Is your hospital a hotspot for doubling up on CT scans? NYT interactive map makes it easy to see

The hotter the color on this map, the more likely the local hospital is to be doubling up on computerized tomography (CT) scans, part of a phenomenon costing Medicare an extra $25 million a year and exposing patients to radiation without it being medically necessary, according to an analysis of data by The New York Times. Typically, one scan will use iodine to check blood flow and one will not. "Radiologists say one scan or the other is needed depending on the patient’s condition, but rarely both," Walt Bogdanich and Jo Craven McGinty report.

Nationally, 5.4 percent of outpatients on Medicare got two scans in one day during 2008. At major teaching hospitals the rate was usually less than 1 percent, but at more than 200 hospitals the average was more than 30 percent. Those over 25 percent are marked by red dots on the map, those between 15 and 25 percent with yellow dots, and those below 15 percent with blue. Data for 2009, which are very similar, are to be released next month by the Centers for Medicare and Medicaid Services. (Click on map to get interactive version with data for individual hospitals)

"Double scans expose patients to extra radiation while heaping millions of dollars in extra costs on an already overburdened Medicare program," the Times points out. "A single CT scan of the chest is equal to about 350 standard chest X-rays, so two scans are twice that amount. . . . Officials at hospitals with high scan rates said radiologists ordered the extra chest scan figuring that more information is better. In rare instances, the two scans might help a doctor distinguish between tangled blood vessels and a tumor," according to Dr. Michael J. Pentecost, a radiologist who reviews claims for CT scans.

The phenomenon appears more prevalent at rural hospitals. "Dr. Harold Smitson, who helps to oversee radiology at two East Texas Medical Center hospitals with high double-scan rates, told the Times, “These are small and rural hospitals, without a complete range of medical services, which are mandated to evaluate patients quickly and efficiently to determine the need for transfer to a higher level of care. ... “Combining these tests expedites the diagnosis and the care to the patient.” (Read more)

East Texas was one of the rural hotspots; ETMC Fairfield's double-scan rate was 88 percent, one of the highest in the nation. Another rural hotspot was in Tennessee and adjoining areas of Virginia and Kentucky. The highest in the region was Livingston Regional Hospital, at 87 percent.

House votes against tighter limit on farm subsidies, for cuts in nutrition and other programs

There's so much in (and not in) the appropriations bill for agriculture and nutrition programs, which narrowly passed House with no Democratic votes last night, 223-197, that we hardly know where to begin. But let's start with the vote to drop an amendment, approved in committee, that would have prohibited subsidy payments to farmers with adjusted gross income of more than $250,000 a year.

"The 228-186 vote still reflected growing support for this reform, which is strongly opposed by Southern land interests but has had the support of President Barack Obama and many Midwest farm-state lawmakers," writes David Rogers of Politico, who has been covering such measures for a long time.

"The farm lobby concedes that Thursday’s votes are only the opening shot in a bigger fight over a new farm bill next year. Annual direct payments are almost certain to be reduced under the recommendations coming from the House-Senate negotiations being led by Vice President Joe Biden. . . . As food aid programs —at home and abroad — are targeted for major reductions, this has strained old alliances for the farm lobby even as Republicans have felt less committed to agriculture — and traditional farm powerhouses like the ethanol lobby," which was losing a skirmish in the Senate.

"The current [subsidy] limit is $1.25 million per individual with separate maximums for farm and off-farm income," Philip Brasher of the Des Moines Register explains. Brasher also writes, "In a rebuff to Agriculture Secretary Tom Vilsack, the House voted to stop him from spending money on the administration’s Know Your Farmer, Know Your Food initiative that’s promoting local foods and small-scale agriculture."

The House voted 223-197 to stop paying $147 million a year to the Brazil Cotton Institute in compensation for a World Trade Organization ruling that U.S. cotton subsidies violate trade treaties. That threatened final passage of the bill, so Republican leaders rounded up votes by saying that the issue would be addressed in a House-Senate conference committee.

That also seems likely for other features of the bill, such as elimination of money for the Food and Drug Administration "to implement landmark food safety laws approved by the last Congress" and cuts in nutrition programs that "hunger groups said ... would deny emergency nutrition to about 325,000 mothers and children," Layton writes. Also approved was an amendment by Rep. Don Young, R-Alaska, to ban the sale of genetically modified salmon, "which would be the first genetically engineered animal sold as food in the United States."

The bill also would prevent the Department of Agriculture from going through with new regulations on livestock and poultry contracts, designed to help small producers.

