Mass honors bomb victim on day he would turn 9

BOSTON (AP) — The youngest victim of the Boston Marathon bombings was honored Sunday at a Roman Catholic Mass on what would have been his ninth birthday.

The family of Martin Richard was joined by hundreds of people from Boston and the region in Sunday's tribute at St. Ann Parish in Boston's Dorchester neighborhood. The congregation cheered as Martin's 7-year-old sister, Jane, who lost a leg in the explosion, wheeled herself up the center aisle with the pastor.

Martin's father, Bill Richard, described his son as an outstanding and curious student who loved astronomy, math and solving complicated problems, The Dorchester Reporter reported (http://bit.ly/19dT8VM).

Bill Richard, wearing a peace symbol button, said Martin helped younger students and settled disputes and enjoyed playing and winning at Monopoly.

Martin was one of three people killed in the April 15 bombings. More than 260 others were hurt, including most of Martin's family.

His mother, Denise, suffered a head injury and lost vision in an eye. Father Bill received shrapnel wounds and burns to his legs and suffered hearing loss. The eldest child, Henry, was unharmed.

The Rev. Sean Connor spoke with Jane as they sat on the altar, surrounded by about 100 other youngsters, many of them friends and classmates. He recalled that Jane's first words to him when he visited her at the hospital were, "Where have you been? You have to pray."

The two prayed for the nurses, doctors and first responders and for Martin. Connor said Jane told him that Martin "lives in my heart."

He advised the children to read the rosary and pray at home with their parents to help ease the pain of Martin's loss.

"You teach your moms and dads to laugh and to love and that makes hope real for us," he said.

Via Yahoo News!

APNewsBreak: Plan would lift wolf protections

BILLINGS, Mont. (AP) — The Obama administration is proposing to lift most remaining federal protections for gray wolves across the Lower 48 states almost four decades after they were added to the endangered species list.

An official announcement is scheduled Friday.

More than 6,100 wolves roam parts of the Northern Rockies and western Great Lakes.

U.S. Fish and Wildlife Service Director Dan Ashe told The Associated Press in an exclusive interview that those populations are robust enough to stave off extinction.

Federal protections would remain only for a fledgling population of Mexican gray wolves in the desert Southwest.

Some prominent scientists and dozens of lawmakers in Congress want broader protections to remain in place so wolves can expand, including in the Northeast and along the West Coast.

___

Flesher reported from Traverse City, Mich.

Via Yahoo News!

In Peru, the Daughter Who Would Be President Too (Time.com)

Keiko Fujimori is running for President of Peru under a shadow that will never dissipate: her father. He is at once an important reason for the viability of her candidacy as well as a cautionary tale, the lessons of which she must insist she has learned.

Alberto Fujimori was President of Peru from 1990 to 2000 and was credited with, among other things, the revival of the economy and the brutal suppression of the leftist uprising that made the country a byword for terror in Latin America. As a result, the elder Fujimori is now sitting in prison, a cozy one by most standards, indeed built specifically for him, but a penitentiary nevertheless. While his case is still under appeal, he could be in jail for a quarter century. (Read "Peru Runoff: Coup Leader vs. Convict's Daughter.")

Keiko Fujimori has spent the last couple of months trying to dispel the impression that she is merely a stand-in for her father. "They are trying to say that my father is influencing the campaign, but it's not true," she says. "He is in prison. I make the decisions, I picked the campaign team and wrote the government plan, I am here talking to Peruvians, not my father." She is adamant. "If my opponents want to think otherwise, they have underestimated me. Let them continue thinking that way."

If she does win the June 5 run-off against her left-wing opponent Ollanta Humala, she will become the country's first female president, Peru's youngest head of state, if only by just two days (she turns 36 on Wednesday), and the first child of a president to be elected to the same office. She will also be the first woman of Asian descent to rule a nation in the Americas, as well as the first person with an MBA to govern Peru, having graduated from Columbia University in 2006. And while the past two presidents have also had foreign-born spouses, she will be the first with a US-born First Gentleman, Mark Villanella, a Jersey boy.

