Starbucks' $7-a-cup coffee: Can you tell the difference?

Some coffee aficionados have a difficult decision to make: Spend $7 on a full lunch or on a single cup of Starbucks coffee?

The brew in question: the Seattle giant's new Costa Rica Finca Palmilera, its most expensive offering ever and also one of its rarest. The coffee is part of the company's Reserve line and costs $7 for a grande — a 16-ounce cup.

An 8-ounce package of beans costs $40.

The uber-premium beans and brew are available only in 46 Starbucks stores in Portland and Seattle, a licensed store in Idaho and Starbucks' Roy Street Coffee & Tea offshoot in Washington.

With a limited quantity of beans available, the company said it will not expand the offering beyond the Pacific Northwest to its more than 11,000 Starbucks stores nationwide.

Online, Starbucks already has sold out of a similar premium offering — the Costa Rica Tarrazu Geisha, listed on the website as having "rose petal aromas with ripe banana and subtle red current notes and silky mouth feel." The 450 half-pound bags of beans available were snapped up within 24 hours after being offered Nov. 8.

Both kinds of beans are known as Geisha heirloom varietals, which were first discovered in Ethiopia before making their way to Central America in the 1950s.

Starbucks justifies the high price by explaining that Geisha plants don't produce many cherries, making the beans extremely rare and also full of concentrated flavor. This is the company's first go-round with Geisha beans.

Starbucks is working through 3,800 pounds of Finca Palmilera beans, which feature notes of white peach and pineapple, company spokeswoman Alisa Martinez said.

"It leaves a tingly, kind of light feeling," she said. "It's a very exquisite coffee."

But try telling that to the consumers pranked this week by comedian Jimmy Kimmel, who set up a fake taste test in Hollywood asking people to distinguish between standard coffee and what was supposedly the Finca Palmilera brew. Turns out, both cups contained the same basic Joe.

"I feel like this is a test to find out just how stupid we are," Kimmel said on his show. "Although, while it's ridiculous to spend $7 on a cup of coffee, it's actually not that much more ridiculous to spend $4 on a cup of coffee."

tiffany.hsu@latimes.com

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Twin car bombs in Damascus kill at least 34 people

Dozens of people were killed Wednesday morning in four consecutive explosions that rocked a pro-regime suburb of the Syrian capital.

Twin car bombings first struck Jaramana around rush hour near the town’s main square. An eyewitness told activists that the first bomb went off near the entrance of a building and as people gathered to help the injured a nearby Mercedes also exploded. Witnesses reported many bodies lying in the street and photos from the scene showed damaged buildings and cars under rubble.

Soon after planted explosives were set off on the nearby Qariyat highway, said Damascus activist Alexia Jade.

The Syrian Arab News Agency reported that the last two explosions happened in Damascus in the Nahda and Qerayyat neighborhoods.

The opposition reported 45 people were killed, mostly civilians, and state media said the death toll was 34. Many more are injured, some in critical condition.

Jaramana is a mostly pro-government town but has also become a safe haven for many refugees fleeing violence in nearby areas. But this was not the first time the town has been attacked.

State media blamed the bombings on “terrorists,” the catch-all term the government has used to describe the opposition since the beginning of the uprising last year.

Opposition activists said no rebel group had claimed responsibility for the bombings and they pinned the blame on the government. Ambulances and state media were on the scene almost immediately, they said.

“Checkpoints surround Jaramana from all sides and are manned by the People’s Committee, so where did the car bombs enter from?” Jade said. “It is just a message of fear for the residents of Jaramana.”

Jaramana's hospital was inundated with victims and many had to be transferred elsewhere.

Schools that were already in session closed for the day and parents rushed to pick up their children, Jade said.

Roads around the town were closed in the wake of the bombings and security forces and members of the pro-regime People’s Committee were patrolling throughout the area, activists reported.

“Till this moment indications are that the regime was behind it,” Jade said. “And if (a rebel group) claims responsibility I’m going to be angry, because there are civilians lying in the street.”

ALSO:

Yasser Arafat's grave dug up in poisoning probe 

Egyptians pour into Tahrir Square to protest presidential decree

Kim Jong Un 'sexiest man,' Onion says; China's People's Daily buys it

-- Times staff in Amman, Jordan

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Nokia wins tribunal ruling on wireless patents

HELSINKI (Reuters) – Nokia has won its dispute with BlackBerry maker Research In Motion (RIM) over use of its patents related to wireless local access network (WLAN) technology, the Finnish company said on Wednesday.

Announcing that an arbitrator had ruled in its favor, Nokia said: “It found that RIM was in breach of contract and is not entitled to manufacture or sell WLAN products without first agreeing royalties.”

Nokia, which is trying to boost its royalty income as its phone business tumbles, said that it had filed cases in the United States, Britain and Canada to enforce the arbitrator’s ruling.