Senate votes 73-27 to repeal ethanol subsidies; lobby offers to trade tax aid for help with pumps

The U.S. Senate voted 73 to 27 today to repeal the federal subsidies for ethanol, a vote that will have no immediate effect but probably signals the eventual end of a tax break that was politically popular in much of the country and drove corn production to the point that two of every five bushels are now used to make ethyl alcohol for blending with gasoline.

"The prospects for repealing the tax credit in the House are shaky, Michael Cohn of Accounting Today reports. "It is opposed by many farm state lawmakers whose constituents benefit from the tax credits for corn-based fuel additives. Sen. Charles Grassley, R-Iowa, who has led opposition to the measure, said on the Senate floor that the bill was not likely to even be voted on in the House. . . . However, the tax credit repeal may be included as part of a larger deficit reduction deal." (Read more)

UPDATE, June 18: In the wake of the vote, "Ethanol producers are offering to let Congress end the industry's 45-cent-per-gallon tax credit ahead of schedule so some of the savings can be put toward installing pumps and storage tanks needed to increase the amount of ethanol being sold by service stations," reports Bilip Brasher of The Des Moines Register. "With Congress committed to cutting the federal deficit, waiting until the end of the year in hopes of finding another source of money for the industry isn't an option, said Tom Buis, CEO of Growth Energy, an industry trade group." (Read more)

National Rural Assembly is next week

June 28-30, more than 250 leaders and supporters of rural America are expected to gather in St. Paul, Minn., for the 2011 National Rural Assembly. The gathering "will focus on health reform, housing, transportation, immigration, broadband access and opportunities for young people," the assembly says in a press release. Speakers for the event include Federal Communications Commissioner Mignon Clyburn, Navy Capt. Wayne Porter and Marine Col. Mark Mykleby.

"We can stand pat and just get more of the same in rural America, including the highest rates of child poverty and the hollowing out of our towns," Dee Davis, chairman of the Assembly's steering committee. said in the release. "Or we can start down a different rural path toward sustainable energy, local food production, and Internet connectivity that can help the whole country get back on its feet."

Registration for the event is open to individuals and organizations interested in the future of rural America. Click here to learn more about the event or to register.

Officials in an Eastern Kentucky county at odds with each other over the power of coal

At a recent city council meeting in Lynch, Ky. (Wikipedia map), Mayor Taylor Hall and several city council members accused Harlan County Judge-Executive Joe Grieshop of "criminal coercion" following a meeting between Hall and Grieshop, Anders Eld of the Harlan Daily Enterprise reports.

"When you say to us, that we will negotiate with the coal companies or not receive any money through the fiscal court, I think that is paramount to criminal coercion," Hall said of Grieshop's actions. He said he plans to talk to the state prosecutor about it. City officials oppose coal companies' plan to strip-mine mountains above the town, population 900.

Hall told Eld that Grieshop's "response on the fiscal court's original pledge to help with the match was that there were certain concessions he wanted. He told me that Lynch would have to go back into negotiations with the coal operators on mountain top removal and make concessions or there will be no funds."


Greishop essentially acknowledged what Hall alleged, thought it is open to interpretation. "Asking the city to sit-down with the coal company across from the table and negotiate on the issues is not criminal coercion," Grieshop told Eld. "I simply said that if you are not going to work with the coal companies and that's the source of money to help you. How do you expect the fiscal court to help you?"
Grieshop added, "I just told them that the coal companies are where the money comes from. If you're not willing to work with them and you're anti-coal, then the fiscal court members are not going to support you. They have already stated that. They don't feel comfortable helping out cities with coal monies, when the city is not trying to work with the coal company." (Read more)

Environmental group starts website with information about the Marcellus Shale

The Pennsylvania Environmental Council unveiled "a new website aimed at organizing the avalanche of information on all things Marcellus Shale," the rock formation that is producing much natural gas with hydraulic fracturing, the council says in a press release.

MarcellusFacts continuously searches the Internet for new information on Marcellus Shale and presents it in an easy-to-read format. The site collects information from gas industry sources, nonprofit environmental organizations, Pennsylvania newspapers, Google News, universities, and the council's website. The goal is to present unedited information from all sides of the debate in a "clear and concise format for computers or smartphones," it says.

"There is so much information about Marcellus Shale in cyberspace that it has become very difficult to manage it all," Council President Paul King says. "Our goal in creating MarcellusFacts is to simplify the challenge of being well-informed on the issues and to make the people of Pennsylvania better participants in the public process."