So far, she can claim virtually dramatic turnaround in her campaign. Going into the first round of voting in April, her support fluctuated around 20%, which most opponents and pundits attributed to the core support for her father. Part of that support was due to an original pledge to free her father. She has since stepped back from that, though partisans are still believe she may alleviate his imprisonment if elected. (See Fujimori's conviction for human rights abuses.)

However, the other 76% of voters in the first round, which included 11 candidates, remember the long list of crimes from her father's government. He fled Peru for Japan in November 2000, as a corruption scandal tore apart his administration. The Germany-based anti-corruption organization, Transparency International, calls his regime a "kleptocracy" and lists him among the top 10 most corrupt leaders in modern times. Some estimates put the amount of money allegedly stolen by the regime at more than $1.5 billion.

Keiko Fujimori has managed to rebrand herself partly because of a savvy campaign that focuses simply on her first name - the symbol of her Fuerza 2011 party is a "K" for Keiko, putting distance between herself and her father. She has also benefited from Humala's negative ratings, which are on a par with her own. A former Army officer, he has been plagued by memories of his failed 2006 presidential bid, when he was linked to Venezuela's Hugo ChAvez. Fear of this leftist bond lingers, even though he denies it exists. Most of Peru's media is unabashedly opposed to Humala.

Nevertheless, the first round of voting gave Humala 32% of the vote to Fujimori's 24%. She now has 43% to his 39%, according to the most respected polling firm, Ipsos Apoyo. The difference is still within the margin of error and the polls do not include many rural areas where Humala is strongest. A defining moment could be the presidential debate scheduled for May 29. (See why the issue of same-sex marriages roiled the presidential race.)

Fujimori insists she is naturally shy. But there has been no evidence of that inclination through her campaign. It was not present on May 22, as she attended meetings in jungles towns along a stretch of highway from Tarapoto to Yurimaguas, in the northern jungle. She graciously accepted flowers offered by supporters, took hats from women in the crowd - women account for the bulk of townsfolk who braved the midday jungle sun to hear her - and easily launched into a spiel tailor-made for each audience.

As she campaigns, she offers to put in running water in towns where there is none, provide school breakfast and lunch programs, free uniforms and shoes for grade-schoolers and a much more active state. Tossed into the mix are airports, hospitals, universities and a string of other major infrastructure undertakings. The promises, which sound extremely ambitious for a five-year presidential term, and her folksy style have helped erase the six-point advantage enjoyed by Humala, with just two weeks to go before the election.

Fujimori says the tide has turned. "There are huge crowds wherever we go. You get a feeling that people know that we are the winning option," she says as she tosses t-shirts from the window of her car to supporters lining the street.

Jair Rodriguez, 20, a college student who was on hand to greet Fujimori when she landed at the airport in Tarapoto, says he is voting for her because of her ideas, but also because of her father. "The president [Alberto Fujimori] saved our country from terrorism and created the foundation for today's growth. We shouldn't forget the past," he says. If she does win, she owes part of the victory to her imprisoned dad.

See people protesting Fujimori's re-election campaign in 2000.

See the world's most influential people in the 2011 TIME 100.

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MasterCard says 62 percent of people would make payments using mobile phones (Appolicious)

Google (GOOG) and a number of other companies think that paying for things using smartphones might be the future of brick-and-mortar commerce.

It’s called Near-Field Communication, and it’s a technology found in Google’s Nexus S phone and other smartphones that have recently hit the market. It allows the devices to broadcast a short-range signal that can interact with certain receivers. Users could wave the phone at a payment terminal when they go to check out at the grocery store, and their credit card information would be used instantly to complete the transaction. It could also be used to gather information from movie posters, for example, that would offer advertising information or show times.

But payments are the real power of NFC technology, it seems. According to a report from Fierce Mobile Content, MasterCard (MA) has been surveying customers to see if they’d be willing to use their mobile devices as payment tools for transactions, with 62 percent of those asked responding in the affirmative.

The survey found that 63 percent of respondents between ages 18 and 34 would be willing to make mobile NFC purchases, but that number dropped down to 37 percent for respondents who were 37 or older. MasterCard also found a disparity between men and women in mobile payments, finding that 51 percent of males said they were comfortable with NFC transactions, compared to 40 percent of females.

