Poynter Online - Al's Morning Meeting

FRIDAY, JULY 18, 2008

Unneeded MRIs and CT Scans Help Docs, Hurt Medicare

The Government Accountability Office (GAO) says Medicare would save a bundle if it required patients to get pre-approval before they had MRI or CAT scan imaging done.

"In-office" imaging is growing, and the report says that doctors make a lot of money from it. In 2000, cardiologists got about 23 percent of their income from imaging; only six years later that percentage rose to 36 percent.

The GAO said:

From 2000 through 2006, Medicare spending for imaging services paid for under the physician fee schedule more than doubled -- increasing to about $14 billion. Spending on advanced imaging, such as CT scans, MRIs, and nuclear medicine, rose substantially faster than other imaging services such as ultrasound, X-ray, and other standard imaging. GAO's analysis of the six-year period showed certain trends linking spending growth to the provision of imaging services in physician offices. The proportion of Medicare spending on imaging services performed in-office rose from 58 percent to 64 percent. Physicians also obtained an increasing share of their Medicare revenue from imaging services. In addition, in-office imaging spending per beneficiary varied substantially across geographic regions of the country, suggesting that not all utilization was necessary or appropriate. By 2006, in-office imaging spending per beneficiary varied almost eight-fold across the states--from $62 in Vermont to $472 in Florida.

See this story from The Wall Street Journal for more details.

Posted at 3:00:00 PM

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More Homeowners Renting Rooms to Pay Bills

The New York Times reports:

Modest but growing numbers are turning to agencies nationwide like the St. Ambrose Housing Aid Center Homesharing Program in Baltimore, which screen boarders to find appropriate matches and relieve some of the fear of strangers.

"We’re seeing greater numbers of marginal people," said Kirby Dunn, executive director of HomeShare Vermont, one of several hundred programs around the country that have been formed since the 1980s to help elderly or disabled homeowners exchange spare rooms for income or, more often, help around the house, but now being pressed to meet different needs.

"Historically," Ms. Dunn said, "the people who come to us have been looking for someone to provide services in the home. But now, money is the bigger issue for folks. There’s definitely an increase in people looking for a revenue stream."

Ms. Dunn said volume at the agency was up this year, with three or four times as many people seeking rooms as seeking boarders.

There are more than 100 home-sharing organizations around the country. (Here's a directory.) Many local agencies help with these home-sharing projects, such as this one in San Mateo, Calif., and this one in Kansas City.

No doubt a quick check of your local newspaper classifieds and/or a scan of Craigslist will point you to other leads.

In Chicago alone there are a dozen home-sharing organizations up and running. The Chicago Tribune explains:

Not all home-sharing arrangements involve rent. Home seekers sometimes provide services and companionship in exchange for free rent. But in most cases, home seekers pay rent.

"Most of the homeowners in the program need income," said Sue Carlson, home-sharing specialist at the north suburban Interfaith Housing Center. Rents average about $350 a month. The agency, which has had its home-sharing program for 18 years, requires that the home seeker have some source of income. "We don't have a rule of thumb. But our instincts say someone paying more than 50 percent of their income for rent will end up in trouble," Carlson said.

Most home-sharing agencies ask the parties to sign an agreement, though it's not a legally binding lease. The agreement typically includes the amount of rent as well as certain expectations, such as when the renter might be available to help around the house. Usually, the agreements ask that the parties give each other 30 days' notice if they'd like to terminate the arrangement.

Home-sharing agencies admit it's hard to make a match and even the best matches aren't permanent situations. "The little things are really important," said Melody Geraci, home-sharing coordinator at the Lawyers' Committee. She notes that people like the concept of sharing a house, but the real stumbling blocks are issues such as whether the homeowner allows pets or smoking, or whether the house is close to public transportation.

St. Ambrose's Web site says home sharing has been especially popular with seniors who rent out a part of their home that was used by kids who moved away long ago. The site says:

Home sharing as a formalized service came into being and was promulgated in the late 1970s and early 1980s. Shared housing was touted originally by Maggie Kuhn and the Gray Panthers as a low-cost, simple-to-administer and neighborhood-friendly housing option for an aging population who wished to remain in their homes and neighborhoods. The concept of shared housing was promoted by AARP and other federal and state agencies as a new affordable housing alternative for seniors and others. Some nationally consistent, general characteristics of the program are:

Home sharing is a housing solution focused on the elderly.
Home sharing caters primarily to women. 75 percent of home providers and 50 percent of home seekers are women.
Home sharing is an affordable housing response. Approximately 60 percent of the home providers are house rich–cash poor, living on a fixed income at or below poverty level. Approximately 70 percent of the home seekers are considered low-income.

