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News You Need To Know

Federal Court Rules That TSA ‘Naked Scans’ Are Constitutional

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Last weekend, a Tennessee woman was arrested at the Nashville airport for disorderly conduct after she refused TSA security measures for her children. The woman didn’t want her two children to have to go through a whole-body-imaging scanner. When a Transportation Security Administration officer told her the machines were safe, she said,  “I still don’t want someone to see our bodies naked.”

She won’t be pleased with a ruling then out of the D.C. Circuit today. This morning, the federal court ruled that the “naked scans” of air travelers do not violate Americans’ constitutional rights. Privacy rights group EPIC had sued the Department of Homeland Security, alleging violations of innocent passengers’ Fourth Amendment right to be free of unreasonable searches. The court says that argument doesn’t fly.

In the opinion [pdf] from the D.C. Circuit Court (the Volokh Conspiracy), Judge Douglas Ginsburg writes that the advance imaging technology is not unreasonable given the security concerns on airplanes, and that people have the option to opt out for a pleasurable patdown. The court notes that some “have complained that the resulting patdown was unnecessarily aggressive,” but the judges don’t seem overly concerned about that. Ginsburg writes:

On the other side of the balance, we must acknowledge the steps the TSA has already taken to protect passenger privacy, in particular distorting the image created using AIT and deleting it as soon as the passenger has been cleared. More telling, any passenger may opt-out of AIT screening in favor of a patdown, which allows him to decide which of the two options for detecting a concealed, nonmetallic weapon or explosive is least invasive.

Good news for body scanner manufacturers Rapiscan and L-3. Bad news for those who don’t like having to choose between digital nudity and frisking. Legal scholar Orin Kerr of the Volokh Conspiracy expresses mild surprise at how easily the court dismissed privacy concerns with the TSA screens, as he regards the court as a Fourth-Amendment-friendly one.

Photos: How To Protect Your Dignity From The TSA

There was a small rebuke in the opinion for the TSA. The judges ruled that the TSA had violated an administrative law requiring public comment before issuing a new rule making the body scanners their primary tool for airport security. It would be too disruptive to have the TSA stop using the scanners, writes Judge Ginsburg, but they do expect that the TSA will now take comments. In this case, “better late than never” doesn’t really mean much.

 Jul. 15 2011 - 12:13 pm

A Restaurant to Ban Kids Under 6

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Older Customers Complained About Rowdiness

Starting July 16, McDain's, a Pittsburgh-area restaurant, will ban children under the age of 6 from its dining area. Restaurant owner Mike Vuick said the policy came in response to complaints he'd received from older customers about kids causing a ruckus. In an email to his clientele, Vuick wrote, "We feel that McDain's is a not a place for young children … and many, many times they have disturbed other customers."


A few weeks ago, Malaysia Airlines announced that it would ban infants from flying in the first-class cabin because other passengers had complained about squalling babies. And last February it was rumored that Virgin Atlantic and British Airways had been pressured to consider child-free zones and even child-free planes to appease business travelers who, according to a travel survey, listed unruly children as their No. 1 travel-related complaint.

So, just when did our precious "pets" become everyone else's pet peeves? Are these bans even legal? Apparently yes. Federal law forbids discrimination on racial or religious grounds, but there is no blanket protection for children. For business owners like Vuick that means they can set the rules.

For his part, Vuick said it's all about keeping his customers happy – the older ones anyway. McDain's is a small restaurant that seats 40 people. It's nestled on a golf course, so it's natural that the casual eatery caters to an older clientele. Vuick said, "We have had lots of older people complaining, and the parents refuse to do anything about their kids' behavior. They just ignore it."

Unruly behavior is exactly what recently infuriated Kristen Johnston of 3rd Rock from the Sun fame. According to the website TMZ, Johnston stalked off an L.A.-bound flight because Nadya Suleman (Octomom) could not or would not control her kids who were acting up in business class.