Respondents in the survey were also asked how they feel about having cell phones on them – 65 percent of 18- to 34-year-olds said they felt more ‘naked’ without their phones than their wallets, compared to 34 percent of respondents older than 35. Between men and women, 50 percent of women said they felt more exposed without a mobile device than a wallet, with only 36 percent of men responding in the affirmative.

MasterCard has worked with Google in the past to help embed NFC payment technology in smartphones, which is supported by Google’s Android 2.3 Gingerbread operating system.  Other companies, like Amazon (AMZN), are considering getting in on near-field technology, considering it the cutting edge of mobile capabilities. Verifone (PAY), a maker of payment terminals for retailers (you’ve probably seen them – they’re often used for scanning credit and debit cards and inputting PINs), is adding NFC capabilities to all its newly manufactured terminals, as well.

But MasterCard’s survey suggests that while 62 percent of respondents are willing to go along with mobile NFC payments, that means almost half of respondents still feel the technology is a bit dubious. There’s a lot of investment going into NFC from many sources, but it’s going to take an investment in convincing people that near-field communication is a trustworthy and safe way of passing financial information before it really takes off.

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Bills would transfer oversight of terror cases

WASHINGTON — In the Justice Department's ornate Great Hall, a space traditionally reserved for its most important functions, Attorney General Eric Holder stepped before staffers last week to mark the department's accomplishments in the first two years of the Obama administration and the challenges to be confronted in the term's second half.

Attorney General Eric Holder says the U.S. will continue to rely on the federal court system to bring terror suspects to justice.

By Paul J. Richards, Getty Images, AFP

Attorney General Eric Holder says the U.S. will continue to rely on the federal court system to bring terror suspects to justice.

Perhaps most striking about the speech ? which reaffirmed the department's commitment to national security ? were words that Holder did not utter: Guantanamo Bay.

Just weeks after the administration capitulated on its promise to shut down the prison at Guantanamo and referred the suspects there to trials by military commissions ? not civilian courts ? Holder's address was partly an attempt to turn the page on a painful political loss.

Even so, the Guantanamo decision may mark just the first fight in a continuing battle to undermine his authority in terrorism prosecutions.

At least two bills before Congress threaten to transfer much of the investigative oversight in terrorism cases, which are currently Holder's responsibility as the attorney general, to the Defense secretary.

'A paradigm shift'

A bill in the House of Representatives, sponsored by Rep. Bobby Shilling, R-Ill., would require terrorism suspects, including those arrested in the United States, to be placed in military custody unless the Defense secretary rules otherwise.

"It acknowledges that the attorney general has played a too important role in these cases," said Josh Holly, a Republican spokesman for the House Armed Services Committee. "This represents a paradigm shift to the law of war."

A Senate bill, sponsored by Arizona's John McCain and other Republicans, includes a similar provision that calls for "members of al-Qaeda, the Taliban and affiliated terrorist groups" to be held by the military when captured.

The bill also would give authority to the Defense secretary ? not the attorney general ? to determine whether the suspect should be transferred to civilian custody.

"This much-needed legislation would improve our current ad hoc military detention system for members of al-Qaeda and their affiliated terrorist groups," McCain said when introducing the bill.

The proposed legislative provisions were inspired partly by the controversy that followed the arrest of Umar Farouk Abdulmutallab, charged with trying to blow up a commercial airliner over Detroit with a bomb hidden in his underwear on Christmas Day 2009.

At that time, some lawmakers, including Sen. Joseph Lieberman, I-Conn., a co-sponsor of the current Senate bill, assailed Obama administration officials for the decision to inform Abdulmutallab of his right to a lawyer during a break in the interrogation.

Lieberman and others have argued that the Nigerian terrorism suspect should have been turned over to military authorities for interrogation rather than risk losing the suspect's cooperation on the advice of a defense lawyer.

"These are lessons learned from (Abdulmutallab)," Holly said.

In his speech to staffers, Holder, while not referring to the Guantanamo decision, vowed to press federal law enforcement's anti-terrorism efforts.

"Let me be very clear about this: We will continue to rely on our most powerful and most proven tool in bringing terrorists to justice: our federal court system," Holder said.

Later, in a meeting with reporters, Holder said that the federal court system has demonstrated a "capacity" to prosecute terrorism cases.

