seen and I’ve been on some plane crashes,” said a visibly moved Wendell Hissrich, the Pittsburgh public safety director.

The synagogue is located in the tree-lined residential neighborhood of Squirrel Hill, about 10 minutes from downtown Pittsburgh and the hub of Pittsburgh’s Jewish community.

Jonathan Greenblatt, chief executive officer of the Anti-Defamation League, said the group believes it is the deadliest attack on the Jewish community in U.S. history.

“Our hearts break for the families of those killed and injured at the Tree of Life Synagogue, and for the entire Jewish community of Pittsburgh,” Greenblatt said.

Israeli Prime Minister Benjamin Netanyahu said he was “heartbroken and appalled” by the attack.

“The entire people of Israel grieve with the families of the dead,” Netanyahu said. “We stand together with the Jewish community of Pittsburgh. We stand together with the American people in the face of this horrendous anti-Semitic brutality. And we all pray for the speedy recovery of the wounded.”

World Jewish Congress President Ronald S. Lauder called the shooting “an attack not just on the Jewish community, but on America as a whole.”

Trump called the shooting a “wicked act of mass murder” that “is pure evil, hard to believe and frankly something that is unimaginable.”

Trump has at times been accused by critics of failing to adequately condemn hate, such as when he blamed “both sides” for the violence at a Charlottesville white supremacist rally.

On Saturday, he said that anti-Semitism “must be confronted anywhere and everywhere it appears.”

In 2010, Tree of Life Congregation — founded more than 150 years ago — merged with Or L’Simcha to form Tree of Life (asterisk) Or L’Simcha.

The synagogue is a fortress-like concrete building, its facade punctuated by rows of swirling, modernistic stained-glass windows illustrating the story of creation, the acceptance of God’s law, the “life cycle” and “how human-beings should care for the earth and one another,” according to its website. Among its treasures is a “Holocaust Torah,” rescued from Czechoslovakia.

Its sanctuary can hold up to 1,250 guests.

Michael Eisenberg, the immediate past president of the Tree of Life Synagogue, lives about a block from the building.

He was getting ready for services when he received a phone call from a member who works with Pittsburgh’s Emergency Services, saying he had been notified through scanner and other communications that there was an active shooter at their synagogue.

“I ran out of the house without changing and I saw the street blocked with police cars. It was a surreal scene. And someone yelled, ‘Get out of here.’ I realized it was a police officer along the side of the house. … I am sure I know all of the people, all of the fatalities. I am just waiting to see,” Eisenberg said.

He said officials at the synagogue had not gotten any threats that he knew of prior to the shooting. The synagogue maintenance employees had recently checked all of the emergency exits and doors to make sure they were cleared and working.

“I spoke to a maintenance person who was in the building and heard the shots. He was able to escape through one of the side exit doors we had made sure was functioning,” Eisenberg said.

Jeff Finkelstein of the Jewish Federation of Greater Pittsburgh said local synagogues have done “lots of training on things like active shooters, and we’ve looked at hardening facilities as much as possible.”

“This should not be happening, period,” he told reporters at the scene. “This should not be happening in a synagogue.”

Just three days before the shooting, Rabbi Jeffrey Myers posted a column on the congregation’s website, noting that people make time to attend funerals, but not for life’s happy occasions.

“There is a story told in the Talmud of a wedding procession and a funeral procession heading along parallel roads, with the roads intersecting,” Myers wrote on Wednesday. “The question asked is: when they meet at the fork, which procession goes first, funeral or wedding? The correct answer is wedding, as the joy of the couple takes precedence. In fact, the funeral procession is to move out of sight so that their joy is not lessened.”

Myers ended his column with words that now seem all too prescient.

“We value joy so much in Judaism that upon taking our leave from a funeral or a shiva house, the customary statement one makes (in Yiddish) is ‘nor oyf simches’ – only for s’machot,” Myers wrote. “While death is inevitable and a part of life, we still take our leave with the best possible blessing, to meet at joyous events. And so I say to you: nor oyf simches!”

___

SHAWNEE COUNTY — Law enforcement authorities are investigating a shooting and asking for help to locate suspects.

Just after 2:15a.m. Saturday, the Shawnee County dispatch center began receiving calls of shots fired in the area of 5222 SW 10th Street in Topeka, according to Lt. Manuel Munoz.