Posted at 11:56:41 AM

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Booming Business for Repo Men

The Miami Herald tells the story of how business is booming for repo men. National Liquidators, a boat repossessor and auction company in Fort Lauderdale, Fla., says business has tripled in the last year-and-a-half.

The story includes this passage, which puts some perspective on the business:

Along with nine other agents, the company recovers up to five boats daily throughout Florida. Each is listed online for auction within a week; most are bought by foreigners.

''I remember years ago when we used to pick up a boat a day,'' says company President Bob Toney. Right now he has 650 boats for sale or ready for sale across the country -- in addition to Florida, he has teams working in Los Angeles and Cleveland. "People that have gotten into boating more recently are not as experienced and may not have realized the costs involved. Fuel is a big part of it. Marinas are charging $5 to $6 a gallon, and you've got a 300- to 400-gallon tank.''

Posted at 12:01:00 AM

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THURSDAY, JULY 17, 2008

Why Thursday May Be a Big Day for Wind Power

AFTERNOON UPDATE: The vote passed. Click here for more. Read below for background.

It's referred to as docket number 33672. It is an unpretentious little measure sitting on the docket of the Texas Public Utility Commission meeting Thursday. But this one measure may open wind-powered electricity production in some remarkable ways.

The vote on Thursday will be to expand the state's grid system. Right now, Texas is emerging as the nation's leader in wind power. Wind-powered electricity production in the state could get bigger -- a LOT bigger -- if the remote areas of West Texas and the Gulf region of the state can get connected to the urban areas of the state where people use more power.

Wind power enthusiasts hope that if Texas can solve the grid problems that are so common to the wind industry, other regions will wake up, too. Wind power developers don't want to build if there is not enough of a grid to pass along the power, and power companies don't want to build a grid if there is no power to pass along.

The Dallas Morning News summarizes the issue this way:

The PUC could decide as early as Thursday among four transmission scenarios proposed by the Electric Reliability Council of Texas. The scenarios cost between $3 billion and $6.4 billion.

Texas has about 5,000 megawatts of wind capacity, more than any other state. But without more transmission lines, construction could stall as wind power is stranded in rural areas.

At issue is whether the investment in wind farms and transmission lines will pay off with lower power prices across the grid. The pro-wind people calculate billions in annual savings. Those who are less enthusiastic worry about hidden costs that could boost prices or stall power generation development.

How interesting that Texas, the heart of the oil country, is emerging as the new wind power state. One of the big drivers is T. Boone Pickens, a billionaire and oilman from Texas who is promoting wind power generation, especially in the windy Midwest portions of the U.S. There is even a Web site promoting the so-called "Pickens Plan," which includes replacing gasoline-powered cars with natural gas-driven vehicles.

Additional resources:
"Legendary Oilman Pickens Promotes Revamping U.S. Power Policy," The Dallas Morning News
"Don't Mess with Texas Wind," Living on Earth
"Move Over, Oil, There's Money in Texas Wind," The New York Times

The Times' story explains why Texas is so important to the development of wind power in America:

Texas surpassed California as the top wind farm state in 2006. In January alone, new wind farms representing $700 million of investment went into operation in Texas, supplying power sufficient for 100,000 homes.

Supporters say Texas is ideal for wind-power development, not just because it is windy. It also has sparsely populated land for wind farms, fast-growing cities and a friendly regulatory environment for developers.

"Texas could be a model for the entire nation," said Patrick Woodson, a senior development executive with E.On, a German utility operating here.

Posted at 4:10:02 PM

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Slowing Growth in Bedroom Communities

My friend Boyd Huppert, a reporter at KARE-11 in Minneapolis, found a story that he and I believe plays out around the country. Huppert tells me:

New census data released last week had me traveling to Roberts, Wis., -- the fourth fastest growing city in Wisconsin since 2000, according to the new census data. It appeared to be a story about rapid growth in a bedroom community. Not anymore. Roberts issued nearly 70 building permits in 2001. Last year the town wrote three. So far this year -- zero. The mortgage mess and high gas prices are hitting these sorts of commuter communities especially hard. So much so that the census data can be outdated by the time it's released.

Watch Huppert's related story here.

Posted at 3:18:41 PM

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Rural Areas Still Fertile Ground for Military Recruiters

The St. Louis Post-Dispatch has produced a database showing where U.S. Army recruits call home. The paper said its research shows that rural communities are still fertile ground for military recruiters.

The paper said:

Four of the top 10 counties in the United States were home to large Army posts.

Residents of such areas tend to have more familiarity and interaction with the military and are more receptive to the idea of military service, the Army says. Installations host activities open to the public and are active in civic life. In addition, many military retirees and families congregate in such areas.

You can search the database by state, county, the number of recruits and the recruiting rate by population.

The three major stories the paper produced are:

Answering the call to serve

Pride, tradition entice recruits

Not much to keep these teens home

Posted at 11:30:00 AM

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Should Women Stop Breast Self-Exams?