Christopher Elliott a consumer advocate and author of the syndicated Travel Troubleshooter column, said that although the "kids or no kids" debate on airplanes has been around forever, something has changed. "The way airlines feel about kids has changed. Air travel has gone from being an experience to [something] commoditized. A seat is a seat is a seat. … By and large you're just self-loading cargo, and that includes your children," said Elliott.

In a tough economic climate airlines – like restaurant owners – want to cater to their best clients, which happen to be business travelers, not babies. "The case for getting rid of kids in first class is actually fairly solid. … When you're dealing with lie-flat seats and Champagne, a child is not going to fully appreciate that anyway," said Elliott. But the father of three adds, "I think how a society treats its children is important, and getting rid of kids entirely is a whole different discussion."

Certainly the Pittsburgh-restaurant owner's decision to ban kids has caused a stir online. Moms have been weighing in on various mommy blogs expressing their outrage and insisting that Mike Vuick will likely rue the day he closed his doors to kids. "If said restaurant can afford the loss in money, then go for it. I don't care to go where I'm not welcomed," wrote one commenter on CafeMom.

Perhaps McDain's is taking a page the case of Old Salty's in North Carolina. Last year, the seaside restaurant posted a sign in its front window that read "No screaming children allowed." And shortly thereafter, there was a storm of negative media coverage. So, how's business these days? According to the daytime manager, business has actually increased. "People know they can come in and enjoy their dinners quietly. They always comment on the sign and take pictures and tell us "I love your sign." The only ones who seem to get upset are the ones who don't control their children."

Shocking details of Atlanta cheating scandal

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It’s one thing to say there was widespread cheating on standardized tests in Atlanta public schools, as the newly released results of a state investigation showed. It’s another thing to actually read the volunimous report. The details are shocking.

For those who haven’t been paying attention, Georgia Gov. Nathan Deal (R) on Tuesday released the results of a 10-month state investigation he had ordered into suspicions of cheating on state standardized Criterion-Referenced Competency Tests (or CRCT) in the Atlanta School System.

The results confirmed the suspicions and then some: The report said that cheating on 2009 standardized tests in Atlanta Public Schools was widespread and didn’t start that year, “significant and clear” warnings were ignored by top administrators, an environment of fear and intimidation ruled the system and thousands of students and resulted primarily from “pressure to meet targets” in the data-driven system.

The superintendent at the time, Beverly Hall, had been hailed for years for driving up standardized test scores. She just left the post, her reputation shattered. Hall has denied knowing about any cheating despite repeated assertions in the report by investigator that she and other administrator must have known.

Investigators went school by school, interviewing teachers, principals, top administrators and others to get to the bottom of the scandal, and then detailed what they learned.

I found a copy of the report on this Web site of CBS Atlanta affiliate. Here are some of the revelations, taken directly from the report, which give you an idea of how the cheating was done:


Connally Elementary School


“Of the 55 flagged classrooms at Connally, 47 (85 percent of the total) had standard deviations that exceeded five, and 32 classrooms exceeded ten standard deviations. At five standard deviations, the probablity that the number of wrong-to-right erasures occurred without adult intervention, or cheating, is no better than one in a million. At ten standard deviations, the probability is no better than one in a trillion.”


Perkerson Elementary School

“During the 2009 CRCT, Jocelyn Mack was a first grade teacher. Her reading and language arts classes were flagged for high wrong-to-right erasures with standard deviations of six and five. Principal [Mable] Johnson asked Mack if she wanted her tests early. Mack received her tests by 7:00 a.m., when they normally were not distributed until 8:15 a.m. Mack also was told to erase stray marks, but was not comfortable doing so. Tony Allen [testing coordinator] erased stray marks for Mack and other teachers.

“Mack was surprised that two of her students passed the 2009 CRCT. One student sat uner a table, then randomly filled in answers and still passed. There was a student Mack wanted to keep in first grade at the request of the student’s parent. Johnson said the student had to be promoted to second grade because the student passed the CRCT. Several students passed first grade reading but are now struggling to read in the third grade. Everyone at the school was afraid of Johnson.”


