Zynga shares slide after privileged status with Facebook ends












(Reuters) – Shares of gaming company Zynga Inc fell as much as 10 percent, a day after the “Farmville” creator reached an agreement with Facebook Inc that reduces its dependence on the social networking giant.


The companies reported in regulatory filings on Thursday that they have reached an agreement to amend a 2010 deal that was widely seen as giving Zynga privileged status on the world’s No.1 social network.












Zynga gets a freer hand to operate a standalone gaming website, but gives up its ability to promote its site on Facebook and to draw from the thriving social network of about 1 billion users.


“Although Zynga investors have reacted negatively to Thursday’s announcements so far, we view them as a long-term positive for both companies,” Wedbush Securities analyst Michael Pachter said in a note to clients.


“Zynga now has an advantage to offer more payment options which could result in additional subscribers who are not Facebook users,” he said, maintaining his “outperform” rating and price target of $ 4 on the stock.


Both internet companies have been trying to reduce their interdependence, with Zynga starting up its own Zynga.com platform, and Facebook wooing other games developers.


In recent quarters, fees from Zynga contributed 15 percent of Facebook’s revenue, while Zynga relies on Facebook for roughly 80 percent of its revenue.


Francisco-based Zynga’s shares were down 7 percent at $ 2.44 in morning trading on the New York Stock Exchange on Friday.


Facebook shares were down more than 1 percent at $ 26.98.


(Reporting By Aurindom Mukherjee in Bangalore; Editing by Don Sebastian)


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Adkins explains Confederate flag earpiece












NEW YORK (AP) — Trace Adkins wore an earpiece decorated like the Confederate flag when he performed for the Rockefeller Center Christmas Tree Lighting but says he meant no offense by it.


Adkins appeared with the earpiece on a nationally televised special for the lighting on Wednesday. Some regard the flag as a racist symbol and criticized Adkins in Twitter postings.












But in a statement released Thursday, the Louisiana native called himself a proud American who objects to any oppression and says the flag represents his Southern heritage.


He noted he’s a descendant of Confederate soldiers and says he did not intend offense by wearing it.


Adkins — on a USO tour in Japan — also called for the preservation of America’s battlefields and an “honest conversation about the country’s history.”


___


Online:


http://www.traceadkins.com


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Man Wins Suit Over Sex Addiction












A French man who claimed a Parkinson’s drug turned him into a gambling and gay sex addict has been awarded 197,000 euros in damages, the French Press Agency reported.


Didier Jambart, 52, of Nantes, France, sued the pharmaceutical giant GlaxoSmithKline in 2011, claiming the drug, Requip, caused him to lose 82,000 euros gambling on the Internet. He said he also became addicted to gay sex and risky sexual encounters. He said he was raped after starting the drug in 2003 and attempted suicide eight times.












“It’s a great day,” Jambart, who was accompanied by his wife during the emotional ruling, told the French Press Agency. “It’s been a seven-year battle with our limited means for recognition of the fact that GSK lied to us and shattered our lives.”


Parkinson’s disease destroys neurons deep within the brain that release the “feel-good” neurotransmitter dopamine. Requip belongs to a class of drugs called dopamine agonists that relieve Parkinson’s symptoms — such as shaking, stiffness, slowness and trouble balancing — by activating dopamine receptors. But the drugs have side effects that, while rare, can be serious.


“There are plenty of reports of people developing side effects from Parkinson’s drugs, such as hypersexuality, gambling and excessive shopping,” Dr. David Standaert of the Center for Neurodegeneration and Experimental Therapeutics at the University of Alabama at Birmingham told ABC News when the lawsuit was filed. “It’s uncommon, but very dramatic when it happens.”


Up to 17 percent of people with Parkinson’s disease who take dopamine agonists exhibit an impulse control disorder, according to a 2010 study published in the Archives of Neurology.


“It can be devastating for those people,” said Dr. Mark Stacy, the Duke University neurologist who first linked the drugs to gambling in 2000. “And I think that because of the embarrassing nature of the complaint, it’s a bit amplified.”


