Obama Hangs Tough on the Fiscal Cliff

President Barack Obama made clear today that he plans to take a tough line in budget negotiations with congressional Republicans. That pretty much assures that there will be no deal soon and we’ll be hearing about the “fiscal cliff” of automatic spending cuts and scheduled tax hikes long past Jan. 1.

The fiscal cliff is scheduled to be reached at the start of 2013. But the most likely outcome now is that the parties will come up with a patch—a temporary agreement to postpone the effects of the fiscal cliff while negotiations continue. That will keep the economy from suffering an immediate blow, but it will also mean continued uncertainty, which discourages consumers from spending and businesses from investing.

Tired of hearing about the fiscal cliff now? Wait until next summer, when it could still be a topic of daily conversation inside the Beltway. On the eve of the election, Representative James Clyburn of South Carolina, the third-ranking House Democrat, told Fox News Channel’s Neil Cavuto that a patch could last “up to, maybe, around a year.”

In a speech in the White House East Room, Obama said the election showed that “a majority of Americans agree with my approach.”

Obama wants to end the Bush tax cuts on household income above $ 200,000 a year (individuals) or $ 250,000 a year (couples). That will affect just 2 percent of Americans. Republicans want to preserve all of the Bush tax cuts, including for the highest-income Americans. In a gambit to put the Republicans in a politically difficult position, Obama called on Congress to extend the Bush tax cuts for people earning under $ 250,000 a year while negotiations continue on the top brackets. “We shouldn’t need long negotiations or drama,” he said.

House Speaker John Boehner said Nov. 8 that GOP leaders were open to increasing revenue, but by closing deductions and credits, not by raising tax rates, which they continue to oppose. Boehner also said any revenue increase should come as part of a package that overhauls entitlement spending and the tax code.

Obama said he was inviting congressional leaders of both parties to the White House next week for talks.

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Syria opposition bloc elects Christian as leader

DOHA, Qatar (AP) — Syria‘s main opposition group in exile has elected a Christian Paris-based former geography teacher as its new president.

George Sabra said Friday that his election as head of the Syrian National Council is a sign that the opposition is not plagued by sectarian divisions.

Sabra says the SNC‘s main demand is to receive weapons from the international community. The U.S. and some other foreign backers of rebels fighting the regime of President Bashar Assad have so far refused to send weapons for fear they can fall into the wrong hands.

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Walmart Moves Up Black Friday

Walmart is kicking off Black Friday shopping earlier than ever this year, opening stores at 8 p.m. on Thanksgiving Day.

“In addition to offering amazing low prices on the season’s top gifts, Walmart is taking the historic step to ensure wishlist items like the Apple iPad2 are available for customers during a special one-hour event on Thanksgiving,” the world’s largest retailer said in a statement today.

“We know it’s frustrating for customers to shop on Black Friday and not get the items they want,” said Duncan Mac Naughton, chief merchandising and marketing officer, Walmart U.S. “This year, for the first time ever, customers that shop during Walmart’s one-hour event will be guaranteed to have three of the most popular items under their tree at a great low price.”

Other retailers will also be opening earlier, including Sears at 8 p.m. on Thanksgiving, moved up from 4 a.m. on Black Friday last year. Kmart will be open Thanksgiving Day 6 a.m. to 4 p.m., then it will close and reopen 8 p.m. to 3 a.m. Macy’s, Kohl’s and Best Buy open at midnight; Toys R Us hasn’t announced its plans. Advice on how to snag the best deals.

To help convince folks to head out to the store after dinner, Walmart said it will guarantee that customers who are inside the store and in line between 10 p.m. and 11 p.m. can get these deals:

Apple iPad ®2 16GB with Wi-Fi – $ 399 plus get a $ 75 Walmart Gift Card

Emerson ® 32 720p LCD TV – $ 148

LG ® Blu-ray™ Player – $ 38

“If any of these items happen to sell out before 11 p.m. local time, Walmart will offer a Guarantee Card for the item which must be paid for by midnight and registered online. The product will then be shipped to the store where it was purchased for the customer to pick up before Christmas,” the retailer said.

