Israel moves to build 3,000 new homes

JERUSALEM (AP) — Israel responded swiftly Friday to U.N. recognition of a Palestinian state, revealing it will build 3,000 more homes for Jews on Israeli-occupied lands that the world body overwhelmingly said belong to the Palestinians.

The plans also include future construction in a strategic area of the West Bank where critics have long warned that Jewish settlements would kill hopes for a viable Palestinian state.

Israel's moves served as a harsh reminder to Palestinians — euphoric over the U.N. upgrade — that while they now have a state on paper, most of it remains very much under Israeli control.

"This is a doomsday scenario," Daniel Seidemann of Ir Amim, a group that promotes coexistence in Jerusalem, said of the building plans.

Israel's decision was bound to embarrass the United States, which was among just nine countries in the 193-member General Assembly to vote against accepting Palestine as a nonmember observer state.

Accelerated settlement construction could also set a more confrontational tone as Palestinian President Mahmoud Abbas weighs his next moves.

In Washington, State Department spokeswoman Victoria Nuland criticized the Israeli announcement. "These actions are counterproductive and make it harder to resume direct negotiations or achieve a two-state solution," she said.

Friday's decision was taken by Prime Minister Benjamin Netanyahu and eight senior Cabinet ministers, according to the Israeli news website Ynet.

The plans include 3,000 new apartments in the West Bank and east Jerusalem, as well as preparations for new construction in other large West Bank settlements, including Maaleh Adumim, near east Jerusalem, said an Israeli government official.

Among the projects is an expansion of Maaleh Adumim, known as E-1, said the official, speaking on condition of anonymity because he was not authorized to discuss the decision with reporters.

Successive U.S. administrations have pressured Israel not to build in E-1 because it would effectively cut off east Jerusalem from the West Bank, and split the northern part of the territory from the southern part. Israel has said in the past it envisions 3,500 apartments there.

"E-1 will be the death of the two-state solution," said Seidemann, referring to the establishment of a state of Palestine alongside Israel. "If the pronouncements are to be treated seriously, we are months away from the implementation of E-1. This is very serious and very problematic."

Tzipi Livni, Israel's former foreign minister and chief negotiator with the Palestinians, warned that "the decision to build thousands of housing units as punishment to the Palestinians only punishes Israel ... (and) only isolates Israel further."

Since 1967, the number of Israelis living in settlements in the West Bank and east Jerusalem has risen to half a million, compared with 2.7 million Palestinians in those areas, and continued construction makes partition of the land increasingly unlikely.

The new U.N. observer state status could enable the Palestinians to pursue possible war crimes charges against Israel at the International Criminal Court over settlement construction on war-won land.

In his speech to the U.N. on Thursday, Abbas said he would coordinate with sympathetic countries and act responsibly, suggesting he would not seek confrontation with Israel.

"It is our right to get the membership of the ICC, but we don't want to go to it now," Abbas told reporters in New York on Friday, before the Israeli decision on new settlements became known. "We will not go unless we are attacked."

Following Israel's decision to accelerate settlement building, however, Abbas aide Saeb Erekat said the Palestinian leadership was studying its options. He would not elaborate.

Erekat accused Netanyahu of "defying the whole international community and insisting on destroying the two-state solution."

The U.N. endorsed a Palestinian state in territories Israel captured in 1967. Abbas has said he is ready to negotiate the final borders with Israel, provided Netanyahu drops his refusal to use the 1967 lines as a starting point.

Abbas asserted Friday that a Palestinian demand for a settlement freeze ahead of negotiations still stands.

"I'm ready for negotiations," Abbas said, rejecting Netanyahu's portrayal of the demand for a settlement freeze as a precondition. "Is stopping settlement activities a precondition?" he said. "There are 15 Security Council resolutions that say settlements are an obstacle to peace."

On the Israeli side, compromise on settlements seemed unlikely. Netanyahu is seeking re-election two months from now at the helm of a Likud party turned more hawkish since primaries earlier this week and in an electoral alliance with an ultra-nationalist pro-settler party.

Abbas returns Sunday to the West Bank, where Palestinians are preparing a hero's welcome. The U.N. bid has given a boost to his standing, which has been suffering after years of failed peace efforts with Israel. At the same time, the rival Islamic militant group Hamas in Gaza has scored points domestically, after an eight-day cross-border conflict with Israel earlier this month.

Abbas aides say his top priority is to reconcile with Hamas, which seized Gaza from him in 2007 and has been running its own government there since then. Abbas heads the Palestinian Authority, a self-rule government that administers 38 percent of the West Bank, while he has no say in Israeli-annexed east Jerusalem.