Since the 9/11 attacks, there have been more than 400 convictions in terror and terror-related prosecutions, according to Justice Department records.

"We have the capacity to try terrorists in (federal) courts," Holder said.

A question of authority

Despite the federal courts' record of dealing with terrorism cases, some advocates for civilian prosecutions said, the Guantanamo decision diminishes the Justice Department's standing in terror prosecutions.

"The flip-flop by the Obama administration makes the Justice Department look symbolically weaker," said Hina Shamsi, director of the ACLU's National Security Project, "but we shouldn't let a decision based on politics diminish the role the department has played in successfully prosecuting hundreds of terror cases in federal court."

Dixon Osburn, law and security program director at Human Rights First, said the McCain and Shilling bills amount to the next challenge to the administration.

"I don't think anybody has really focused on these (bills) yet," Osburn said. "The White House needs to say that there are lines that cannot be crossed."

For more information about reprints & permissions, visit our FAQ's. To report corrections and clarifications, contact Standards Editor Brent Jones. For publication consideration in the newspaper, send comments to letters@usatoday.com. Include name, phone number, city and state for verification. To view our corrections, go to corrections.usatoday.com.We've updated the Conversation Guidelines. Changes include a brief review of the moderation process and an explanation on how to use the "Report Abuse" button. Read more.

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Bills would transfer oversight of terror cases

WASHINGTON — In the Justice Department's ornate Great Hall, a space traditionally reserved for its most important functions, Attorney General Eric Holder stepped before staffers last week to mark the department's accomplishments in the first two years of the Obama administration and the challenges to be confronted in the term's second half.

var data = blocks.columnist;if (data != undefined){document.getElementById('columnistmug').innerHTML=data;} By Paul J. Richards, Getty Images, AFP

Attorney General Eric Holder says the U.S. will continue to rely on the federal court system to bring terror suspects to justice.

By Paul J. Richards, Getty Images, AFP

Attorney General Eric Holder says the U.S. will continue to rely on the federal court system to bring terror suspects to justice.

Perhaps most striking about the speech ? which reaffirmed the department's commitment to national security ? were words that Holder did not utter: Guantanamo Bay.

Just weeks after the administration capitulated on its promise to shut down the prison at Guantanamo and referred the suspects there to trials by military commissions ? not civilian courts ? Holder's address was partly an attempt to turn the page on a painful political loss.

Even so, the Guantanamo decision may mark just the first fight in a continuing battle to undermine his authority in terrorism prosecutions.

At least two bills before Congress threaten to transfer much of the investigative oversight in terrorism cases, which are currently Holder's responsibility as the attorney general, to the Defense secretary.

'A paradigm shift'

A bill in the House of Representatives, sponsored by Rep. Bobby Shilling, R-Ill., would require terrorism suspects, including those arrested in the United States, to be placed in military custody unless the Defense secretary rules otherwise.

"It acknowledges that the attorney general has played a too important role in these cases," said Josh Holly, a Republican spokesman for the House Armed Services Committee. "This represents a paradigm shift to the law of war."

A Senate bill, sponsored by Arizona's John McCain and other Republicans, includes a similar provision that calls for "members of al-Qaeda, the Taliban and affiliated terrorist groups" to be held by the military when captured.

The bill also would give authority to the Defense secretary ? not the attorney general ? to determine whether the suspect should be transferred to civilian custody.

"This much-needed legislation would improve our current ad hoc military detention system for members of al-Qaeda and their affiliated terrorist groups," McCain said when introducing the bill.

The proposed legislative provisions were inspired partly by the controversy that followed the arrest of Umar Farouk Abdulmutallab, charged with trying to blow up a commercial airliner over Detroit with a bomb hidden in his underwear on Christmas Day 2009.

At that time, some lawmakers, including Sen. Joseph Lieberman, I-Conn., a co-sponsor of the current Senate bill, assailed Obama administration officials for the decision to inform Abdulmutallab of his right to a lawyer during a break in the interrogation.

Lieberman and others have argued that the Nigerian terrorism suspect should have been turned over to military authorities for interrogation rather than risk losing the suspect's cooperation on the advice of a defense lawyer.

"These are lessons learned from (Abdulmutallab)," Holly said.

In his speech to staffers, Holder, while not referring to the Guantanamo decision, vowed to press federal law enforcement's anti-terrorism efforts.