A few of the top items available in store, while supplies last, include:

8 p.m. on November 22: Gifts for the Entire Family – Toys, Gaming, Home and Apparel

Xbox 360 ® 4GB + SkyLanders ™ Bundle – $ 149

Wii ™ Console- $ 89

More than 100 video games priced at $ 10, $ 15 or $ 25 each

Top Toys of the Season: Leappad ® 1.0 Learning Tablet ($ 65) and Furby ® ($ 45)

Razor ® Accelerator 12-Volt Electric Scooter – $ 79

Fisher Price Power Wheels ® Jeep ® Wrangler 6-Volt Ride Ons (Hot Wheels ® and Barbie ®) – $ 89 each

Licensed Boys’ and Girls’ 2-Piece Sleep Set – $ 4.50 each

Mens and Ladies Denim – $ 9.50 each

Home appliances such as a Crock Pot ® 6-Quart Slow Cooker and Mr. Coffee ® Programmable 12-Cup Coffee Maker – $ 9.44 each

Shark ® Steam Pocket Mop and Ninja ® Pulse Blender – $ 39 each

Fashion Dolls such as Barbie ®, Bratz ™ and Disney ® Princess – $ 5 each

Hundreds of DVD and Blu-ray movies such as Brave, The Amazing Spiderman, Hunger Game ranging from $ 1.96 to $ 9.96 each

Better Homes and Gardens ® 700-Thread Count Sheet Set – $ 19.96

48″ Air-Powered Hockey Table – $ 29.86

14′ Trampoline with Enclosure and Bonus Flash Light Zone – $ 159

10 p.m. on November 22: The BIG Event – Brand Name Electronics

Vizio ® 60″ 720p LED Smart TV with built in Wi-Fi – $ 688

Samsung ® 43″ 720p 600Hz Class Plasma HDTV – $ 378

HP ® 15.6″ Laptop with 4GB and 320GB hard drive – $ 279

Nikon ® D3000 Digital Camera with Lens Kit – $ 449

Samsung ® Smart ST195 Digital Camera – $ 99

Beats by Dr. Dre ® Headphones – $ 179.95

Nook ® Color ™ 8GB Tablet – $ 99

Virgin Mobile ® 3G/4G Hotspot – $ 39.88

5 a.m. on Nov. 23: Caffeine Not Needed – Great Savings on Gifts from Jewelry to Tires

Sharp ® 70″ 1080p 120Hz HDTV – $ 1,798

Acer ® 13.3″ Ultrabook ™ with 4GB and 320GB solid state drive – $ 499

$ 100 Walmart gift card with the purchase of select smartphones such as the Samsung ® Galaxy S III, Droid RAZR M by Motorola ® and HTC ® One X

Goodyear Tires ranging from $ 59 – $ 99 each

Forever Bride 1/3 -Carat T.W. Diamond Ring in 10K Gold – $ 198

Stanley ® 6-Drawer Rolling Tool Cabinet with 85-Piece Mechanic Tool Set – $ 99

Singer ® Sew Mate 5400 60-Stitch Sewing Machine – $ 99.97

5? Pre-Lit Harrison Christmas Tree – $ 20

Better Homes and Gardens Deluxe Recliner – $ 199

Black Friday Specials & More Online:

Samsung 50″ Class LED 1080p 60Hz HDTV – $ 698

Ematic 7″ Tablet Android 4.0 1GHz, 4GB – $ 49

Dsi XL Ultimate Bundle – $ 129

Razor A Kick Scooter, Multiple Colors – $ 25

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“Lincoln” Reviews: Is Steven Spielberg’s biopic Oscar-worthy?

LOS ANGELES (TheWrap.com) – “Lincoln,” with a cast of acting titans like Daniel Day-Lewis and Tommy Lee Jones, arrives in theaters Friday with many predicting big things come Oscar night. But does Steven Spielberg‘s biopic of the Great Emancipator live up to the early hype?