The U.N. vote drew mixed reactions among Palestinians trying to reconcile global recognition with the limitations imposed by Israeli control, including border restrictions in Gaza.

Shahira Taleb, a 45-year-old Gaza housewife who has been unable to visit family in the West Bank because of an Israeli travel ban between the territories, was skeptical.

"I don't know if it's something that will change our life or is just a new paper added to thousands of papers issued over the past years in support of our cause," she said, standing in line at a bakery.

But Talal Jafari, a 47-year-old shopkeeper in the West Bank city of Hebron, said for Palestinians, every victory counts. "The entire world supports us, and that by itself is great for us," he said.

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Laub reported from Ramallah. Associated Press writer Mohammed Daraghmeh in Ramallah, West Bank, Nasser Shiyoukhi in Hebron and Ibrahim Barzak in Gaza City contributed reporting.

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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.”

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AP freelance video journalist Ricardo Nunes contributed to this report.

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

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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.”

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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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U.N. recognizes Palestinian state, U.S. objects

UNITED NATIONS (Reuters) - The 193-nation U.N. General Assembly on Thursday overwhelmingly approved the de facto recognition of the sovereign state of Palestine after Palestinian President Mahmoud Abbas called on the world body to issue its long overdue "birth certificate."

The U.N. victory for the Palestinians was a diplomatic setback for the United States and Israel, which were joined by only a handful of countries in voting against the move to upgrade the Palestinian Authority's observer status at the United Nations to "non-member state" from "entity," like the Vatican.

Britain called on the United States to use its influence to help break the long impasse in Israeli-Palestinian peace talks. Washington also called for a revival of direct negotiations.

There were 138 votes in favor, nine against and 41 abstentions. Three countries did not take part in the vote, held on the 65th anniversary of the adoption of U.N. resolution 181 that partitioned Palestine into separate Jewish and Arab states.

Thousands of flag-waving Palestinians in the West Bank and the Gaza Strip set off fireworks and danced in the streets to celebrate the vote.

The assembly approved the upgrade despite threats by the United States and Israel to punish the Palestinians by withholding funds for the West Bank government. U.N. envoys said Israel might not retaliate harshly against the Palestinians over the vote as long as they do not seek to join the International Criminal Court.

If the Palestinians were to join the ICC, they could file complaints with the court accusing Israel of war crimes, crimes against humanity and other serious crimes.

U.S. Secretary of State Hillary Clinton called the vote "unfortunate and counterproductive," while the Vatican praised the move and called for an internationally guaranteed special status for Jerusalem, something bound to irritate Israel.

The much-anticipated vote came after Abbas denounced Israel for its "aggressive policies and the perpetration of war crimes" from the U.N. podium, remarks that elicited a furious response from the Jewish state.

"Sixty-five years ago on this day, the United Nations General Assembly adopted resolution 181, which partitioned the land of historic Palestine into two states and became the birth certificate for Israel," Abbas told the assembly after receiving a standing ovation.

"The General Assembly is called upon today to issue a birth certificate of the reality of the State of Palestine," he said.

Israeli Prime Minister Benjamin Netanyahu responded quickly, condemning Abbas' critique of Israel as "hostile and poisonous," and full of "false propaganda.

"These are not the words of a man who wants peace," Netanyahu said in a statement released by his office. He reiterated Israeli calls for direct talks with the Palestinians, dismissing Thursday's resolution as "meaningless."

ICC THREAT

Granting Palestinians the title of "non-member observer state" falls short of full U.N. membership - something the Palestinians failed to achieve last year. But it would allow them access to the ICC and other international bodies, should they choose to join them.

Abbas did not mention the ICC in his speech. But Palestinian Foreign Minister Riyad al-Maliki told reporters after the vote that if Israel continued to build illegal settlements, the Palestinians might pursue the ICC route.

"As long as the Israelis are not committing atrocities, are not building settlements, are not violating international law, then we don't see any reason to go anywhere," he said.

"If the Israelis continue with such policy - aggression, settlements, assassinations, attacks, confiscations, building walls - violating international law, then we have no other remedy but really to knock those to other places," Maliki said.

In Washington, a group of four Republican and Democratic senators announced legislation that would close the Palestinian office in Washington unless the Palestinians enter "meaningful negotiations" with Israel, and eliminate all U.S. assistance to the Palestinian Authority if it turns to the ICC.

"I fear the Palestinian Authority will now be able to use the United Nations as a political club against Israel," said Republican Senator Lindsey Graham, one of the sponsors.

Abbas led the campaign to win support for the resolution, which followed an eight-day conflict this month between Israel and Islamists in the Gaza Strip, who are pledged to Israel's destruction and oppose a negotiated peace.