Officers who were working another call nearby reported hearing the shots. They responded and located three victims who appeared to be suffering from non-life threating gunshot wounds. All three individuals were transported to a local hospital, according to Munoz.

Detectives and officers have interviewed witness and are gathering information.

Anyone with information regarding this crime is encouraged to contact the Topeka Police Criminal Investigation Bureau at (785) 368-9400 or Crime Stoppers at (785) 234-0007.

By NOMIN UJIYEDIIN

Kris Kobach says his proposal to reform Kansas Medicaid could save the state $2 billion.

At campaign events, the Republican nominee for governor touts the benefits of combining Medicaid with direct primary care, an unconventional payment system that avoids the bureaucracy of health insurance.

But the people who gave Kobach the idea say they haven’t calculated that direct primary care would save $2 billion for Kansas Medicaid.  And Kobach’s campaign hasn’t provided an alternative source for that number.

On top of that, health experts say the idea oversimplifies one of the state’s largest and most complex expenditures. While direct primary care is a familiar idea in Kansas in private practice, no one knows whether it could work with Medicaid’s complex structure and recipients’ specialized needs.

Direct primary care, sometimes called “concierge medicine,” allows patients to pay doctors a monthly or yearly fee for unlimited primary care. That often includes office visits, phone calls and texts.

Direct primary care clinics offer patients discounts on procedures, medications and lab tests. They typically don’t take insurance, which saves doctors the hassle and overhead costs of dealing with insurance companies. The Kansas Department of Health and Environment says about 30 doctors use the system in Kansas.

For years, lawmakers have considered bringing direct primary care to KanCare, the Medicaid program that serves 425,000 of the state’s most vulnerable residents. Now, Kobach and his independent opponent, Greg Orman, have included the proposal in their campaign platforms.

“If we had successful direct primary care for our KanCare system, the $3.2 billion that we’re spending for 400,000 people would go down to $1.3 billion for the same 400,000 people,” Kobach said at a July candidate forum in Garden City. “There is an opportunity to realize  great savings in our KanCare system.”

Kobach’s other statements on the subject are frequent, but lack detail. His campaign website doesn’t include a section on his proposals for health policy. At an October press conference, Kobach told the Kansas News Service he would introduce a direct primary care pilot program to one county or region before expanding it to Medicaid across the state and, he promised, reaping $1.9 billion dollars in savings.

“If it works well in that setting, then we would hopefully expand it, “ Kobach said. “You’d have to go statewide with it to save that kind of money.”

Despite repeated requests from the Kansas News Service, the Kobach campaign hasn’t provided a source for that number. A spokeswoman said Kobach based the idea off of work by Steve Anderson, a former state budget director under former Gov. Sam Brownback, and Josh Umbehr, a direct primary care physician. But neither Anderson nor Umbehr say they calculated anywhere near $2 billion in potential savings.

The back of an envelope

Umbehr has long been an advocate for direct primary care, speaking about the subject across the country and making appearances on local and national media.

He’s run a direct primary care clinic in Wichita since 2010 and says the payment system saves his business time and money.

“We cut out a lot of middlemen,” Umbehr said. “We can lower that price and offer that directly to our patients.”

When his father, lawyer Keen Umbehr, ran for Kansas governor as a Libertarian in 2014, Josh Umbehr was his running mate. Their platformpromised to save the state $1 billion by combining direct primary care with Medicaid.

In 2015, Josh Umbehr testified about the idea in front of a Kansas House of Representatives committee, attracting interest from lawmakers. A month later, the committee introduced a bill creating a direct primary care pilot program as part of broader Medicaid reforms. But that legislation stalled.

Now, Umbehr is advising the Kobach campaign on the issue. He also practices medicine in the Hartman Oil Building — the same place where Wink Hartman, Kobach’s running mate, headquarters his oil company.

Umbehr and Anderson remember calculating the potential Medicaid savings of direct primary care over a meal at a Wichita restaurant in 2013 or 2014.

Anderson said they took the discounted prices that Umbehr charged at his clinic and applied those discounts to KanCare procedures and expenses  — minus the cost of nursing home care.

“Three hundred knee replacements, for example,” Anderson said. “And then there would be a calculation, what that costs us, and then what it would have cost under Josh’s system.”

He remembers getting the data from a state spreadsheet and doing the math on the back of an envelope.