During Johnson’s first interview with investigators, she answered questions and “denied any knowledge of cheating on the CRCT test.”

“During her second interview, Principal Johnson invoked her Fifth Amendment rights and refused to answer all the questions asked.”


Parks Middle School


“District Leadership knew Principal [Christopher] Waller was cheating.... Dr. Hall also should have known Waller was cheating at Parks because once he became principal, the school immediately made dramatic gains on the CRCT and other tests. For example, between the 2004-05 and 2005-06 school years, eighth-graders meeting or exceeding standards in reading increased by 31 percentage points, from 50 percent to 81 percent.... In math, the percentage of eighth-graders who met or exceeded the standards increased from 24 percent to 86 percent.”


Teacher “Latasha Smiley admits to cheating in 2009 [at Parks Middle School]. Francesa Thompson-Flagle, a PEC teacher, gave Smiley a copy of the 2009 CRCT. The copy was difficult to read. Later that day, Gregory Reid told Smiley that Damany Lewis had a ‘gift’ for her. Smiley found a manila envelope containing a legible copy of the tests on her desk. During the test, Smiley improperly gave students the correct answers.

“One afternoon, Lewis told Smiley to come with him. They went to [Testing Coordinator Alfred] Kiel’s office and Smiley erased answers with the other teachers in the room. After the testing period was complete, Lewis came to Smiley’s classroom and told her to come with him. They went together to Kiel’s office where Lewis took pictures of the room so that he could place everything back in its original place after they changed the tests. Smiley erased answers with the other teachers in the room.

“Principal Waller told Smiley to let him know if anyone contacted her regarding this investigation.”



“Damany Lewis was the first teacher to assist Principal Waller in cheating. He admitted to cheating in 2006, 2007, 2008 and 2009. In 2006, Waller asked Lewis, ‘Do you think you could get into something undetected?’ Lewis was not sure what Waller meant, but said yes. A few days later, Lewis was summoned to the main office where he found Principal Waller and [Success for All Facilitator] Sandra Ward with the CRCT booklets. Principal Waller looked at Lewis and then immediately looked at the test booklets. Lewis then knew what Principal Waller was asking him to ‘get into undetected’ — the test booklets. Lewis found a key in his desk drawer that opened the room where the tests were kept. Lewis used a razor blade to open the plastic wrapping around the test booklets, copied the test for each grade, and resealed the wrapping using a lighter to melt the plastic. Once Lewis copied the booklets, he placed a copy of the social studies test in [teacher] Damien Northern’s car and a copy of the reading and language arts test in [teacher] Dorothea Wilson’s car.’


Teacher “Damien Northern confessed to cheating in 2008 and 2009 and possibly in 2007 as well.”


Teacher “Dorothea Wilson confessed to cheating in 2008 and 2009.... Principal Waller walked by her classroom often and said, ‘I need the numbers, I need the numbers.’”


Principal “Waller denied causing or participating in cheating.”


Dr. Alfred Kiel [the testing coordinator] “would not allow cheating so Principal Waller orchestrated Kiel’s absence from the school building so the cheating could take place. On one occasion in 2009, Principal Waller took Kiel out for a ‘retirement lunch.’ In another year, Principal Waller scheduled an impromptu after-school dance so that the teachers could stay late in the afternoon and cheat without raising suspicion. Kiel once noticed that things in his office had been disturbed while he was out and became angry. After that occasion, teacher Damany Lewis took pictures of Kiel’s office before he altered the tests so that everything would be put back in exactly the same place so as not to raise Kiel’s suspicions. No one implicated Kiel except Principal Waller.”


Success for All Facilitator Sandra Ward “refused to answer questions after invoking her Fifth Amendment right not to incriminate herself.”


