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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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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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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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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Wall Street jumps in another “fiscal cliff” swing

NEW YORK (Reuters) – Stocks rallied on Wednesday after comments from House Speaker John Boehner, the top Republican in Congress, on a possible compromise to avoid the “fiscal cliff” turned the market around.

The S&P 500 rebounded from a 1 percent decline, gaining more than 20 points from its low after Boehner, an Ohio Republican, said he was optimistic that a budget deal to avoid big spending cuts and tax hikes can be worked out. President Barack Obama added to the good feelings, saying he hoped to get a deal done in the next four weeks.

Whether or not those remarks reflect the reality of negotiations is another story.

“The fiscal cliff is dominating the discussion, and short term, we’re a little bit too optimistic on it being fixed right away,” said John Manley, chief equity strategist for Wells Fargo Advantage Funds in New York.

In expectation of higher dividend tax rates in 2013, companies have been shifting dividends or announcing special payouts to shareholders.

Costco Wholesale Corp , up 6.3 percent at $ 102.58, was the S&P 500′s biggest percentage gainer after it became the latest company to announce a special dividend.

The market’s move marked the second straight day where a leading legislator dictated trading action. On Tuesday, stocks fell on pessimistic remarks from Senate Majority Leader Harry Reid, a Democrat from Nevada.

The market has been swinging for weeks now on headlines from Washington, with Wednesday’s gyrations once again highlighting the importance that Wall Street is giving to finding a solution to avoid the series of tax increases and spending cuts that could push the U.S. economy into recession.

The Dow Jones industrial average <.DJI> rose 106.98 points, or 0.83 percent, to 12,985.11 at the close. The S&P 500 <.SPX> gained 10.99 points, or 0.79 percent, to 1,409.93. The Nasdaq Composite <.IXIC> added 23.99 points, or 0.81 percent, to close at 2,991.78.

The S&P 500 bounced off a strong support area near 1,385 that includes both its 200- and 14-day moving averages. It closed above 1,400 for the third session in four – an optimistic sign for stock bulls.

Knight Capital Group Inc shares jumped 15.2 percent to $ 3.42 on news that Getco Holding proposed a $ 1.4 billion merger with Knight, while Virtu Financial offered to buy Knight for at least $ 1.1 billion.

Apparel retailer Express Inc rose 8.9 percent to $ 14.15 after it forecast strong earnings for the current quarter as lower prices and easy-to-understand discounts led to robust Black Friday sales.

The S&P retail index <.SPXRT> gained 1.4 percent.

Green Mountain Coffee Roasters surged 27.3 percent to $ 36.86 a day after it forecast quarterly and full-year earnings well ahead of analysts’ expectations.

Nearly 6.1 billion shares changed hands on the New York Stock Exchange, the Nasdaq and NYSE MKT, below the daily average so far this year of about 6.48 billion shares.

On the NYSE, roughly seven stocks rose for every three that fell, and on Nasdaq, five issues rose for every three that fell.

(Reporting by Rodrigo Campos; Editing by Jan Paschal)

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Family learns of student’s death on Facebook

ATLANTA (AP) — The parents of a south Georgia college student first learned from Facebook that their daughter had been found dead in a dormitory study room shortly before Thanksgiving. Now, they hope that Facebook and other social media sites can help solve the death of 17-year-old Jasmine Benjamin, which police are investigating as a homicide.

The Valdosta State University freshman was found unresponsive on a study room couch on Nov. 18.

A family friend forwarded the Facebook post about the teen’s death to her parents before they were officially notified by authorities, said A. Thomas Stubbs, an attorney for the victim’s mother, Judith Brogdon, and her stepfather, James Jackson. But many questions remain unanswered about how she died.

The family has hired a private investigator, and a new Facebook site has been set up in hopes that students and others might share tips.

While some Facebook comments have already been turned over to law enforcement officers, the family hopes friends, classmates or others who noticed suspicious comments will also alert authorities.

“Anything that reveals a little more information than what’s publicly known about her death, those are the kind of comments police are looking for as someone who might warrant a closer examination,” Stubbs said.

Also of interest are “unusual comments or unusually timed comments about her death,” he said.

Police detectives have canvassed dormitories and interviewed several students on the campus, located about 250 miles south of the family’s home in Gwinnett County, outside Atlanta.

Benjamin wanted to follow the career path of her mother and become a nurse.

Police say they’re treating the case as a homicide, though autopsy results are not complete and they can’t say for certain whether she was killed. There were no obvious signs of a crime when her body was found, but an autopsy raised questions, authorities have said.

“We’re providing what resources are necessary to assist Valdosta State University police in solving this crime,” Georgia Bureau of Investigation spokesman John Bankhead said. “The crime lab is expediting evidence from this incident.”

Shortly after Benjamin’s parents learned of her death from Facebook, Lawrenceville police officers knocked on the doors of the family home to inform them officially that their daughter was dead, Stubbs said.

“As frustrating as that may be for the family to learn that way, they understand it’s a different world,” Stubbs said.

The family has yet to learn the possible timeframe of when their daughter died, and police have not shared any theories about how she was killed, Stubbs said.