Jambart is not the first Parkinson’s patient to sue a drug maker over these symptoms. In 2008, a court in Minneapolis awarded Gary Charbonneau $ 8.2 million in a suit against the makers of Mirapex, Pfizer and Boehringer Ingelheim. And in 2010, more than 100 patients in Australia sued Pfizer and Aspen Pharmacare — the makers of Cabaser and Permax respectively — over sex and gambling addictions.


“Dopamine is a reward signal,” Standaert said, adding that certain illicit drugs, such as cocaine and methamphetamine, act on dopamine receptors. Standaert said he has met patients who have gambled or shopped away hundreds of thousands of dollars. “In certain individuals who seem sensitive to this, these dopamine agonists really make them overcome their normal inhibitions… They lose their moral compass.”


Compulsive behaviors such as pathological gambling and hypersexuality are now listed as side effects on the drugs’ package inserts. But Jambart claimed this wasn’t the case when he starting taking Requip in 2003. By the time he stopped taking Requip in 2005, he had already been demoted at work and suffered psychological trauma because of his addictions, his lawyers told the French Press Agency.


In the United States, GSK added warnings about unusual behaviors to the Requip package insert in July 2005 and expanded them in 2006, company spokeswoman Mary Anne Rhyne told ABC News at the time the lawsuit was filed.


“We urge patients to talk to their doctor before deciding to stop or start taking any medicine,” she said. “Anyone receiving treatment with dopamine agonists who notices unusual behaviors, such as new or increased gambling urges, increased sexual urges or other intense urges should talk to their doctor.”


Standaert stressed that while the drug’s side effects are “colorful and serious,” they’re very rare.


“These are very useful medications,” he said. “People shouldn’t be frightened, they should just know about the risks.”


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Man Wins Suit Over Sex Addiction












A French man who claimed a Parkinson’s drug turned him into a gambling and gay sex addict has been awarded 197,000 euros in damages, the French Press Agency reported.


Didier Jambart, 52, of Nantes, France, sued the pharmaceutical giant GlaxoSmithKline in 2011, claiming the drug, Requip, caused him to lose 82,000 euros gambling on the Internet. He said he also became addicted to gay sex and risky sexual encounters. He said he was raped after starting the drug in 2003 and attempted suicide eight times.












“It’s a great day,” Jambart, who was accompanied by his wife during the emotional ruling, told the French Press Agency. “It’s been a seven-year battle with our limited means for recognition of the fact that GSK lied to us and shattered our lives.”


Parkinson’s disease destroys neurons deep within the brain that release the “feel-good” neurotransmitter dopamine. Requip belongs to a class of drugs called dopamine agonists that relieve Parkinson’s symptoms — such as shaking, stiffness, slowness and trouble balancing — by activating dopamine receptors. But the drugs have side effects that, while rare, can be serious.


“There are plenty of reports of people developing side effects from Parkinson’s drugs, such as hypersexuality, gambling and excessive shopping,” Dr. David Standaert of the Center for Neurodegeneration and Experimental Therapeutics at the University of Alabama at Birmingham told ABC News when the lawsuit was filed. “It’s uncommon, but very dramatic when it happens.”


Up to 17 percent of people with Parkinson’s disease who take dopamine agonists exhibit an impulse control disorder, according to a 2010 study published in the Archives of Neurology.


“It can be devastating for those people,” said Dr. Mark Stacy, the Duke University neurologist who first linked the drugs to gambling in 2000. “And I think that because of the embarrassing nature of the complaint, it’s a bit amplified.”


Jambart is not the first Parkinson’s patient to sue a drug maker over these symptoms. In 2008, a court in Minneapolis awarded Gary Charbonneau $ 8.2 million in a suit against the makers of Mirapex, Pfizer and Boehringer Ingelheim. And in 2010, more than 100 patients in Australia sued Pfizer and Aspen Pharmacare — the makers of Cabaser and Permax respectively — over sex and gambling addictions.