At least 17 European nations voted in favor of the Palestinian resolution, including Austria, France, Italy, Norway and Spain. Abbas had focused his lobbying efforts on Europe, which supplies much of the aid the Palestinian Authority relies on. Britain, Germany and others chose to abstain.

The Czech Republic was unique in Europe, joining the United States, Israel, Canada, Panama and tiny Pacific Island states likes Nauru, Palau and Micronesia in voting against the move.

PALESTINIANS RALLY

Peace talks have been stalled for two years, mainly over Israeli settlements in the West Bank, which have expanded despite being deemed illegal by most of the world. There are 4.3 million Palestinians in the West Bank and Gaza.

After the vote, U.S. Ambassador to the United Nations Susan Rice called for the immediate resumption of peace talks.

"The Palestinian people will wake up tomorrow and find that little about their lives has changed save that the prospects of a durable peace have only receded," she said.

She added that both parties should "avoid any further provocative actions in the region, in New York or elsewhere."

Palestinian Prime Minister Salam Fayyad said he hoped all sides would use the vote to push for new breakthroughs in the peace process.

"I hope there will be no punitive measures," Fayyad told Reuters in Washington, where he was attending a conference.

"I hope that some reason will prevail and the opportunity will be taken to take advantage of what happened today in favor of getting a political process moving," he said.

Britain's U.N. ambassador, Mark Lyall Grant, told reporters it was time for recently re-elected U.S. President Barack Obama to make a new push for peace.

"We believe the window for the two-state solution is closing," he said. "That is why we are encouraging the United States and other key international actors to grasp this opportunity and use the next 12 months as a way to really break through this impasse."

(Additional reporting by Andrew Quinn in Washington, Noah Browning in Ramallah, Jeffrey Heller in Jerusalem, Robert Mueller in Prague, Gabriela Baczynska and Reuters bureaux in Europe and elsewhere; Editing by Peter Cooney and Eric Beech)

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Rapper PSY wants Tom Cruise to go ‘Gangnam Style’

BANGKOK (AP) — The South Korean rapper behind YouTube’s most-viewed video ever has set what might be a “Mission: Impossible” for himself.

Asked which celebrity he would like to see go “Gangnam Style,” the singer PSY told The Associated Press: “Tom Cruise!”

Surrounded by screaming fans, he then chuckled at the idea of the American movie star doing his now famous horse-riding dance.

PSY’s comments Wednesday in Bangkok were his first public remarks since his viral smash video — with 838 million views — surpassed Justin Bieber‘s “Baby,” which until Saturday held the record with 803 million views.

“It’s amazing,” PSY told a news conference, saying he never set out to become an international star. “I made this video just for Korea, actually. And when I released this song — wow.”

The video has spawned hundreds of parodies and tribute videos and earned him a spotlight alongside a variety of superstars.

Earlier this month, Madonna invited PSY onstage and they danced to his song at one of her New York City concerts. MC Hammer introduced the Korean star at the American Music Awards as, “My Homeboy PSY!”

Even President Barack Obama is talking about him. Asked on Election Day if he could do the dance, Obama replied: “I think I can do that move,” but then concluded he might “do it privately for Michelle,” the first lady.

PSY was in Thailand to give a free concert Wednesday night organized as a tribute to the country’s revered King Bhumibol Adulyadej, who turns 85 next month. He paid respects to the king at a Bangkok shopping mall, signing his name in an autograph book placed beside a giant poster of the king. He then gave an outdoor press conference, as screaming fans nearby performed the pop star’s dance.

Determined not to be a one-hit wonder, PSY said he plans to release a worldwide album in March with dance moves that he thinks his international fans will like.

“I think I have plenty of dance moves left,” he said, in his trademark sunglasses and dark suit. “But I’m really concerned about the (next) music video.”

“How can I beat ‘Gangnam Style’?” he asked, smiling. “How can I beat 850 million views?”

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Associated Press writer Thanyarat Doksone contributed to this report.

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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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No more government contracts for BP

WASHINGTON (Reuters) - The U.S. government banned BP Plc on Wednesday from new federal contracts over its "lack of business integrity" in the 2010 Deepwater Horizon oil spill, possibly imperiling the company's role as a top U.S. offshore oil and gas producer and the No. 1 military fuel supplier.

The suspension, announced by the Environmental Protection Agency, comes on the heels of BP's November 15 agreement with the U.S. government to plead guilty to criminal misconduct in the Gulf of Mexico disaster, the worst offshore oil spill in U.S. history. The British energy giant agreed to pay $4.5 billion in penalties, including a record $1.256 billion criminal fine.

BP and its affiliates are barred from new federal contracts until they demonstrate they can meet federal business standards, the EPA said. The suspension is "standard practice" and BP's existing U.S. government contracts are not affected, it said.