A new report from the Cochrane Collaboration, an international group that evaluates medical research, says there is no solid evidence that breast self-exams do any good. Furthermore, the report says it is fine if women don't do them.

Researchers now say that self exams often lead to unnecessary biopsies. In other words, if the self exams turn up what looks like a lump, the woman and doctor don't want to ignore the lump so the woman gets a biopsy that turns out to be unnecessary. Even worse, TIME points out:

A benchmark study from 1998, published in the Journal of Public Health Medicine, indicates that five months after a benign surgical biopsy, 61% of women still struggled with symptoms of anxiety and psychological distress, including trouble sleeping, change in appetite and a general malaise fueled by thoughts of breast cancer.

This new study was based on women in China and Russia, but it is far from the first to recommend less emphasis on self exams. I recommend this thoughtful and calming story from US News & World Report about the new study and what it means.

Let's face it. The new findings about breast self-exams contradict conventional wisdom and advice, but they are in line with emerging thought about self exams.

You might recall that about five years ago, the American Cancer Society stopped recommending that all women do breast self-exams monthly and instead called self exams optional. The society pointed out, however, that while self exams turn up a lot of false alarms and they have not been proven to reduce the risk of cancer, they might still make sense in populations that have known cancer risks.

So what should women do? The American Cancer Society recommends:

Mammogram: Women age 40 and older should have a mammogram every year and should continue to do so for as long as they are in good health. While mammograms can miss some cancers, they are still a very good way to find breast cancer.

Clinical breast exam: Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a regular exam by a health expert, preferably every 3 years. After age 40, women should have a breast exam by a health expert every year. It might be a good idea to have the CBE shortly before the mammogram. You can use the exam to learn what your own breasts feel like.

Breast self-exam (BSE): BSE is an option for women starting in their 20s. Women should be told about the benefits and limitations of BSE. Women should report any changes in how their breasts look or feel to their health professional right away.

If you decide to do BSE, you should have your doctor or nurse check your method to make sure you are doing it right. If you do BSE on a regular basis, you get to know how your breasts normally look and feel. Then you can more easily notice changes. But it’s OK not to do BSE or not to do it on a fixed schedule.

The most important thing is to see your doctor right away if you notice any of these changes: a lump or swelling, skin irritation or dimpling, nipple pain or the nipple turning inward, redness or scaliness of the nipple or breast skin, or a discharge other than breast milk. But remember that most of the time these breast changes are not cancer.

How did this whole self exam push begin anyway? An Australian study says it may just be that researchers found that women believed breast cancer was so serious that they would not do self examinations if the exams were going to turn up bad news. So the researchers started pushing early detection as the only hope. One step in early detection was self examination followed by mammograms, even though self examinations had not been clinically proven effective.

One reason self exams are so ineffective is because women do not know what they are feeling for. A bNet article points out:

But as Dr. Susan Love notes in her comprehensive book on breast cancer, `Unfortunately, women are rarely given the proper information about BSE, and the misinformation often leads to unnecessary anxiety." She states that the lump a woman is looking for will be at least "a centimeter or two, almost an inch, or the size of grape," and will be persistent and unchanging. She explains that "beebee" sized things are almost never early cancer because at that stage a cancer has not developed the "fibrous, scarlike tissue" which forms around it which together with the cancer "makes up the palpable lump."

Cancer.org's breast cancer resource page is worth a look.

Links from that page include:
"What Causes Breast Cancer?"
"Can Breast Cancer Be Prevented?"
"How Is Breast Cancer Found?"
"If Breast Cancer Is Suspected"
"After the Tests: Staging"

Use this Web site to send yourself a reminder to get a mammogram.

Posted at 7:32:20 AM

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WEDNESDAY, JULY 16, 2008

Misidentifying Gang Members

The (San Diego) Union-Tribune reports that it is getting harder to figure out whether a suspect is a member of a real gang:

Some experts say law enforcement officials face a growing risk of misidentifying people as gang members as aspects of gang culture move into the mainstream. Misidentification can have serious consequences in court, where gang-related crimes can carry stiffer sentences, and on the streets, where imitators could have violent encounters with actual gang members.

"Kids act like gangsters who aren't gangsters," said Al Valdez, a sociology professor at the University of California Irvine who specializes in the history and culture of gangs.

Valdez testified recently as an expert witness in a high-profile San Diego Superior Court case.

"Kids mimic what they see," he said. "You see kids flashing gang signs, using words once only associated with gangs. I see that all the time."

Some defense lawyers say individuals are often branded as gang members undeservedly, because of the clothes they wear or the neighborhoods where they live.

Posted at 12:32:02 PM

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Newest Internet Worm Uses Fake News Headlines