"Let me be very clear about this: We will continue to rely on our most powerful and most proven tool in bringing terrorists to justice: our federal court system," Holder said.

Later, in a meeting with reporters, Holder said that the federal court system has demonstrated a "capacity" to prosecute terrorism cases.

Since the 9/11 attacks, there have been more than 400 convictions in terror and terror-related prosecutions, according to Justice Department records.

"We have the capacity to try terrorists in (federal) courts," Holder said.

A question of authority

Despite the federal courts' record of dealing with terrorism cases, some advocates for civilian prosecutions said, the Guantanamo decision diminishes the Justice Department's standing in terror prosecutions.

"The flip-flop by the Obama administration makes the Justice Department look symbolically weaker," said Hina Shamsi, director of the ACLU's National Security Project, "but we shouldn't let a decision based on politics diminish the role the department has played in successfully prosecuting hundreds of terror cases in federal court."

Dixon Osburn, law and security program director at Human Rights First, said the McCain and Shilling bills amount to the next challenge to the administration.

"I don't think anybody has really focused on these (bills) yet," Osburn said. "The White House needs to say that there are lines that cannot be crossed."

For more information about reprints & permissions, visit our FAQ's. To report corrections and clarifications, contact Standards Editor Brent Jones. For publication consideration in the newspaper, send comments to letters@usatoday.com. Include name, phone number, city and state for verification. To view our corrections, go to corrections.usatoday.com.We've updated the Conversation Guidelines. Changes include a brief review of the moderation process and an explanation on how to use the "Report Abuse" button. Read more.

USATODAY.com

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Bartlett 'Sanctuary' Plan Would Rescue Chimps, Taxpayers

FoxNews.com

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WASHINGTON -- Rep. Roscoe Bartlett, R-Md., a noted budget hawk, has introduced a novel way to take a tiny chunk out of the federal deficit: Pinch pennies by preserving primates.

Bartlett joined with the Humane Society of the United States and the Physicians Committee for Responsible Medicine to stump for a bill to prohibit "invasive research" on chimpanzees and retire the approximately 500 government-owned chimps currently in laboratories to private sanctuaries within three years.

At a news conference Wednesday at the U.S. Capitol Visitor Center, Bartlett, who has a doctorate in human physiology, said science has changed and it is time to end chimp research.

"There's just no valid argument to continue to keep these great apes as they're now being kept," Bartlett said. "Very few of them are used in research and I'm not sure that any of them need to be used."

With his background in science and his reputation as a fiscal conservative, Bartlett would seem to be the perfect spokesman for the bill, called the "Great Ape Protection and Cost Savings Act."

With Bartlett's backing, it has become an endangered species of Capitol Hill politics: a bipartisan effort. The bill had almost 170 co-sponsors when it was introduced in the last congressional session, and already has 40 this time around -- a list that includes Democrats, Republicans and Independent Vermont Sen. Bernie Sanders.

Michael Markarian, the Humane Society's executive vice president of external affairs, said that 80 to 90 percent of the chimps in U.S. laboratories are not part of active research, but are being warehoused in crowded conditions at taxpayer expense. Under National Research Council guidelines published in 1997, "surplus" chimps may not be euthanized, but must be kept for their natural life span, which can run to 60 years.

Markarian's organization estimates that the bill could save $25 million to $30 million per year.

That figure is contingent on a lot of variables, though. According to Humane Society estimates, only about $7 million in savings would come from transferring the 511 government-owned chimps to private sanctuaries and ending government support of research on 244 privately-owned chimps. The rest of the savings -- about $22.2 million -- comes from ending the research itself.

The cost to medical advancements is also matter of debate. The Federation of American Societies for Experimental Biology opposed the bill when it was introduced last year, saying it would "harm medical research that helps both humans and great apes." The group noted that chimps are used as research models for a host of diseases, including hepatitis C, malaria and rotovirus.

"Our position on research using great apes has not changed," FASEB spokesman Howard Garrison said by phone Wednesday.

According to the New England's Anti-Vivisection Society's "Project R&R: Release and Restitution for Chimpanzees at U.S. Laboratories," the National Institutes of Health owns about 500 chimps.