Teacher Francesca Thompson-Flagle “denied knowledge of cheating or that she gave a copy of the test to anyone.”


Usher/Collier Heights Elementary School


“We conclude that Testing Coordinator Donald Bullock and Principal Rogers directed and orchestrated a schoolwide scheme to erase and change student answer sheets. Mr. Bullock provided teachers access to student answer documents by allowing them to pick up tests early, keep them throughout the day, or by returning tests to certain teachers each day after the testing period ended. Bullock instructed teachers to change answers to make sure their students made their targets.”

“Principal Rogers denied participating in, or having knowledge of, cheating on the 2009 CRCT or any other year. She denied ever making a statement in f aculty meeting that ‘if Johnny can’t read he’d better be able to read on test day.’


“Mr. Bullock denied participation in, or knowledge of, cheating.”


Peyton Forest Elementary School


Teacher “Bahji Varner’s first year at Peyton Forest was the 2009-2010 school year. Varner was not at the school for the 2009 CRCT, but witnessed cheating in 2010.

“Varner saw teachers cheat on the APS district-wide benchmark tests. She proctored during this test and saw teachers point to certain questions and then identify the correct answer. After completing, the tests were scanned and scored at the school. [Teacher] Enolar Callands would watch the tests as they were scored. If the scores were not high enough, the teachers would review the tests with the students. Then, the students with low scores were sent to Callands’ or [teacher] Bess Mae Paschal’s classroom to retake the test.

“On the Fifth Grade Writing Test, Paschal instructed students to write drafts, and bring them to her to review and revise. Only after her revisions were the students allowed to write the essay on the official paper.”


“Enolar Callands denied knowledge of cheating on the CRCT.”


“Bess Mae Paschal denied knowledge of cheating on the CRCT.”


East Lake Elementary School

“On her first day at East Lake in 2009, Principal [Gwendoyn] Benton told [teacher] Raqketa Williams, ‘At East Lake we do whatever we have to do even if it means breaking the rules,’ pointed to the prior year’s CRCT scores and said, ‘See the scores? East Lake makes its targets.’ ”


“Principal Benton instructed [teacher] Stephanie Walls to create a seating charter for her students to be used during the 2010 Fifth Grade Writing Test. Principal Benton instructed Morresia Withers to pass out the writing test to [teacher Stephanie’ Walls’ students in a particular order. Walls explained that by passing the tests out in the order Principal Benton wanted, the lower performing students would receive easier writing questions. Walls and Withers discussed Principal Benton’s instruction and decided to ignore it. They passed the tests out randomly.


Teacher Morresia Withers said “that Principal Benton and [Testing Coordinator Fran] Standifer instructed Withers and Walls to seat the students in a particular order for the Fifth Grade Writing Test.”


“Teacher Stephanie Walls said ‘Principal Benton instructed Stephanie Walls to create a seating chart for her students to be used during the 2010 Fifth Grade Writing Test.’”


“Testing Coordinator Fran Standifer described Principal Benton as overbearing... Fran Standifer denies any knowledge of cheating.”


“Principal Benton denied any knowledge of cheating on the CRCT at East Lake.”


Finch Elementary School


“Three teachers confessed to cheating. Two teachers pointed to answers, re-read questions, or used other cues to ensure their students chose correct answers. One teacher confessed to erasing and changing answers in the principal’s conference room where teachers were gathered by grade levels to erase stray marks.”