The EPA acted hours before a government auction of offshore tracts in the Gulf of Mexico, a region where BP is the largest investor and lease-holder of deep-water tracts and hopes for further growth. BP is also the top fuel supplier to the U.S. military, the largest single buyer of oil in the world.

Suspension of contracts could give the government leverage to pressure BP to settle federal and state civil litigation that could top $20 billion if a court finds BP was grossly negligent in the Deepwater Horizon disaster.

An EPA official said government-wide suspensions generally do not exceed 18 months, but can continue longer if there are ongoing legal cases.

In a statement, BP said it has been in "regular dialogue" with the EPA, and that the agency has informed BP that it is preparing an agreement that "would effectively resolve and lift this temporary suspension." The EPA has notified BP that the draft agreement will be available soon, BP said.

U.S. operations accounted for more than 30 percent of BP's pre-tax profits in the third quarter, and the United States accounts for about a fifth of BP's global oil production.

The U.S. military has been a reliable customer of BP's jet fuel and other refined products. As recently as September, BP affiliates won two military fuel contracts worth as much as $1.37 billion, according to a website that tracks U.S. military contracts.

The EPA's action is a sign that all federal contractors will be held to high standards, said Scott Amey, general counsel for the Project on Government Oversight, a private watchdog group.

"BP had years to improve its business ethics and is paying the price for its inaction," Amey said.

On November 15, BP Finance Director Brian Gilvary told investors on a conference call that any blanket ban could force the company to rethink its entire U.S. business.

The Justice Department says it intends to prove in a court case set to get underway in February 2013 that BP was grossly negligent under the Clean Water Act, a claim the company has adamantly denied.

"The critical question is whether this a shot across BP's bows to get settlement, or a more sustained stance, in which case the importance of the context is underlined" by Gilvary's comments, said Peter Hutton, an analyst with RBC Capital Markets.

The EPA's suspension will not impair BP's ability to produce oil and gas from existing U.S. assets, said Pavel Molchanov, an analyst with Raymond James & Associates Inc in Houston.

"BP's supply contract of fuels to the Pentagon might be at risk, but of course BP could supply other customers if this supply contract is not renewed," Molchanov said in a research note.

BP and the U.S. government likely worked out a deal on the timing of the suspension before BP agreed to sign off on the November 15 criminal plea deal, said Samuel Buell, a Duke University Law School professor and former federal prosecutor.

"It's just inconceivable to me that BP's lawyers ... would have entered into that agreement last week without the issue of a suspension or debarment having been addressed," Buell said.

BP did not participate in Wednesday's federal auction of 20 million acres (8 million hectares) of drilling tracts in the Gulf of Mexico, one of BP's biggest oil production regions globally.

One long-time critic of BP applauded the decision.

"After pleading guilty to such reckless behavior that killed men and constituted a crime against the environment, suspending BP's access to contracts with our government is the right thing to do," U.S. Rep. Edward Markey, a Democrat from Massachusetts, said in a statement.

BP's U.S.-traded shares closed flat, while London-traded shares were down less than 1 percent at 427 pence.

(Additional reporting by Andrew Callus in London, Ayesha Rascoe in Washington, Joshua Schneyer in New York and Kristen Hays in Houston; Writing by Chris Baltimore; Editing by John Wallace, Grant McCool, Andrew Hay and Marguerita Choy)

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Rugby-England add flyhalf Burns to squad for All Blacks’ test

LONDON, Nov 27 (Reuters) – England called up uncapped Gloucester flyhalf Freddie Burns on Tuesday to their squad for Saturday’s test against New Zealand in place of the injured Toby Flood.

Flood sustained ligament damage to a big toe during the 16-15 loss to South Africa at Twickenham last Saturday.

Owen Farrell, whose last start was in the first test in South Africa this year, is set to replace Flood in the starting XV against the world champions.

Lock Courtney Lawes, who missed England’s first three tests of the November series because of a knee injury, has also been included in the 23-man squad. Two other locks, Mouritz Botha and Tom Palmer, have been omitted.

After beating Fiji in their opening match, England have lost to Australia and the Springboks and now face a daunting match against the All Blacks who are unbeaten in 20 tests since the start of their victorious World Cup campaign last year.

“For those in Saturday’s squad the message is clear – last week we went toe to toe with the second best team in the world and felt we should have won,” England head coach Stuart Lancaster said in a statement.

“Now we have a chance to take on the number one side in front of a passionate Twickenham crowd, who have been fantastic throughout the Internationals, and it is a challenge we will meet head on.” (Reporting by John Mehaffey; Editing by Ken Ferris)

Australia / Antarctica News Headlines – Yahoo! News

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