NIH spokeswoman Jenny Haliski declined to comment on the pending legislation, but provided a link to an NIH website on animal research. It notes that the use of animals in research is heavily regulated, advanced computer research models often stem from animal research and that the polio vaccine was developed using a monkey as the research model.

But Elizabeth Kucinich, spokeswoman for PCRM and wife of Bartlett's ideological opposite, Dennis Kucinich, D-Ohio, said little would be lost in the world of medical research if the chimps were retired. She said there were significant physiological differences between chimps and humans -- particularly in their response to hepatitis C -- and the suffering and stress that chimps endure in captivity skews research results anyway.

Bartlett agreed, and said modern research methods with human cells are more effective than "whole animal" research. He said his own work with primates for NASA in the 1950s was necessary because methods were crude and human lives were at risk.

"Nobody had ever been weightless before and we had no idea what would happen when you were weightless," Bartlett said. "So this was a pioneering thing and it was probably a legitimate use of these animals."

He said better alternatives have been developed since then and groups like MD Anderson Cancer Center should no longer need primate research.

"I'm surprised that we're still doing whole-body experiments with cancer," Bartlett said. "I would think that they know enough about it now that they should be down at the cellular level."

MD Anderson spokesman Scott Merville said his organization is doing research at the molecular level, but also has 176 NIH-owned chimps, some of which are being used to test drugs targeting genes and proteins only present in humans and chimpanzees.

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Fox News Poll: Most Would Vote Against Raising Debt Limit

FoxNews.com

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American voters would rather shut down the government than raise the debt limit, even though most believe a shutdown would have a dramatic effect on everyday Americans.

A Fox News poll released Wednesday asked voters to imagine being a lawmaker in Washington who had to decide whether to increase the debt ceiling. The poll found 62 percent would vote against raising it -- even at the risk of shutting down the government.

About one-in-four voters (26 percent) would raise the limit to allow the government to spend more.

Looking at views by political party, Republicans would overwhelmingly vote against raising the debt ceiling (79 percent). So would a majority of independents (62 percent). Democrats, however, split more evenly: 42 percent would vote to raise the limit and 46 percent would vote against it.

Is shutting down the government a big deal? A 58 percent majority thinks a government shutdown would have a dramatic effect on the lives of everyday Americans, while 34 percent think it’s more of a technical issue that lacks real consequences.

Click here for complete poll results.

Voters’ willingness to close the government while at the same time believing it would have a major effect on everyday Americans may stem from the low regard many voters have for those receiving government benefits. Voters are more likely to think people who receive substantial benefits from the government are mostly

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Federal plan would streamline Medicare

File photo by Chip Somodevilla, Getty Images

Health and Human Services Secretary Kathleen Sebelius wants to put the focus on quality preventive care.

EnlargeCloseFile photo by Chip Somodevilla, Getty Images

Health and Human Services Secretary Kathleen Sebelius wants to put the focus on quality preventive care.

Affordable care organizations could save Medicare $960 million over the next three years, Health and Human Services Secretary Kathleen Sebelius said. She emphasized the need for preventive care, saying that one in five Medicare patients who visit the hospital are back within 30 days, and that one in seven suffer a harmful mistake. An additional 100,000 patients die from infections every year.

"These results are unacceptable," she said.

Under the proposed system, which would begin in 2012, hospitals and other medical facilities serving more than 5,000 Medicare patients could form teams of primary care doctors, nurse practitioners and specialists to coordinate a patient's care. The patient would still be able to choose his or her own doctor, and the system is voluntary. The regulation comes as part of the federal health care law passed last year but is open for public comment before it is finalized this year.

Half of Medicare beneficiaries have more than one chronic condition and often receive care from several doctors, according to Health and Human Services. If doctors don't talk to each other, they can make mistakes in prescribing medications that shouldn't be taken with the patient's other prescriptions, or could administer care or tests the patient has already received.

"It describes what we've been up to for 10 years," said Steve Safyer, president of Montefiore Medical Center in New York City. "It really is what people are moving toward."