“Dopamine is a reward signal,” Standaert said, adding that certain illicit drugs, such as cocaine and methamphetamine, act on dopamine receptors. Standaert said he has met patients who have gambled or shopped away hundreds of thousands of dollars. “In certain individuals who seem sensitive to this, these dopamine agonists really make them overcome their normal inhibitions… They lose their moral compass.”


Compulsive behaviors such as pathological gambling and hypersexuality are now listed as side effects on the drugs’ package inserts. But Jambart claimed this wasn’t the case when he starting taking Requip in 2003. By the time he stopped taking Requip in 2005, he had already been demoted at work and suffered psychological trauma because of his addictions, his lawyers told the French Press Agency.


In the United States, GSK added warnings about unusual behaviors to the Requip package insert in July 2005 and expanded them in 2006, company spokeswoman Mary Anne Rhyne told ABC News at the time the lawsuit was filed.


“We urge patients to talk to their doctor before deciding to stop or start taking any medicine,” she said. “Anyone receiving treatment with dopamine agonists who notices unusual behaviors, such as new or increased gambling urges, increased sexual urges or other intense urges should talk to their doctor.”


Standaert stressed that while the drug’s side effects are “colorful and serious,” they’re very rare.


“These are very useful medications,” he said. “People shouldn’t be frightened, they should just know about the risks.”


Also Read
Seniors/Aging News Headlines – Yahoo! News


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Lawmakers unveil new round of Iran sanctions












WASHINGTON (AP) — Senators pressed ahead Thursday on a new set of tough sanctions against Iran‘s domestic industries as it seeks to cripple the Islamic republic’s economy and thwart its nuclear ambitions.


Sens. Bob Menendez, D-N.J., and Mark Kirk, R-Ill., unveiled a package of penalties that would designate Iran‘s energy, port, shipping and ship-building sectors as entities of proliferation and sanction transactions with these areas. The legislation also would penalize individuals selling or supplying commodities such as graphite, aluminum and steel to Iran.












The punitive measures build on the sanctions on Tehran’s oil industry that the two lawmakers have shepherded through Congress in the past year.


“Yes, our sanctions are having a significant impact, but Iran continues their work to develop nuclear weapons,” Menendez said in a statement, adding that with the new penalties, “We will send a message to Iran that they can’t just try to wait us out.”


Kirk said the measure “will greatly increase the economic pressure on the Iranian regime and send a clear message of support to the Iranian people.”


The sanctions are contained in an amendment the two lawmakers hope to add to a far-reaching defense policy bill that the Senate was debating and could wrap up by week’s end. Congress has overwhelmingly backed previous efforts by Menendez and Kirk.


The legislation also would designate the Islamic Republic of Iran Broadcasting and its president as human rights abusers for broadcasting forced televised confessions and show trials.


The United States and European Union have imposed tough sanctions on Iran that have weakened its economy. But Tehran has found ways to bypass the penalties, such as Turkey’s use of gold to pay for Iranian natural gas imports.


The Menendez-Kirk measure would allow the president to impose sanctions in cases of the sale or transfer of precious metals, targeting efforts by Iran to circumvent the penalties.


Iran maintains that its nuclear program is for peaceful purposes only.


Mark Dubowitz, a sanctions expert and executive director of the Foundation for Defense of Democracies, said there is strong bipartisan support for intense sanctions, with the goal of pushing the Iranian economy to the brink of economic collapse.


Only then “can the central thesis of the administration’s sanctions policy be fairly tested: That crippling economic pressure will break the nuclear will of Iran’s supreme leader and his Revolutionary Guards and lead them to meet their obligations under international law,” Dubowitz said.


The president has 90 days from the legislation’s enactment to act. The bill does include the authority to waive the sanctions based on national security.


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Noisy city: Cacophony in Caracas sparks complaints












CARACAS, Venezuela (AP) — This metropolis of 6 million people may be one of the world’s most intense, overwhelming cities, with tremendous levels of crime, traffic and social strife. The sounds of Caracas‘ streets live up to its reputation.


Stand on any downtown corner, and the cacophony can be overpowering: Deafening horns blast from oncoming buses, traffic police shrilly blow their whistles and sirens shriek atop ambulances stuck in bumper-to-bumper traffic.