Based on initial reviews, it seems like Spielberg and company have delivered. Critics are raving about Day-Lewis’ performance and crediting the film with taking a historical figure who is cloaked in myth and making him relatable and sympathetically human. Instead of uncoiling a birth-through-death chronology of Father Abraham, “Lincoln” narrows its gaze to a few key months in 1865 when the president was trying to simultaneously end the Civil War and pass an amendment abolishing slavery.

The film, which will expand nationally next week after opening in limited release this weekend, scored a bullish 92 percent “fresh” rating on critics aggregator Rotten Tomatoes.

In TheWrap, Alonso Duralde lavished praise on the film and its literate script from Pulitzer Prize winner Tony Kushner for finding the man behind the monument. His one bone of contention was not with the film itself but with its gauzy ad campaign.

“The dreadful trailer makes ‘Lincoln‘ look like an awful collection of Spielbergian excesses, including swelling John Williams moments (admittedly, there are one or two) and Janusz Kaminski’s honey-baked lighting (OK, granted, it appears, but not too often), not to mention Tommy Lee Jones‘ terrible wig (which actually winds up being organic in his memorable turn as Thaddeus Stevens),” Duralde writes. “Don’t let the marketing campaign keep you from seeing one of the best American movies this year, and Spielberg’s finest work in decades.”

Perhaps no critical enthusiasm could match that of A.O. Scott. In a glowing review in The New York Times, Scott sounds the trumpets for Spielberg’s epic, urging parents to bundle their children into the local multiplex to see history unfurl across the screen.

“Some of the ambition of ‘Lincoln‘ seems to be to answer the omissions and distortions of the cinematic past, represented by great films like D. W. Griffith‘s ‘Birth of a Nation,’ which glorified the violent disenfranchisement of African-Americans as a heroic second founding, and ‘Gone With the Wind,’ with its romantic view of the old South,” Scott writes. “To paraphrase what Woodrow Wilson said of Griffith, Mr. Spielberg writes history with lightning.”

For Kenneth Turan, the greatness of the film lies in its understatedness. Writing in the Los Angeles Times, he lauded Spielberg for abandoning his more bombastic impulses to focus on the interior life of an American president.

“There is nothing bravura or overly emotional about Spielberg’s direction here, but the impeccable filmmaking is no less impressive for being quiet and to the point,” Turan writes. “The director delivers selfless, pulled-back satisfactions: he’s there in service of the script and the acting, to enhance the spoken word rather than burnish his reputation.”

It’s an “A,” declares Entertainment Weekly’s Owen Gleiberman, who hails the film for getting its hands dirty while depicting the sausage-making of politics.

“The Lincoln we see here is that rare movie creature, a heroic thinker,” he writes. “He has the serpentine intellect of a master lawyer, infused with a poet’s passion. ‘Lincoln’ brilliantly dramatizes the delicacy of politics, along with the raw brutality of it.”

In New York magazine, David Edelstein savored the film, but admitted that a few moments could have gone down more smoothly. In particular, he said the film’s initial scenes suffered from musty dialogue and some of the political wrangling it depicted was difficult to follow. Ultimately, however, he credited the picture with finding a fresh take on a president whose legacy has been dissected and debated for generations.

“By the time the movie ends, you don’t feel as if you know Lincoln – few, in his own time, claimed to know him,” Edelstein writes. “But you feel as if you know what it was like to be in his presence. And so an icon (it’s a measure of how promiscuously that word is thrown around that it seems inadequate for one of history’s truly iconic figures) has become a man – and, startlingly, within reach.”

There were a few critics, of course, who were not ready to endorse “Lincoln.” In the Newark Star-Ledger, Stephen Whitty slammed the movie for choking on its own self-serious and mocked it for too many scenes of intense debates held by men with copious facial hair.

“So if you’ve been sitting around wondering, ‘Gee, when is Spielberg ever going to make another ‘Amistad?’ ’ here’s your answer,” Whitty writes.

Apparently, Whitty would prefer another “Jaws.”