Community journalism principles still apply in digital age, Institute director says in national journal

The director of the Institute for Rural Journalism and Community Issues and several other well-known journalism scholars join together in the latest issue of Nieman Reports from Harvard University to address the impact of digital tools on people's sense of community. Al Cross, the publisher of The Rural Blog, specifically addresses the impact of the digital age on community journalism.

Chris Evans, editor and publisher,
The Crittenden Press, Marion, Ky.

Cross says the basic principles of community journalism remain unchanged. He writes of Tom and Pat Gish of The Mountain Eagle in Whitesburg, Ky., revealing "mutual respect they had with their readers" as key to their "ability to keep going for more than 50 years in the face of economic boycotts, personal shunning, and even a firebombing by a local policeman" as they "crusaded against the abuses of coal companies and feckless or corrupt officials."

Digital media presents community journalism with new challenges, "some so fundamental that they are altering the meaning of the word 'community'," Cross writes. He suggests community journalists "use social media to maintain and improve contact with community members and weekly newspapers use Facebook to keep readers up to date on breaking news, sports scores, and other topics of daily community interest."

"Our task is to be in a position to provide credible information in whatever form people what it in," Chris Evans, editor and publisher of The Crittenden Press in Western Kentucky, told Cross. "You've got to embrace technology, understand where your audience is at, and get there — and the credibility you have will draw people back to you." (Read more)

Rural library recognized for energy-efficient design

Residents of Naturita, Colo., never imagined they would get a new energy-efficient library almost eight times the size of their old library, let alone have it recognized by The Library Journal, the leading comprehensive publication for public, academic, and special librarians covering technology, management, policy, and other professional concerns, as 2011's Best Small Library. (Read more)

Ethanol subsidy remains in the cross hairs; allies file a repeal bill with an alternaitve

The ethanol subsidy was temporarily spared in a Senate vote Tuesday as opponents of the subsidy got only "40 of the 60 votes needed to cut off debate on a proposal to abolish the tax credit immediately," Philip Brasher of the Des Moines Register reports. However, opponents of the subsidy could get a chance to vote again as early as the end of next week.

Democratic leaders have agreed to allow a new vote because as many as 20 Democrats who voted against the subsidy "objected to the vote on procedural grounds," Brasher reports. Senate Majority Leader and Democratic Sen. Harry Reid of Nevada, objected to Oklahoma Republican Sen. Tom Coburn's forced scheduling of Tuesday's vote.

The new vote will include an alternative bill by industry allies "that would repeal the 45-cent subsidy July 1 and devote $1 billion of the savings to deficit reduction," Brasher reports. The bill includes a new subsidy to protect the ethanol industry against a decline in biofuel interest by refiners from oil prices dropping and government financial assistance to install new ethanol pumps at service stations.

Next week's votes "are still likely to be largely symbolic, because the House is expected to object to a tax-related measure originating in the Senate," Brasher writes. "But the votes will put senators on record on the issue, and lawmakers are reluctant to switch sides once they have taken a position."

This has the ethanol industry concerned. "Having 40 votes in favor of immediate repeal of the subsidy was a bad sign for the ethanol industry," analysts with Clear View Partners wrote. "That should leave little doubt about congressional will to spend on energy subsidies of any kind in the current fiscal environment." (Read more)

AEP wrongly blaming EPA for coal-fired plant shutdows, EPA chief says, with some evidence

American Electric Power was misleading when it blamed the shutdown of five coal-fired power plants on new Environmental Protection Agency regulations, EPA administrator Lisa Jackson told reportes this morning after a Senate committee hearing.

AEP's claims were "misleading at best, scare tactics at worst," Jackson said. Gabiriel Nelson of Environment & Energy News writes, "Critics say that the new rules are not the main driver of the shutdowns. Of the 6,000 megawatts to be retired, 4,000 megawatts are the result of a 2007 settlement deal with states and the George W. Bush administration to resolve claims that AEP's plants were releasing too much air pollution."

Nelson notes CEO Michael Morris told during an investor conference last month "that most of the coal plants AEP planned to retire, with 5,500 megawatts of capacity, were 'high cost plants' that 'dispatch infrequently'." (Read more, subscription required)

Almost 1/4 of counties had fewer births than deaths in 2010, and 90 percent of those counties are rural

Almost one-fourth of U.S. counties had more deaths than births last year, and 90 percent of those counties were rural, says a researcher at the University of New Hampshire. "And, for the first time in U.S. history, deaths now exceed births in an entire state," West Virginia, said Kenneth Johnson, senior demographer with the university's Carsey Institute.