Air horns routinely used by bus drivers are so powerful they make pedestrians on crosswalks recoil, and can even leave their ears ringing. Loud salsa music blares from the windows of buses, trucks with old mufflers rumble past belching exhaust, and “moto-taxis” weave through traffic beeping high-pitched horns.


Growing numbers of Venezuelans are saying they’re fed up with the noise that they say is getting worse, and the numbers of complaints to the authorities have risen in recent years.


One affluent district, Chacao, put up signs along a main avenue reading: “A honk won’t make the traffic light change.”


“The noise is terrible. Sometimes it seems like it’s never going to end,” said Jose Santander, a street vendor who stands in the middle of a highway selling fried pork rinds and potato chips to commuters in traffic.


Prosecutor General Luisa Ortega recently told a news conference that officials have started “putting an increased emphasis on promoting peaceful coexistence” by punishing misdemeanors such as violations of anti-noise regulations and other minor crimes. That effort has translated into hundreds of noise-related cases in recent years.


Some violators are ordered to perform community service. For instance, two young musicians who were recently caught playing loud music near a subway station were sentenced to 120 hours of community service giving music lessons to students in public schools.


Others caught playing loud music on the street have been charged with disturbing the peace after complaints from neighbors. Fines can run as high as 9,000 bolivars, or $ 2,093.


On the streets of their capital, however, Venezuelans have grown used to living loudly. The noisescape adds to a general sense of anarchy, with many drivers ignoring red lights and blocking intersections along potholed streets strewn with trash.


“This is something that everybody does. Nobody should be complaining,” said Gregorio Hernandez, a 23-year-old college student, as he listened to Latin rock songs booming from his car stereo on a Saturday night in downtown Caracas. “We’re just having fun. We’re not hurting anybody.”


Adding to the mess is the country’s notoriously divisive politics, which regularly fill the streets with marches and demonstrations.


On many days, the shouts of protesters streaming through downtown can be heard from blocks away, demanding pay hikes or unpaid benefits.


And the sporadic crackling of gunfire in the slums can be confused for firecrackers tossed by boisterous partygoers.


It’s difficult to rank the world’s noisiest cities because many, including Venezuela’s capital, don’t take measurements of sound pollution, said Victor Rastelli, a mechanical engineering professor and sound pollution expert at Simon Bolivar University in Caracas. But Rastelli said he suspects Caracas is right up there among the noisiest, along with Sao Paulo, Mexico City and Mumbai.


Excessive noise can be more than simply an annoyance, Rastelli said. “This is a public health problem.”


Dr. Carmen Mijares, an audiologist at a private Caracas hospital, said she treats at least a dozen patients every month for hearing damage caused by prolonged exposure to loud noises.


“Many of them work in bars or night clubs, and their maladies usually include temporary hearing loss and headaches,” Mijares said. For others, she said, the day-to-day noise of traffic, car horns and loud music can exacerbate stress and sleeping disorders.


Several cities have successfully reduced noise pollution, said Stephen Stansfeld, a London psychiatry professor and coordinator of the European Network on Noise and Health.


One of the most noteworthy initiatives, Stansfeld said, was in Copenhagen, Denmark, where officials used sound walls, noise-reducing asphalt and other infrastructure as well as public awareness campaigns to fight noise pollution.


But such high-tech solutions seem like a remote possibility in Caracas, where streets are literally falling apart and aging overpasses regularly lack portions of their guard rails. Prosecutors, angry neighbors and others hoping to fight the noise will have to persuade Venezuelans to do nothing less than change their loud behavior.


For Carlos Pinto, however, making noise is practically a political right.


The 26-year-old law student and his friends danced at a recent street party to house music booming from woofers in his car’s open trunk, with neon lights on the speakers that pulsed to the beat.


When asked about the noise, he answered: “We will be heard.”


___


AP freelance video journalist Ricardo Nunes contributed to this report.