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California teen steps into rattlesnake nest, survives

SAN DIEGO (Reuters) – A teenage California girl searching for a cell phone signal to call her mother in a rural area outside San Diego inadvertently stepped into a nest of rattlesnakes and was bitten six times, but survived.

The 16-year-old, Vera Oliphant, spent four days in the intensive care unit of Sharp Grossmont Hospital, and doctors gave her 24 vials of antivenom after she was bitten by an adult rattlesnake and five young rattlers outside her uncle’s home.

“I was trying to find a signal to call my mom and text my boyfriend,” Oliphant said on Friday, a day after she was released from the hospital following the October 27 incident.

“I didn’t see them until I already stepped on their nest and I felt them biting me.”

“My vision started to go right away. First it looked like the snakes blended into the leaves and then I started seeing black spots around the edges and I started blacking out.”

She returned to her uncle’s home in Jamul, outside San Diego, and he immediately packed her into the car and rushed her to the emergency room, she said.

On the way, she talked to her mom and her boyfriend, who told her to stay calm so the venom wouldn’t spread.

“I told my mom and my boyfriend I love them in case I don’t get to see them again,” she said.

Doctors there administered 24 vials of antivenom to quash the dangerous toxins, according to a hospital spokesman. Snakebites usually aren’t fatal, although a handful of people die in the United States each year from snake bites, including bites from rattlesnakes.

Oliphant has recovered and will be returning to classes at Chaparral High School in El Cajon on Monday. She said the next time she can’t get a signal, she will handle it differently.

“Be careful where you step,” she said. “If you don’t need to, just wait until you are somewhere that you can call people.”

(Editing By Cynthia Johnston and Todd Eastham)

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Wall Street Week Ahead: “Fiscal cliff” blues may lead to correction

NEW YORK (Reuters) – Wall Street‘s post-election sell-off may gather steam in the coming weeks as worries mount about the looming “fiscal cliff” and technical weakness suggests a possible correction ahead.

The benchmark Standard & Poor’s 500 <.SPX> closed below its 200-day moving average – a measure of the market’s long-term trend – on Thursday for the first time in five months, and ended below it again on Friday. More than half of the Dow components are trading below key technical levels.

“I don’t think you have to panic here, but I think you really want to be looking for the market to move lower for the next couple of months,” said Frank Gretz, market analyst and technician for Wellington Shields & Co., a brokerage in New York. “I think the next rally is the rally you want to sell.”

At the heart of the market’s worry is whether U.S. leaders can come to agreement on some $ 600 billion in spending cuts and tax increases that are due to kick in early next year. Some fear dramatic cutbacks could send the U.S. economy into another recession.

The prospect of higher tax rates in 2013 is driving investors to sell shares as they seek to decrease the tax impact from their positions this year and next.

“You would have thought the fiscal cliff scenarios would have been already mulled over and priced in, but they weren’t. It’s almost like the market has ADD and can only focus on one thing at a time,” said Natalie Trunow, chief investment officer of equities at Calvert Investment Management in Bethesda, Maryland, whose firm manages about $ 13 billion in assets.

The S&P 500 fell 2.4 percent for the week, its worst weekly percentage drop since June. The index is now down 6.4 percent from its intraday high for the year of 1,474.51 reached on September 14. That drop puts the benchmark index below its 50-day moving average, but not yet into correction territory, defined as a 10 percent drop from a peak.

READING THE TECHNICAL SIGNS

The S&P 500 has been trading in a range between the 50-day moving average of 1,433.50 and the 200-day moving average of 1,380.98 for about two weeks. A significant break below that lower level could be a precursor to further weakness, analysts said.

“There’s a technical breakdown in the market that indicates further losses,” said Adam Sarhan, chief executive of Sarhan Capital in New York. “A 10 percent drop is the next big line in the sand.”

The primary driver of stock prices in coming weeks looks likely to be investor concern about the U.S. fiscal situation.

In a sign of the risks involved, comments by President Barack Obama on Friday about the upcoming negotiations caused stocks to sharply cut their gains.