“This could have a significant financial impact, as all BlackBerry devices support WLAN, although the volumes are currently very low in these countries,” IDC analyst Francisco Jeronimo said.

RIM was not immediately available to comment.

Nokia said it signed a cross-license agreement with RIM covering standards-essential cellular patents in 2003; a deal that was amended in 2008. RIM sought arbitration in 2011, arguing that the license should be extended to cover WLAN patents.

Nokia, along with Ericsson and Qualcomm, is among the leading patent holders in the wireless industry. Patent royalties generate annual revenue of about 500 million euros ($ 646 million) for Nokia.

Based on a Nortel patent sale and Google’s acquisition of Motorola Mobility, some investors and analysts say that Nokia’s patent portfolio alone merits its current share price of 2.50 euros.

However, the patent market has cooled since those deals were made and industry experts say that fair value of patents in large portfolios is $ 100,000 to $ 200,000, pricing Nokia’s portfolio at up to 0.50 euros per share. ($ 1 = 0.7733 euros)

(Editing by David Goodman)

Tech News Headlines – Yahoo! News

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In elf ears and wizard hats, 'Hobbit' fans rejoice

WELLINGTON, New Zealand (AP) — Wearing elf ears and wizard hats, sitting atop their dad's shoulders or peering from balconies, tens of thousands of New Zealanders watched their favorite "Hobbit" actors walk the red carpet Wednesday at the film trilogy's hometown premiere.

An Air New Zealand plane freshly painted with "Hobbit" characters flew low over Wellington's Embassy Theatre, eliciting roars of approval from the crowd.

Sam Rashidmardani, 12, said he came to see Gollum actor Andy Serkis walk the red carpet — and he wasn't disappointed.

"It was amazing," Rashidmardani said of the evening, adding his Gollum impression: "My precious."

British actor Martin Freeman, who brings comedic timing to the lead role of Bilbo Baggins, said he thought director Peter Jackson had done a fantastic job on "The Hobbit: An Unexpected Journey."

"He's done it again," Freeman said in an interview on the red carpet. "If it's possible, it's probably even better than 'The Lord of the Rings.' I think he's surpassed it."

While it is unusual for a city so far from Hollywood to host the premiere of a hoped-for blockbuster, Jackson's filming of his lauded 'LOTR' trilogy and now "The Hobbit" in New Zealand has helped create a film industry here. The film will open in theaters around the world next month.

One of the talking points of the film is the choice by Jackson to shoot it using 48 frames per second instead of the traditional 24 in hopes of improving the picture quality.

Some say the images come out too clear and look so realistic that they take away from the magic of the film medium. Jackson likens it to advancing from vinyl records to CDs.

"I really think 48 frames is pretty terrific and I'm looking forward to seeing the reaction," Jackson said on the red carpet. "It's been talked about for so long, but finally the film is being released and people can decide for themselves."

Jackson said it was strange working on the project so intimately for two years and then having it suddenly taken away as the world got to see the movie.

"It spins your head a little bit," he said.

Aidan Turner, who plays the dwarf Kili in the movie, said his character is reckless and thinks he's charming.

"I don't get to play real people it seems, I only get to play supernatural ones," he said. "So playing a dwarf didn't seem that weird, actually.

Perhaps the most well-known celebrities to walk the carpet were Cate Blanchett and Elijah Wood, who reprise their roles in the LOTR in the "Hobbit."

"Mostly I came here to see everyone. I like them all," said fan Aysu Shahin, 16, adding that Wood was her favorite. She said she wanted to see the movie "as soon as possible. I'm excited for it."

At a news conference earlier in the day, Jackson said many younger people are happy to watch movies on their iPads.

"We just have to make the cinema-going experience more magical and more spectacular to get people coming back to the movies again," he said.

Jackson said only about 1,000 of the 25,000 theaters that will show the film worldwide are equipped to show 48 frames, so most people will see it in the more traditional format. The movie has also been shot in 3D.

A handful of animal rights protesters held signs at the premiere.

The protest by the group People for the Ethical Treatment of Animals comes after several animal wranglers said three horses and up to two dozen other animals had died during the making of the movies because they were housed at an unsafe farm.

Jackson's spokesman earlier acknowledged two horses had died preventable deaths at the farms but said the production company worked quickly to improve stables and other facilities and that claims of mistreatment were unfounded.

"No mistreatment, no abuse. Absolutely none," Jackson said at the news conference.

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The New Old Age Blog: Doctor's Orders? Another Test

It is no longer news that Americans, and older Americans in particular, get more routine screening tests than they need, more than are useful. Prostate tests for men over 75, annual Pap smears for women over 65 and colonoscopies for anyone over 75 — all are overused, large-scale studies have shown.

Now it appears that many older patients are also subjected to too-frequent use of the other kind of testing, diagnostic tests.