___


Christopher Toothaker on Twitter: http://twitter.com/ctoothaker


Latin America News Headlines – Yahoo! News


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Taking a page from Louis C.K., Chill launches online store for films, comedy specials












NEW YORK (TheWrap.com) – Chill, a social video platform with close to 20 million users, has launched Chill Direct, a new store for creatives like Maria Bamford and Michael Urie to sell their movies, specials and documentaries directly to fans.


Comedian Louis C.K. sent shockwaves through the entertainment industry this summer by selling a comedy special directly online rather than making a distribution deal with a television network or online service. He made millions, and various others have followed suit, including Jim Gaffigan and Aziz Ansari.












Chill sees an opportunity to enter this emerging market, empowering artists and offering them an opportunity to control the distribution and monetization of their ongoing projects.


“The community gives filmmakers and comedians the ability to distribute premium video directly to fans,” CEO Brian Norgard told TheWrap. “The common analogy is to Louis C.K. and his ‘Live at Beacon Theater.‘ That was a seminal moment in the entertainment business and a lot of things now allow direct-to-fan to become a viable model.”


Artists who choose to sell through Chill also can sell their videos elsewhere, but Chill Direct launches with eight videos exclusive to the site. That slate includes “Maria Bamford: the Special Special Special!,” an hour-long comedy special starring Bamford, “Thank You For Judging,” a documentary from “Ugly Betty” actor Urie about high school speech and debate and “Unknown Sender,” a suspense series from “48 Hrs” and “Die Hard” scribe Stephen E. de Souza.


Starting Thursday, any artist can create a page for a project and has complete creative control over the page, from information about the project to trailers to pricing. Meanwhile, Chill handles distribution across devices as well as payments.


Artists retain rights to their own intellectual property while Chill takes a 30 percent cut of any transaction.


“What Chill does is let anyone build out socially integrated marketing pages – we call them story pages – beautiful, high-resolution tantalizing receptacles of premium videos,” Norgard said.


Chill, funded by WME and Kleiner Perkins Caulfield & Byers and others, has previously enabled frictionless uploading, consumption and sharing of the web’s most popular videos. This maintains a social layer, allowing for commenting and offering bundles that combine the video with other perks like merchandise or meeting the creator.


“The land of premium video is still a very closed marketplace,” Norgard said. “If you have tremendous business development skills or connections to sell a film to Netflix or Hulu, you’re lucky. The ad-supported model doesn’t fit every type of content. There is plenty of stuff out there like documentary films and comedy specials where creators are between a rock and a hard place and wan to get it out there, distribute it, own the right but not put it on a free streaming site like YouTube.”


Selling direct to fans also offers a new revenue stream to a company that until now was mostly luring people a few times a day for videos.


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Adele’s “21″ sells 10 million, Rihanna leads Billboard












LOS ANGELES (Reuters) – British singer and Grammy darling Adele reached the 10 million sales mark in the United States on Wednesday with her heartbreak album “21″ becoming the first by British woman to reach the milestone, Nielsen SoundScan said.


“21,” released in February 2011, produced the hits “Someone Like You” and “Rolling In The Deep” and became the top-selling album of 2011. Earlier this year, Adele swept the Grammy Awards with six, including song, record and album of the year.












“21″ became the third album to cross 10 million in 2012, along with Linkin Park‘s “Hybrid Theory” and Usher’s “Confessions.” But it is the only album to reach the milestone in less than two years in the last decade, Nielsen said.


“What an incredible honor,” Adele said in a statement. “A huge, huge thank you to my American fans for embracing this record on such a massive level.”


“21″ will receive the diamond certification from the Recording Industry Association of America, marking its 10 million milestone, joining the ranks of albums by artists such as Michael Jackson, The Beatles and Madonna.


Adele‘s unique talent is a gift to music fans, and her success is certainly cause for a celebration of Diamond magnitude,” Cary Sherman, RIAA’s chairman & CEO, said in a statement.


Adele, 24, is enjoying the success of her latest single “Skyfall,” the official theme song for the James Bond film of the same name. It has sold more than 2 million copies worldwide. The singer also gave birth to her first child earlier this year.