The president, who defeated Republican candidate Mitt Romney in Tuesday’s U.S. election, outlined a position for the fiscal issues on Friday that is far apart from that of his political opponents, suggesting a long battle is to come.

“If the market anticipates a resolution to the fiscal cliff or Europe or any of the other bricks in the wall of worry, we could easily take off,” Sarhan said.

Seventeen of the Dow’s 30 components are trading below both their 50-day and 200-day moving averages, while another eight are under their 50-day levels, but not their 200. Only five components – Bank of America , JPMorgan Chase & Co , Home Depot Inc , Johnson & Johnson and Travelers Cos – are above both support levels.

Another big negative for the market has been heavy selling of Apple shares. The stock of the world’s biggest company, ranked by market capitalization, lost 5.2 percent this week, weighing heavily on both the S&P 500 and the Nasdaq <.IXIC>. The stock is down 22.4 percent from its September 21 all-time intraday high of $ 705.07.

BIG RETAILERS’ REPORT CARDS

The election and fiscal cliff concerns, which came on the heels of Superstorm Sandy and its devastating effects on many parts of the U.S. Northeast, have captured so much attention that they’ve overshadowed weakness coming from third-quarter earnings.

With results in from 449 of the S&P 500 companies, third-quarter earnings now are estimated to have declined 0.3 percent from a year ago, which is slightly better than the forecast at the start of the reporting period. Results have been especially weak on the revenue side, however, with just 38 percent of companies beating on sales, Thomson Reuters data showed.

But recent stronger economic data, including a report on Friday showing consumer sentiment at more than a five-year high in early November, suggests that retailers, many of which have yet to report, could be among the stronger performers this earnings period.

Next week, results are expected from such big names as Target , Wal-Mart and Home Depot.

Consumer discretionary companies have outperformed the broader S&P 500 in earnings, with 72 percent of the companies in that sector beating analysts’ expectations, compared with 63 percent for the S&P 500 as a whole.

Investors will be paying close attention to those results with the holiday shopping period around the corner, said Rick Meckler, president of LibertyView Capital Management in Jersey City, New Jersey, which oversees about $ 1 billion in assets.

“It’s really the beginning of the Christmas sell season, and I think there’s going to be a lot of interest with the outlook for that season and how promotional companies are going to be,” Meckler said.

(Wall St Week Ahead runs every Friday. Questions or comments on this column can be emailed to: caroline.valetkevitch(at)thomsonreuters.com )

(Reporting by Caroline Valetkevitch and Ryan Vlastelica; Editing by Jan Paschal)

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Myanmar says Obama to visit later this month

YANGON, Myanmar (AP) — President Barack Obama will make a groundbreaking visit later this month to Myanmar, an official said Thursday, following through with his policy of rapprochement to encourage democracy in the Southeast Asian nation.

The Myanmar official speaking from the capital, Naypyitaw, said Thursday that security for a visit on Nov. 18 or 19 had been prepared, but the schedule was not final. He asked not to be named because he was not authorized to give information to the media.

The official said Obama would meet with opposition leader Aung San Suu Kyi as well as government officials including reformist President Thein Sein.

It would be the first-ever visit to Myanmar by an American president. U.S. officials have not yet announced any plans for a visit, which would come less than two weeks after Obama’s election to a second term.

Obama’s administration has sought to encourage the recent democratic progress under Thein Sein by easing sanctions applied against Myanmar’s previous military regime.

Officials in nearby Thailand and Cambodia have already informally announced plans for visits by Obama that same week. Cambodia is hosting a summit meeting of the Association of Southeast Asian Nations, and Thailand is a longtime close U.S. ally.

The visit to Myanmar, also known as Burma, would be the culmination of a dramatic turnaround in relations with Washington as the country has shifted from five decades of ruinous military rule and shaken off the pariah status it had earned through its bloody suppression of democracy.