Teacher Ashley “Daniel said that there were several reasons teachers would cheat. Principal Paden linked test scores to evaluations, and told Daniel that she needed better scores to get a better evaluation. Scores were posted at faculty meetings and teachers were singled out in front of their colleagues. Principal Paden threatened teachers in a meeting, and told them if she was going to be on a PDP [a professional development plan developed and implemented to correct perceived deficiencies in performance of teachers and administrators] then they should be on one also. Principal Paden made threatening statements, like ‘The door swings both ways,’ and ‘Walmart is hiring.’ ”


“Principal Paden admitted that she had been placed on a PDP more than once . .. for not meeting targets... She denied pressuring teachers to meet targets, stating that the pressure was just their ‘perception.’ ”


Dobbs Elementary School


Teacher Arlette “Crump admits to ‘bumping’ students’ desks when she noticed a wrong answer on the CRCT and instructing the student to ‘look at that again.’ ”


Fain Elementary School


Teacher Yolanda McQueen reported that “Principal [Marcus] Stallworth told the teachers that they should ‘use whatever means necessary’ to ensure students passed the CRCT.”


“Douglas Rozier taught at Fain for fifteen years. When Stallworth was principal, Principal Stallworth told teachers during faculty or grade-level meetings to use voice inflection to assist the students on the CRCT. He instructed teachers to ‘make it work’ and that when monitoring the room, teachers should direct students to the correct answers. Principal Stallworth also said teachers should give students additional time on the test....”


Principal Marcus Stallworth “denied cheating on the CRCT or encouraging teachers to cheat.”

By  for The Washington Post 07/07/2011 

77 separate CT tax increases?!

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According to a tally by the Yankee Institute, the State of Connecticut will impose at least 77 separate tax increases over 24 categories as part of the changes recently made by the General Assembly.

1. Raises income tax on individuals making as little as $50K and couples making at least $100K
a. Expands the number of brackets from 3 to 6
b. “Bracket Creep” shifts many taxpayers into higher brackets
c. Highest marginal rate rises from 6.5% to 6.7%
d. Phases out the 3% tax bracket for taxpayers with CT AGI of over 56,500 for individuals, $100,500 for joint filers
e. Income tax hikes retroactive to January 1, 2011
2. Recapture Provision for high income earners effectively flattens the income tax rate on high income earners for the entire amount of their income

3. Property tax credit reduced from $500 to $300 and phased out for couples over $100,500 
4. Sales and Use Tax – Increased the general sales and use tax rate from 6% to 6.35% 
5. Eliminates Sales and Use Tax Exemptions for:
a. Hazardous waste removal
b. Valet parking at any airport
c. Yoga instruction at a yoga studio
d. Clothing and footwear costing less than $50
e. Non-prescription drugs and medicine
f. Cloth or fabric for non-commercial sewing
g. Property or services used in operating solid waste-to-energy facilities
h. Yarn
i. Smoking cessation products
6. Expands the Sales and Use Tax to include:
a. Motor vehicle storage
b. Packing and crating
c. Motor vehicle towing and road services
d. Intrastate transportation via limousine, community car, or van with a driver
e. Pet grooming and boarding
f. Cosmetic medical procedures
g. Manicures and pedicures
h. Spa services
7. Estate Tax – Lowers the threshold at which the estate tax applies from $3.5 million to $2 million. The estate tax has eight rates starting at 7.2% for estates between $2 million and $3.5 million up to 12% on estates over $10.1 million
8. Hotel tax – Increased from 12% to 15%
9. Luxury Goods Tax – 7% sales and use tax on motor vehicles costing more than $50,000, boats over $100,000, jewelry over $5,000, and clothing over $1000. Rate applies to the entire cost of the item, not just the amount over the threshold.
10. Rental Car Surcharge – Increased from 6.35% to 9.35% on short term car rentals
11. Alcoholic beverages tax
a. Increases excise taxes on alcoholic beverages by 20%
b. One-time floor tax on alcoholic beverages in inventory as of 7/1/2011
12. Corporate Tax Surcharge – 20% corporation tax surcharge for the 2012 and 2013 income years for companies with at least $100 million in annual gross income in those years and a tax liability that exceeds $250. This replaces a temporary 10% surcharge in law for FY2011.
13. Cigarette tax
a. Increases from $3 to $3.40 per pack
b. One-time floor tax on cigarettes in the inventory of stores as of 6/30/2011
14. Tobacco Products Tax
a. Increased on snuff tobacco from $0.55 to $1/ounce
b. Increases of 27.5% to 50% on all other tobacco products such as cigars, pipe tobacco, etc.
15. Diesel Fuels Tax
a. Increases the base tax on diesel fuel from $0.26 to $0.29 per gallon
b. Imposes a $0.03/gallon tax on diesel in inventory as of 6/30/2011
16. Real Estate Conveyance Tax
a. Increases the real estate conveyance tax rates from 0.5% to 0.75% on the first $800,000 of the sale price of a residential property
b. Increases the marginal tax on nonresidential and residential property over $800,000 from 1.00% to 1.25%
17. Electric Generation Tax – Imposes a new temporary tax of .25 of one cent per net kilowatt hour of electricity generated and uploaded into the regional bulk power grid at Connecticut facilities, except for solar, wind, or fuel cell energy