These are more than demographic trends, Johnson says, with "implications that reach far beyond demography to institutions that are the bedrock of communities." For example, "The viability of local schools becomes precarious as the student and parent populations diminish. ... And, the needs of families and children may get less attention in the political arena than those of the growing senior population." For Johnson's full report, click here. For the press release from Carsey, go here.

Fracking crackdown, natural-gas prices depress N.Y. leases, but activity spawns a new publication

Exxon Mobil's recent $1.7 billion acquisition of Phillips Resources and TWP's Marcellus Shale gas leases may mean Marcellus prices are dropping, report Christopher Swann and Reynolds Holding of Reuters.

Exxon is paying about $5,000 an acre; in 2010 leases were selling for as much as $17,000 an acre. Falling natural-gas prices and state regulators' crack down on hydraulic fracturing are leading many energy firms to find other locations, Swann and Holding report. "Marathon Oil paid $20,000 an acre for oil-rich land in Texas earlier this month." Marcellus land does have at least one advantage over many other locations. Its proximity to New York City, where the gas sells for a premium, has Shell "mulling a new petrochemical plant in the region," Swann and Holding report.

However, the closeness to Gotham, which draws its water from a Catskills area underlain by the Marcellus, also makes activity in the area more environmentally sensitive. An online publication, The Watershed Post, has sprung up to cover the rural area, and fracking in particular. Here is a story about it from Brett Norman of Columbia Journalism Review.

Duncan may grant No Child Left Behind waivers if Congress doesn't change law before school starts

As schools await Congress's rewrite of the No Child Left Behind Act, Education Secretary Arne Duncan "is preparing to grant states relief from key provisions of the federal school accountability law in exchange for what he calls 'commitments to key reforms'," Michele McNeil reports for Education Week. Duncan's announcement came during a June 10 call with reporters in response to Congress' lack of action and a growing fear of schools' abilities to meet the 2014 deadline for proficiency in reading and math.

Though the details of Duncan's plans are unclear, he did say "he'd like to give states the ability to focus on student gains rather than absolute test scores . . . and he'd like to grant more flexibility in how Title I money for disadvantages students is spent," McNeil reports. The relief would primarily be waivers, Duncan spokesman Justin Hamilton told McNeil. "Unlike the Race to the Top, which allowed states to devise their own education improvement plans, the department would present states with a basket of strategies they would have to adopt in exchange for relief," he added. (Read more)

Duncan said his administration will start reaching out to governors, state school commissioners, and other leaders to discuss possible waivers and identify the most serious obstacles schools face and what improvements could be executed in exchange for waivers, Sam Dillon of The New York Times reports.

The announcement got mixed reactions. Democratic Sen. Tom Harkin of Iowa, chairman of the Senate Education Committee, said, "Given the bipartisan commitment in Congress to fixing No Child Left Behind, it seems premature at this point to take steps outside the legislative process that would address NCLB's problems in a temporary and piecemeal way." But Diane DeBacker, commissioner of education in Kansas, which was denied a waiver in February, told Dillon, "I'm pleased that there is an option for a Plan B." (Read more)

As farmland values rise, so does investor interest

The value of U.S. farmland is on the rise, according to several regional Federal Reserve Bank reports. The Chicago branch reported a 16 percent "year-over-year increase in farmland values in in the first quarter of 2011," and the Kansas City branch reported that in the fourth quarter of 2010, Midwestern cropland values jumped almost 20 percent above year-ago levels."

Rising commodity prices and low interest rates have led to the increased demand for farmland, leading to a 30 percent decrease in the amount of farmland for sale, Lee Vermeer, vice president of real estate operations at Farmers National Co., told The Sun-Times in Heber Springs, Ark.

In Arkansas "75 to 85 percent of land buyers continue to be farmers," Vermeer said, but there is growing interest from outside investors. Keith Morris, area sales manager for Farmers National in Arkansas, southern Missouri, western Kentucky, Tennessee, Alabama, Mississippi and Louisiana, told the Sun that in his region, half the land buyers are investors. (Read more)

USPS defends use of suburbanites to sample rural opinion about ending Saturday mail delivery

The U.S. Postal Service, fighting to get Congress to let it stop delivering mail on Saturdays, is disputing an advisory opinion that questioned its cost-savings estimates and its lack of consideration for the effect that five-day delivery would have on rural areas.