Obama’s ending of the long-standing U.S. isolation of Myanmar’s generals has played a part in coaxing them into political reforms that have unfolded with surprising speed in the past year. The U.S. has appointed a full ambassador and suspended sanctions to reward Myanmar for political prisoner releases and the election of Nobel laureate Suu Kyi to parliament.

From Myanmar’s point of view, the lifting of sanctions is essential for boosting a lagging economy that was hurt not only by sanctions that curbed exports and foreign investment, but also by what had been a protectionist, centralized approach. Thein Sein’s government has initiated major economic reforms in addition to political ones.

A procession of senior diplomats and world leaders have traveled to Myanmar, stopping both in the remote, opulent capital city, which was built by the former ruling junta, and at Suu Kyi’s dilapidated lakeside villa in the main city of Yangon, where she spent 15 years under house arrest. New Zealand announced Thursday that Prime Minister John Key would visit Myanmar after attending the regional meetings in Cambodia.

The most senior U.S. official to visit was Hillary Rodham Clinton, who last December became the first U.S. secretary of state to travel to Myanmar in 56 years.

The Obama administration regards the political changes in Myanmar as a marquee achievement in its foreign policy, and one that could dilute the influence of China in a country that has a strategic location between South and Southeast Asia, regions of growing economic importance.

But exiled Myanmar activists and human rights groups are likely to criticize an Obama visit as premature, rewarding Thein Sein before his political and economic reforms have truly taken root. The military — still dominant and implicated in rights abuses — has failed to prevent vicious outbreaks of communal violence in the west of the country that have left scores dead.

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US video game sales drop 25 percent in October

NEW YORK (AP) — A research firm says U.S. retail sales of new video game hardware, software and accessories fell 25 percent in October.

The drop marks the 11th straight month of declining sales for physical game products. Many gamers are waiting for big holiday releases such as Activision Blizzard Inc.‘s “Call of Duty: Black Ops II.”

The NPD Group said Thursday that sales fell to $ 755.5 million from $ 1 billion a year earlier.

Sales of video games themselves, excluding PC titles, fell 25 percent to $ 432.6 million. Sales of hardware such as Microsoft’s Xbox 360 fell 37 percent to $ 187.3 million. Sales of accessories, meanwhile, grew 5 percent to $ 135.6 million.

NPD estimates that retail sales account for about half of all video game spending. The rest is downloads, apps and the like.

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“Twilight” fans camp out days ahead of “Breaking Dawn-Part 2″

LOS ANGELES (Reuters) – Dozens of excited “Twilight” fans set up tents in Los Angeles on Thursday ahead of next week’s world premiere of the last film in the vampire romance franchise.

Some 2,200 people from all over the world have registered to camp on a concrete plaza outside a downtown Los Angeles movie theater, movie studio Summit Entertainment said.

The fans – most of them young women – will get guaranteed spots to see stars Kristen Stewart, Robert Pattinson and Taylor Lautner walk the red carpet for the November 12 premiere of “The Twilight Saga: Breaking Dawn – Part 2.”

Summit has laid on special activities during the five day wait, including a marathon screening of the four other films in the blockbuster franchise, surprise appearances from some cast members, and a “Twilight”-themed workout.

“We figured it was a once in a lifetime opportunity for some of us. This is the last movie. We’re never going to get to do it again and we wanted to hang out with some of our friends for the last one,” Bri-Anne Glover told Reuters Television as she settled in at the camp on Thursday.

“I love ‘Breaking Dawn’ because that’s kind of where I am in my life. I’ve got the husband, I’ve got my children, and we’re getting on with our lives and having a happy life and the same with Edward and Jacob and Bella,” said fan Eryka Bradford.

The “Twilight” books by author Stephenie Meyer have been a publishing sensation and the four movies have made more than $ 2.5 billion combined at box offices worldwide.

The final film sees the bliss of newlyweds Bella (Stewart) and Edward (Pattinson) and their daughter threatened by an ancient vampire coven.

“The Twilight Saga: Breaking Dawn – Part 2″ opens in several European countries on November 14 and arrives in U.S. movie theaters on November 16.