TIMELINE: Road to health care legislationSafyer said coordinated care emphasizes quality and safety, and at his hospital, it means going out to visit elderly patients who live in four-story walk-ups in the Bronx, or making sure patients can get all of their care in one place. One doctor takes charge of each patient's care, while a team nurse coordinates appointments. The care manager makes sure a patient knows what to avoid with his heart-disease medications, as well as calling to ensure a diabetic patient has her blood sugar under control. "From a financial point of view, 80% of our payments are Medicare and Medicaid," he said. "This is the only system, in my mind, that can manage the expense."

The organizations would be eligible for bonuses if they improve the quality of their care and reduce wasteful practices. But there's some risk: The government will create a benchmark that each organization must reach to assess whether it will receive a bonus from the savings created, or repay shared losses. Mike Nugent, co-author of Accountable Care Organizations: Your Guide to Strategy, Design, and Implementation, said there are at least 50 affordable care organization projects being considered across the country. A small number do it because of the shared-savings aspect of the plan, he said, but more do it because they need to cut costs.

"The bigger issue is that (Medicare) reimbursement is not going to increase as it has in the past," he said. In the past, Medicare payments have increased about 3% every year, but now those payments will be capped, and doctors will have to cut costs to keep their services competitive. "Competition pre-empts reform. Competition preempts these regulations."

For more information about reprints & permissions, visit our FAQ's. To report corrections and clarifications, contact Standards Editor Brent Jones. For publication consideration in the newspaper, send comments to letters

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Federal plan would streamline Medicare

File photo by Chip Somodevilla, Getty Images

Health and Human Services Secretary Kathleen Sebelius wants to put the focus on quality preventive care.

EnlargeCloseFile photo by Chip Somodevilla, Getty Images

Health and Human Services Secretary Kathleen Sebelius wants to put the focus on quality preventive care.

Affordable care organizations could save Medicare $960 million over the next three years, Health and Human Services Secretary Kathleen Sebelius said. She emphasized the need for preventive care, saying that one in five Medicare patients who visit the hospital are back within 30 days, and that one in seven suffer a harmful mistake. An additional 100,000 patients die from infections every year.

"These results are unacceptable," she said.

Under the proposed system, which would begin in 2012, hospitals and other medical facilities serving more than 5,000 Medicare patients could form teams of primary care doctors, nurse practitioners and specialists to coordinate a patient's care. The patient would still be able to choose his or her own doctor, and the system is voluntary. The regulation comes as part of the federal health care law passed last year but is open for public comment before it is finalized this year.

Half of Medicare beneficiaries have more than one chronic condition and often receive care from several doctors, according to Health and Human Services. If doctors don't talk to each other, they can make mistakes in prescribing medications that shouldn't be taken with the patient's other prescriptions, or could administer care or tests the patient has already received.

"It describes what we've been up to for 10 years," said Steve Safyer, president of Montefiore Medical Center in New York City. "It really is what people are moving toward."

TIMELINE: Road to health care legislationSafyer said coordinated care emphasizes quality and safety, and at his hospital, it means going out to visit elderly patients who live in four-story walk-ups in the Bronx, or making sure patients can get all of their care in one place. One doctor takes charge of each patient's care, while a team nurse coordinates appointments. The care manager makes sure a patient knows what to avoid with his heart-disease medications, as well as calling to ensure a diabetic patient has her blood sugar under control. "From a financial point of view, 80% of our payments are Medicare and Medicaid," he said. "This is the only system, in my mind, that can manage the expense."

The organizations would be eligible for bonuses if they improve the quality of their care and reduce wasteful practices. But there's some risk: The government will create a benchmark that each organization must reach to assess whether it will receive a bonus from the savings created, or repay shared losses. Mike Nugent, co-author of Accountable Care Organizations: Your Guide to Strategy, Design, and Implementation, said there are at least 50 affordable care organization projects being considered across the country. A small number do it because of the shared-savings aspect of the plan, he said, but more do it because they need to cut costs.

"The bigger issue is that (Medicare) reimbursement is not going to increase as it has in the past," he said. In the past, Medicare payments have increased about 3% every year, but now those payments will be capped, and doctors will have to cut costs to keep their services competitive. "Competition pre-empts reform. Competition preempts these regulations."

For more information about reprints & permissions, visit our FAQ's. To report corrections and clarifications, contact Standards Editor Brent Jones. For publication consideration in the newspaper, send comments to letters

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