“It’s a really big, nine-by-nine envelope,” Anderson said.

Anderson said he hasn’t spoken to Umbehr in years, and admits his memory of that day, and even which year it happened, is spotty. But Anderson remembers coming to the conclusion that direct primary care could save not $1 billion in Medicaid costs, like Umbehr claims, but more like $450 million to $600 million.

“It’s a rough estimate,” Anderson said.

Umbehr told the Kansas News Service that KanCare could save $1 billion by combining direct primary care with a wraparound insurance program to handle other medical expenses. He said cheaper primary care would also decrease non-primary care expenses, such as hospitalizations and emergency room visits.

“We’re pulling all of those things in-house and decreasing the cost of them by 95 percent.” Umbehr said.

‘It’s just inaccurate’

Former Kansas Medicaid director Robert Day says both Anderson and Umbehr did the math wrong.

“These people are idiots. They know nothing about health care financing or costs,” Day said. “To make the statements they make, it’s just blatantly  — it’s so untrue and unfactual that it staggers the mind they would even say something publicly like that.”

Day, who worked for Republican and Democratic governors from 1999 to 2008, said the savings from a private direct primary care clinic can’t be applied to Medicaid. It’s a complicated program, he said, that doesn’t work like regular health insurance.

The elderly and disabled comprise only 25 percent of people receiving Medicaid or the related Children’s Health Insurance Program in Kansas. But they account for 70 percent of KanCare’s spending.

Any savings from direct primary care would most likely not apply to the elderly and disabled, Day said, because their needs are so different from those of the general population.

“Most of the costs of that population is in long-term and nursing home care,” he said. “So they’re not physician-driven costs.”

In 2016, the state spent $1.1 billion on two categories of service primarily for the elderly and disabled: adult care homes and home and community-based services. In the same year, it spent $315 million on two categories of service that include primary care procedures: physician services and outpatient care.

Day said KanCare couldn’t save anywhere near what Anderson, Umbehr and Kobach are claiming, because it doesn’t spend $450 million, $1 billion or $1.9 billion on primary care in the first place. 

“It’s just inaccurate,” Day said. “It shows a complete lack of understanding of the Medicaid program.”

Uncertain benefits

Other health policy experts were skeptical about whether direct primary care could adequately serve the specialized needs of Medicaid recipients when so many are elderly and disabled.

“There’s been no program to even test or look at, at this point,” said Cindy Samuelson, a vice president of the Kansas Hospital Association. “So it’s really hard to answer those questions of what the true impact might be.”

While direct primary care might save time and money by reducing paperwork, Samuelson said interacting with the bureaucracy of Medicaid, especially KanCare’s three managed care organizations, might negate any of those benefits for doctors.

Given those complications, she says it’s unclear whether there are enough doctors who are willing to try both direct primary care and Medicaid.

“Would the program even be something that providers are interested in?” Samuelson said.

That uncertainty highlights the need to run a pilot program before drawing any conclusions, said Kari Bruffett, vice president for policy at of the Kansas Health Institute.

“A pilot could help assess how direct primary care might work for various populations in KanCare,” Bruffett said in an email. “It could also be used to assess beneficiary interest, provider interest and capacity, and whether direct primary care could work either as an alternative to or an option within a managed care model.”

The Kansas Department of Health and Environment, which manages Medicaid, told the Kansas News Service it hasn’t yet done a cost analysis of using direct primary care for Medicaid.  But it’s open to a pilot program if it’s supported by a future governor and legislature.

“Anything innovative like that, we would like to think it warrants exploration,” said Secretary Jeff Andersen.

Andersen agreed that physician availability, negotiations with managed care organizations and other details were uncertain. “Those are things that have to be worked out, but it’s all doable.”

So far, the Kobach campaign hasn’t answered questions about those details, nor has it provided another source for Kobach’s claim of $1.9 billion in savings, despite repeated inquiries.  In an email, a spokeswoman forwarded this statement, attributable to Kobach:

“Direct Primary Care would result in significant savings. We will be looking at all kinds of measures to increase the efficiency of our Medicaid delivery and to improve the satisfaction of Medicaid patients. Direct Primary Care accomplishes both. The patients love it, and the doctors love it, too.”

Nomin Ujiyediin is a reporter for the Kansas News Service. You can reach her on Twitter @NominUJ.