(Reporting by Lindsay Claiborn, editing by Jill Serjeant)

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Hospital guidelines not linked to readmissions: study

NEW YORK (Reuters Health) – Procedural guidelines designed to ensure patients get quality care while in the hospital are also thought to reduce the chances a patient will need to be readmitted down the line, but a new study suggests there’s little connection between the two.

“The idea was, increasing the quality of care provided by these hospitals would improve the outcomes,” said the report’s lead author Dr. Michaela S. Stefan, an academic hospitalist at Baystate Medical Center in Springfield, Mass.

In an effort to control costs, both hospitals and the federal government have been trying for some time to lower the number of patients who are readmitted to the hospital within 30 days of being discharged.

Starting in October, a hospital’s readmission rates are one factor the Centers for Medicare and Medicaid Services (CMS) take into account when deciding what to pay for patient treatment.

Right now, about one in four patients will be readmitted to the hospital within 30 days, according to Stefan and her colleagues. And it’s estimated that those unplanned rehospitalizations cost Medicare $ 17.6 billion in 2004.

One approach to lowering readmissions has been the creation of quality care guidelines for specific conditions, such as heart attack or pneumonia.

CMS also reports readmission numbers for hospitals on the website Hospital Compare: http://1.usa.gov/Z7TeXy.

Still, researchers have been asking whether these approaches make a difference in readmission rates.

Another recent study suggested that many factors outside a hospital’s control can cause a patient to need rehospitalization. For example, the person’s ability to keep up with their medications at home, or to make follow-up visits to a personal physician (see Reuters Health article of October 19, 2012, here: http://reut.rs/Z7uCy9).

For the new study, Stefan and her colleagues looked at whether the degree to which a hospital followed guidelines to the letter predicted how many Medicare patients came back within 30 days of their first discharge.

Using a 2007 database of patients on the government insurance program for seniors, the researchers analyzed patient outcomes for a number of ailments and surgical procedures, including heart attacks, heart failure, pneumonia and stomach, heart and orthopedic surgeries.

Overall, the study included information on patients from thousands of hospitals across the U.S.

For instance, 2,773 hospitals treated 322,668 people for heart failure during the study period while 2,940 hospitals treated 328,830 people with pneumonia.

The researchers gave each hospital a score between zero and 100 percent, based on the percentage of patients who received all the recommended treatments for their condition.

For heart attack patients, these could include receiving an aspirin when they arrived at the hospital or, if appropriate, smoking cessation counseling before discharge. For pneumonia patients, prescribing the correct antibiotics and checking on a patient’s flu vaccine status are among procedures on the checklist.

Of the 117,514 heart attack patients, about 96 percent received some of the recommended treatments. However, only about 88 percent got all of them.

And about 80 percent of stomach surgery patients got some of the recommended treatments, but only about 46 percent received them all.

The researchers then looked at how many of those patients returned to the hospital within 30 days after being discharged.

Overall, they found that hospitals with the best scores for following guidelines did not have “meaningfully” lower readmissions than hospitals with the worst scores.

“Even when the associations were statistically significant, the differences in the readmission rates of high and low-performing hospitals were small,” the team writes in the Journal of General Internal Medicine.

The researchers add that some possible reasons for the lack of association between the two measures could be that these guidelines have “little impact on the risk of readmission” or that the guidelines are too broadly defined.

The study itself did have limitations too, they acknowledge.

For example, it only looked at Medicare patients over 66 years old, so the findings may not apply to younger people. Also, the data are only from a single year and were based on what was reported to Medicare from the hospital records, so the information may not be complete.

Nevertheless, the researchers conclude that encouraging hospitals to report these guideline data to the public, such as on Hospital Compare, will do little to lower readmission rates.

Still, it’s good information to provide to patients, Stefan said.

“It’s important to know that the Hospital Compare site exists. Unfortunately, the public accesses Hospital Compare very little,” she added.

SOURCE: http://bit.ly/SxsNpQ Journal of General Internal Medicine, online October 16, 2012.

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