18. Admissions Tax Exemptions Eliminated – The following locations are no longer exempt from the 10% admissions tax on the ticket price:
a. Hartford Civic Center
b. New Haven Coliseum
c. New Britain Beehive Stadium
d. New Britain Stadium
e. New Britain Veterans Memorial Stadium
f. Bridgeport Harbor Yard Stadium
g. Stafford Motor Speedway
h. Lyme Rock Park
i. Thompson Speedway
j. Waterford Speedbowl
k. Tennis Foundation of Connecticut
l. William A. O’Neill Convocation Center
m. Nature’s Art
n. Connecticut Convention Center
o. Dodd Stadium
p. Arena at Harbor Yard
q. New Britain Rock Cats games
r. New Haven Ravens games
s. Waterbury Spirit games

19. Amazon tax – Requires remote sellers with no physical presence in Connecticut to collect sales taxes on their taxable sales in Connecticut
20. Cremation certificate – fee increases from $100 to $150
21. DMV fee changes
a. Increases fees on late renewals
b. Increases fees on getting a regular drivers license and CDL
c. Increases all vehicle registrations
d. Increases fees paid by violators of certain motor vehicle laws such as speeding, reckless driving, and DUI
22. Hospital Tax – establishes a new 4.6% quarterly tax on hospitals’ net patient revenue
23. Nursing Home Resident User Fee – increases fee from 5.5% to 6%
24. Handicapped Care Fee – establishes a new fee for providers of care to individuals with mental retardation. Currently 5.5% is the Connecticut maximum, but can go up to the federal maximum (currently 6%) as of Oct. 1.

Medicare Plan for Payments Irks Hospitals

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WASHINGTON — For the first time in its history, Medicare will soon track spending on millions of individual beneficiaries, reward hospitals that hold down costs and penalize those whose patients prove most expensive.

The administration plans to establish “Medicare spending per beneficiary” as a new measure of hospital performance, just like the mortality rate for heart attack patients and the infection rate for surgery patients.

Hospitals could be held accountable not only for the cost of the care they provide, but also for the cost of services performed by doctors and other health care providers in the 90 days after a Medicare patient leaves the hospital.

This plan has drawn fire from hospitals, which say they have little control over services provided after a patient’s discharge — and, in many cases, do not even know about them. More generally, they are apprehensive about Medicare’s plans to reward and penalize hospitals based on untested measures of efficiency that include spending per beneficiary.

A major goal of the new health care law, often overlooked, is to improve “the quality and efficiency of health care” by linking payments to the performance of health care providers. The new Medicare initiative, known as value-based purchasing, will redistribute money among more than 3,100 hospitals.

Medicare will begin computing performance scores in July, for monetary rewards and penalties that start in October 2012.

The desire to reward hospitals for high-quality care is not new or controversial. The idea can be traced back to a bipartisan bill introduced in Congress in 2005, when Democrats and Republicans were still working together on health care. However, adding in “efficiency” is entirely new and controversial, as no consensus exists on how to define or measure the efficiency of health care providers.