“We know that they have looked at the phone records, video records that they can find in the school,” he said. Beyond that, they’ve been going through legal procedures that are required to obtain records from Facebook Inc.

The family hired Martinelli Investigations Inc. of Lawrenceville to assist in the investigation.

Private investigator Robin Martinelli said Wednesday that any video near the scene, even if may seem insignificant, could prove helpful in the investigation.

“It wouldn’t matter if it was two weeks before, two hours before or 20 minutes before,” she said.

Martinelli said she’s confident that police are working diligently to follow up on leads, but private investigators can often provide valuable assistance, she said.

“On any homicide, they’re going to work around the clock aggressively every minute, and they’re doing that,” she said.

She said Jasmine Benjamin was a strong student who showed great potential. “Her favorite color was purple, her nickname was Jazzy,” she said.

“She wanted to help people, plain and simple,” her stepfather, James Jackson, told WSB-TV. “That was her goal in life. That’s all she talked about since she was young — ‘I want to be able to help people.’”

Valdosta State campus police, city police and the GBI were working together to conduct interviews and collect evidence, the university said in a statement Tuesday. University officials said they couldn’t release any further information.

Martinelli hopes students away at college keep in touch with their parents — and give them the passwords to social networking sites and their cell phones in case anything happens.

“If you have passcodes to your computer, your phone, please tell your parents,” she said. “Don’t tell everybody in the world, but tell your parents your passcodes.”

She said some of the best advice parents can give students is this: “They should listen to their gut,” she said. “If they walk into a situation and it’s not feeling right, leave.”

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Family learns of student’s death on Facebook

ATLANTA (AP) — The parents of a south Georgia college student first learned from Facebook that their daughter had been found dead in a dormitory study room shortly before Thanksgiving. Now, they hope that Facebook and other social media sites can help solve the death of 17-year-old Jasmine Benjamin, which police are investigating as a homicide.

The Valdosta State University freshman was found unresponsive on a study room couch on Nov. 18.

A family friend forwarded the Facebook post about the teen’s death to her parents before they were officially notified by authorities, said A. Thomas Stubbs, an attorney for the victim’s mother, Judith Brogdon, and her stepfather, James Jackson. But many questions remain unanswered about how she died.

The family has hired a private investigator, and a new Facebook site has been set up in hopes that students and others might share tips.

While some Facebook comments have already been turned over to law enforcement officers, the family hopes friends, classmates or others who noticed suspicious comments will also alert authorities.

“Anything that reveals a little more information than what’s publicly known about her death, those are the kind of comments police are looking for as someone who might warrant a closer examination,” Stubbs said.

Also of interest are “unusual comments or unusually timed comments about her death,” he said.

Police detectives have canvassed dormitories and interviewed several students on the campus, located about 250 miles south of the family’s home in Gwinnett County, outside Atlanta.

Benjamin wanted to follow the career path of her mother and become a nurse.

Police say they’re treating the case as a homicide, though autopsy results are not complete and they can’t say for certain whether she was killed. There were no obvious signs of a crime when her body was found, but an autopsy raised questions, authorities have said.

“We’re providing what resources are necessary to assist Valdosta State University police in solving this crime,” Georgia Bureau of Investigation spokesman John Bankhead said. “The crime lab is expediting evidence from this incident.”

Shortly after Benjamin’s parents learned of her death from Facebook, Lawrenceville police officers knocked on the doors of the family home to inform them officially that their daughter was dead, Stubbs said.

“As frustrating as that may be for the family to learn that way, they understand it’s a different world,” Stubbs said.

The family has yet to learn the possible timeframe of when their daughter died, and police have not shared any theories about how she was killed, Stubbs said.

“We know that they have looked at the phone records, video records that they can find in the school,” he said. Beyond that, they’ve been going through legal procedures that are required to obtain records from Facebook Inc.

The family hired Martinelli Investigations Inc. of Lawrenceville to assist in the investigation.

Private investigator Robin Martinelli said Wednesday that any video near the scene, even if may seem insignificant, could prove helpful in the investigation.

“It wouldn’t matter if it was two weeks before, two hours before or 20 minutes before,” she said.

Martinelli said she’s confident that police are working diligently to follow up on leads, but private investigators can often provide valuable assistance, she said.

“On any homicide, they’re going to work around the clock aggressively every minute, and they’re doing that,” she said.

She said Jasmine Benjamin was a strong student who showed great potential. “Her favorite color was purple, her nickname was Jazzy,” she said.

“She wanted to help people, plain and simple,” her stepfather, James Jackson, told WSB-TV. “That was her goal in life. That’s all she talked about since she was young — ‘I want to be able to help people.’”

Valdosta State campus police, city police and the GBI were working together to conduct interviews and collect evidence, the university said in a statement Tuesday. University officials said they couldn’t release any further information.

Martinelli hopes students away at college keep in touch with their parents — and give them the passwords to social networking sites and their cell phones in case anything happens.

“If you have passcodes to your computer, your phone, please tell your parents,” she said. “Don’t tell everybody in the world, but tell your parents your passcodes.”

She said some of the best advice parents can give students is this: “They should listen to their gut,” she said. “If they walk into a situation and it’s not feeling right, leave.”

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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)

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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.

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