The Postal Regulatory Commission said in March that the Postal Service should not eliminate Saturday delivery without more study of the impact on rural customers. It said a USPS poll asking Americans if they would rather have Saturday mail or pay more for stamps used "an improbable 10 percent rate increase, which may have biased the responses," and that the "rural" people in the service's focus groups about the issue were in Gwinnett County, Georgia, above, in suburban Atlanta, and Snohomish County, Washington, below, in suburban Seattle. (MapQuest images; click on either map for larger version)

USPS said the groups had people from "rural areas surrounding Atlanta and Seattle and are served by rural carriers," and the commission didn't object to that methodology in its 2009 report to the commission about universal service. It said the commission's concern about "customers who might rely on rural carriers to conduct retail transactions along a delivery route in the absence of an accessible post office location on Saturdays ... was not a concern expressed by the rural participants in the market-research focus-group sessions."

That's no surprise, since these were residents of metropolitan areas, not truly rural regions where post offices are the least accessible, making retail transactions with mail carriers much more common than on rural routes near major cities. The exception to that might be lightly populated central and eastern Snohomish County, but what were the chances that someone from there was picked for the Seattle focus group and was willing to drive to the city for it? Yes, the undersigned has an opinion on this subject, having testified before the commission that five-day delivery would have a disproportionate impact on rural America. For a video of the testimony, made on behalf of the National Newspaper Association, click here. For a PDF of the written testimony submitted in advance, click here.

Data on hospital-acquired conditions is online

The federal Centers for Medicare and Medicaid Services (CMS) has posted information about hospital-acquired conditions on its website, and The Courier-Journal of Louisville not only has a story about it today, it has an easily serarchable database of Kentucky hospitals.

This is not information that the American Hospital Association wants online, at least in its current form. “You have to look at the totality of the care. And these little snapshots that CMS wants to pick out are very misleading,” Kentucky Hospital Association Senior Vice President Nancy Galvagni told C-J reporter Patrick Howington. She said the data don't allow for differences between hospitals, such as specialities, that may cause higher rates of acquired conditions.

However, Doug Leonard, president of the Indiana Hospital Association, told Howington that the industry needs to “embrace transparency. Sometimes we don't like the results of that, but I think transparency is good for us and good for the public.” Dr. Kevin Kavanagh of Somerset, Ky., chairman of the nonprofit group Health Watch USA, "said the data's greatest value may be to help hospitals spot areas that need improvement, rather than to help patients choose between hospitals," Howington writes. "In fact, a hospital shown as having a high complication rate 'may be the safest hospital to go to, because they were under pressure to get the problem corrected.'" (Read more)

The conditions tracked are trauma, such as falls; blood and urinary infections from catheters; bedsores; poor blood-sugar control for diabetics; foreign objects left in bodies; air or gas bubbles in blood vessels; and transfusions of the wrong blood type.

Postal commission chairman asks USPS for report that could head off some post-office closings

The head of the federal agency that oversees the U.S. Postal Service told Postmaster General Pat Donahoe in a letter last week that she fears the USPS is not following federal law in closing what appears to be an increasing number of post offices, many of them rural, and asked for detailed information about the topic in a way that could head off some office closings.

Ruth Goldway, chairman of the Postal Regulatory Commission, reminded Donahoe that the Postal Service assured the commission that if new rules for evaluating post offices for closure "indicate that closing a significant number of existing retail outlets appeared justified," the service would seek an advisory opinion from the commission before closing the offices, which she said is required by Title 39 of the U.S. Code.

"Numerous articles have appeared in the press identifying facilities in a number of states that have been closed, or that have been evaluated for potential closing, or shortly will be evaluated for potential closing," Goldway wrote. "The Commission has received an increased number of post office closing appeals, hundreds of inquiries from citizens, and has had communications with concerned members of Congress. Thus, it appears that the Postal Service may already be engaged in a nationwide change in service without prior notification to the Commission as Title 39 requires."

Goldway said the USPS should seek an advisory opinion to avoid "the confusion that now surrounds post office closings," and include "a detailed discussion of how the cumulative impact of the local changes involved will affect the fulfillment of national access and delivery aspects of the Postal Service's universal service obligation." She said the commission wants to know the post offices that have closed since Jan. 1, those "noticed for closure or lease termination and that are still under consideration," the offices "for which cessation of service is currently under internal review," and a state-by-state list of post offices. To download the letter, click here.