The new health care law directs the secretary of health and human services to develop “efficiency measures, including measures of Medicare spending per beneficiary.” Obama administration officials will decide how to calculate spending per beneficiary and how to use it in paying hospitals.

Administration officials hope such efforts will slow the growth of Medicare without risking the political firestorm that burned Republicans who tried to remake the program this year.

In calculating Medicare spending per beneficiary, the administration said, it wants to count costs generated during a hospital stay, the three days before it and the 90 days afterward. This, it said, will encourage hospitals to coordinate care “in an efficient manner over an extended time period.”

If, for example, an 83-year-old woman is admitted to a hospital with a broken hip, she might have hip replacement surgery and then be released to a nursing home or a rehabilitation hospital. When she recovers, she might return to her own home, but still visit doctors and physical therapists or receive care from a home health agency. If she develops a serious infection, she might go back to the hospital within 90 days.

The new measure of Medicare spending per beneficiary would include all these costs, which — federal officials say — could be reduced by better coordination of care and communication among providers.

Here, in simplified form, is an example offered by federal officials to show how the rewards might work. If Medicare spends an average of $9,125 per beneficiary at a particular hospital and if the comparable figure for all hospitals nationwide is $12,467, the hospital would receive high marks — 9 points out of a possible 10 awarded for efficiency. This measure, combined with measures of quality, would be used to compute an overall performance score for the hospital. Based on this score, Medicare would pay a higher or lower percentage of each claim filed by the hospital.

Federal officials are still working out details, including how to distribute the money.

Charles N. Kahn III, president of the Federation of American Hospitals, which represents investor-owned companies, said he supported efforts to pay hospitals according to their performance. But he said the administration was “off track” in trying to hold hospitals accountable for what Medicare spends on patients two or three months after they leave the hospital.

“That’s unrealistic, beyond the pale,” Mr. Kahn said.

Since 2004, Medicare has provided financial incentives to hospitals to report on the quality of care, using widely accepted clinical measures.

Much of the information is posted on a government Web site (, but it has not been used as a basis for paying hospitals.

For years, federal health officials have emphasized the importance of higher-quality care, mentioning efficiency as an afterthought. Now, alarmed at the trajectory of Medicare costs, they emphasize efficiency as an equally important goal.

Under the new health law, Medicare will reduce payments to hospitals if too many patients are readmitted after treatment for heart attacks, heart failure or pneumonia. In addition, Medicare will cut payments to hospitals if they do not replace paper files with electronic health records, and it will further reduce payments to hospitals with high rates of preventable errors, injuries and infections.

Hospital payments account for the largest share of Medicare spending, and Medicare is the single largest payer for hospital services.

Senators Max Baucus, Democrat of Montana and chairman of the Finance Committee, and Charles E. Grassley, Republican of Iowa, have led efforts to pay health care providers for their performance — for the quality of services, rather than the quantity. House members from Iowa, Minnesota, Washington and Wisconsin have pushed for measures of efficiency, saying Medicare should reward low-cost, high-quality care of the type they say is provided in their states.

Without opposing the change, lawmakers from higher-cost states like Massachusetts and New York say the payment formula needs more work.

Teaching hospitals worry that the new policy will penalize them because they treat sicker, more expensive patients. Medicare officials tried to allay this concern, saying they would adjust the data to take account of patients’ age and the severity of their illnesses, as well as geographic differences in hospital wages.

Still, Kenneth E. Raske, president of the Greater New York Hospital Association, said the formula “tends to discriminate against inner-city hospitals with large numbers of immigrant, poor and uninsured patients.”

By contrast, J. Kirk Norris, president of the Iowa Hospital Association, welcomed the new plan. “Medicare ought to pay for value,” he said.

Administration officials said they were aware of concerns that some hospitals might try to increase their performance scores by avoiding high-risk patients. The officials said they would watch closely for signs of such a problem.

The New York Times
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