On the Billboard 200 chart this week, R&B star Rihanna scored her first No. 1 album with “Unapologetic,” selling 238,000 copies.


She held off new entries from “American Idol” winner Phillip Phillips, who landed at No. 4 with his debut album “The World From the Side of the Moon,” and country-rock singer Kid Rock, who rounded out the top five with his latest album “Rebel Soul.”


(Reporting By Piya Sinha-Roy Editing by Jill Serjeant, Grant McCool and Andre Grenon)


Music News Headlines – Yahoo! News


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Cutting consultations led to more Medicare spending












NEW YORK (Reuters Health) – Medicare unintentionally spent more money on doctor’s-office visits in 2010, the year it introduced a simplified fee schedule, according to a new study.


Researchers found that the U.S. government-run insurance for the elderly paid an average of $ 40 more per beneficiary after it stopped paying for consultations with specialists and increased its payments for regular doctors’ visits – even though the goal had been to break even while streamlining fee categories.












“It’s important to emphasize the increase is – as far as we know right now – just a onetime change… We don’t know if this change will last or if the growth rate will go back to what it was,” said the study’s lead author Zirui Song of Harvard Medical School in Boston.


Before the change, Medicare paid doctors about $ 125 for a consultation of “medium complexity,” about $ 92 for a standard first-time office visit and about $ 61 for seeing a regular patient.


Specialists, such as surgeons and obstetrician-gynecologists, typically billed for the more expensive consultations and family doctors, known as primary care physicians, billed for the cheaper office visits.


The income gap between specialists and family doctors is often cited as one reason that medical students choose not to go into primary care, which many fear will cause a doctor shortage within the next decade.


One study from 2010 found that family doctors earn as little as half what their colleagues who specialize in areas such as surgery and oncology take home. (see Reuters Health story of October 25, 2010 here: http://reut.rs/O2mVG9)


By making both family doctors and specialists charge for office visits rather than consultations, the Centers for Medicare and Medicaid Services (CMS) may have leveled the playing field somewhat, but the agency intended the policy change to be “neutral” in cost terms.


To see if that was the result, Song and his collaborators, who include a chairman of the Medicare Payment Advisory Commission, analyzed 2.2 million Medicare patients’ claims made from 2007 through 2010.


The study used a Thomson Reuters database and one of the co-authors is a Thomson Reuters employee.


The researchers, who published their findings in the Archives of Internal Medicine, found that Medicare paid about $ 628 annually per patient from 2007 through 2009.


After the change in 2010, the program paid about $ 668 per patient – a 6.5 percent jump.


Most of the increase can be explained by Medicare’s higher payments for office visits, they conclude, but not all of it. Doctors also started charging Medicare for more “complex” office visits.


The characterization of a patient visit is somewhat subjective, the authors explain in their report. A simple visit might involve a 10-minute exam and “straightforward” attention to a specific problem, whereas a “high-complexity” visit might last 60 minutes, entailing exhaustive history taking, examination and “decision-making.”


“You might say just from a third-party perspective, simply changing the fee schedule should not have an effect on how sick a patient is… but physicians were coding at a higher level,” Song told Reuters Health.


As for specialists being paid more than family doctors, the researchers found the change did help to narrow the payment gap.


Of the 6.5 percent extra Medicare expenditure in 2010, about $ 6 of every $ 10 went to family doctors and the rest to specialists.


“It was a noble effort on the CMS’ part to try and change incentives to improve the payment disparity between primary care physicians and specialists,” said Dr. Patrick O’Malley, an internist at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.


But O’Malley told Reuters Health that “meddling” with fees will not solve the broader problems facing primary care, including high expectations for family doctors, increasingly complex patients and the worsening doctor shortage.


In an editorial accompanying the study, O’Malley says that doctors across specialties and organizations need to help fix these problems.


“It’s not only up to primary care providers alone to fix the primary care problem; it’s up to every physician to be responsible for helping to fix it,” he writes.


“I think it’s going to be a process of incremental change. I’m hoping the Affordable Care Act will move us in the right direction, but I think we will also hit rock bottom, where we’ll see ourselves in a desperate state,” O’Malley said.


SOURCE: http://bit.ly/11cDCDk and http://bit.ly/Se1HFR Archives of Internal Medicine, online November 26, 2012.


Seniors/Aging News Headlines – Yahoo! News


Read More..

Cutting consultations led to more Medicare spending












NEW YORK (Reuters Health) – Medicare unintentionally spent more money on doctor’s-office visits in 2010, the year it introduced a simplified fee schedule, according to a new study.


Researchers found that the U.S. government-run insurance for the elderly paid an average of $ 40 more per beneficiary after it stopped paying for consultations with specialists and increased its payments for regular doctors’ visits – even though the goal had been to break even while streamlining fee categories.












“It’s important to emphasize the increase is – as far as we know right now – just a onetime change… We don’t know if this change will last or if the growth rate will go back to what it was,” said the study’s lead author Zirui Song of Harvard Medical School in Boston.


Before the change, Medicare paid doctors about $ 125 for a consultation of “medium complexity,” about $ 92 for a standard first-time office visit and about $ 61 for seeing a regular patient.


Specialists, such as surgeons and obstetrician-gynecologists, typically billed for the more expensive consultations and family doctors, known as primary care physicians, billed for the cheaper office visits.


The income gap between specialists and family doctors is often cited as one reason that medical students choose not to go into primary care, which many fear will cause a doctor shortage within the next decade.


One study from 2010 found that family doctors earn as little as half what their colleagues who specialize in areas such as surgery and oncology take home. (see Reuters Health story of October 25, 2010 here: http://reut.rs/O2mVG9)


By making both family doctors and specialists charge for office visits rather than consultations, the Centers for Medicare and Medicaid Services (CMS) may have leveled the playing field somewhat, but the agency intended the policy change to be “neutral” in cost terms.


To see if that was the result, Song and his collaborators, who include a chairman of the Medicare Payment Advisory Commission, analyzed 2.2 million Medicare patients’ claims made from 2007 through 2010.


The study used a Thomson Reuters database and one of the co-authors is a Thomson Reuters employee.


The researchers, who published their findings in the Archives of Internal Medicine, found that Medicare paid about $ 628 annually per patient from 2007 through 2009.


After the change in 2010, the program paid about $ 668 per patient – a 6.5 percent jump.


Most of the increase can be explained by Medicare’s higher payments for office visits, they conclude, but not all of it. Doctors also started charging Medicare for more “complex” office visits.


The characterization of a patient visit is somewhat subjective, the authors explain in their report. A simple visit might involve a 10-minute exam and “straightforward” attention to a specific problem, whereas a “high-complexity” visit might last 60 minutes, entailing exhaustive history taking, examination and “decision-making.”


“You might say just from a third-party perspective, simply changing the fee schedule should not have an effect on how sick a patient is… but physicians were coding at a higher level,” Song told Reuters Health.


As for specialists being paid more than family doctors, the researchers found the change did help to narrow the payment gap.


Of the 6.5 percent extra Medicare expenditure in 2010, about $ 6 of every $ 10 went to family doctors and the rest to specialists.


“It was a noble effort on the CMS’ part to try and change incentives to improve the payment disparity between primary care physicians and specialists,” said Dr. Patrick O’Malley, an internist at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.


But O’Malley told Reuters Health that “meddling” with fees will not solve the broader problems facing primary care, including high expectations for family doctors, increasingly complex patients and the worsening doctor shortage.


In an editorial accompanying the study, O’Malley says that doctors across specialties and organizations need to help fix these problems.


“It’s not only up to primary care providers alone to fix the primary care problem; it’s up to every physician to be responsible for helping to fix it,” he writes.


“I think it’s going to be a process of incremental change. I’m hoping the Affordable Care Act will move us in the right direction, but I think we will also hit rock bottom, where we’ll see ourselves in a desperate state,” O’Malley said.


SOURCE: http://bit.ly/11cDCDk and http://bit.ly/Se1HFR Archives of Internal Medicine, online November 26, 2012.


Seniors/Aging News Headlines – Yahoo! News


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