The difference, in brief: Screening tests are performed on people who are asymptomatic, who aren’t complaining of a health problem, as a way to detect incipient disease. We have heard for years that it is best to “catch it early” — “it” frequently being cancer — and though that turns out to be only sometimes true, we and our doctors often ignore medical guidelines and ongoing campaigns to limit and target screening tests.

Diagnostic tests, on the other hand, are meant to help doctors evaluate some symptom or problem. “You’re trying to figure out what’s wrong,” explained Gilbert Welch, a veteran researcher at the Dartmouth Institute for Health Policy and Clinical Practice.

For these tests, medical groups and task forces offer many fewer guidelines on who should get them and how often — there is not much evidence to go on — but there is general agreement that they are not intended for routine surveillance.

But a study using a random 5 percent sample of Medicare beneficiaries — nearly 750,000 of them — suggests that often, that is what’s happening.

“It begins to look like some of these tests are being routinely repeated, and it’s worrisome,” said Dr. Welch, lead author of the study just published in The Archives of Internal Medicine. “Some physicians are just doing them every year.”

He is talking about tests like echocardiography, or a sonogram of the heart. More than a quarter of the sample (28.5 percent) underwent this test between 2004 and 2006, and more than half of those patients (55 percent) had a repeat echocardiogram within three years, most commonly within a year of the first.

Other common tests were frequently repeated as well. Of patients who underwent an imaging stress test, using a treadmill or stationery bike (or receiving a drug) to make the heart work harder, nearly 44 percent had a repeat test within three years. So did about half of those undergoing pulmonary function tests and chest tomography, a CAT scan of the chest.

Cytoscopy (a procedure in which a viewing tube is inserted into the bladder) was repeated for about 41 percent of the patients, and endoscopy (a swallowed tube enters the esophagus and stomach) for more than a third.

Is this too much testing? Without evidence of how much it harms or helps patients, it is hard to say — but the researchers were startled by the extent of repetition. “It’s inconceivable that it’s all important,” Dr. Welch said. “Unfortunately, it looks like it’s important for doctors.”

The evidence for that? The study revealed big geographic differences in diagnostic testing. Looking at the country’s 50 largest metropolitan areas, it found that nearly half the sample’s patients in Miami had an echocardiogram between 2004 and 2006, and two thirds of them had another echocardiogram within three years — the highest rate in the nation.

In fact, for the six tests the study included, five were performed and repeated most often in Florida cities: Miami, Jacksonville and Orlando. “They’re heavily populated by physicians and they have a long history of being at the top of the list” of areas that do a lot of medical procedures and hospitalizations, Dr. Welch said.

But in Portland, Ore., where “the physician culture is very different,” only 17.5 percent of patients had an echocardiogram. The places most prone to testing were also the places with high rates of repeat testing. Portland, San Francisco and Sacramento had the lowest rates.

We often don’t think of tests as having a downside, but they do. “This is the way whole cascades can start that are hard to stop,” Dr. Welch said. “The more we subject ourselves, the more likely some abnormality shows up that may require more testing, some of which has unwanted consequences.”

Properly used, of course, diagnostic tests can provide crucial information for sick people. “But used without a good indication, they can stir up a hornet’s nest,” he said. And of course they cost Medicare a bundle.

An accompanying commentary, sounding distinctly exasperated, pointed out that efforts to restrain overtesting and overtreatment have continued for decades. The commentary called it “discouraging to contemplate fresh evidence by Welch et al of our failure to curb waste of health care resources.”

It is hard for laypeople to know when tests make sense, but clearly we need to keep track of those we and our family members have. That way, if the cardiologist suggests another echocardiogram, we can at least ask a few pointed questions:

“My father just had one six months ago. Is it necessary to have another so soon? What information do you hope to gain that you didn’t have last time? Will the results change the way we manage his condition?”

Questions are always a good idea. Especially in Florida.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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UCLA Medical Center gets failing grade on patient safety

A national report card on patient safety gave a failing grade to Ronald Reagan UCLA Medical Center, one of the country's most prestigious hospitals and one of only 25 nationwide to receive such low marks.

In a report issued Wednesday, the Leapfrog Group, an employer-backed nonprofit group focused on healthcare quality, gave a letter grade of F to UCLA Medical Center for performing poorly on several measures tied to preventing medical errors, patient infections and deaths.

Leapfrog withheld a failing grade for UCLA in June when it released its first-ever hospital safety scores to give low-performing hospitals time to show improvement.

Officials at UCLA disputed the failing grade and they said one patient death in 2010 unfairly lowered its grade from a C to an F under Leapfrog's methodology.

"UCLA is not an F hospital in quality and safety," said Tom Rosenthal, chief medical officer at Ronald Reagan UCLA Medical Center. "It is not a fair scoring system and it does a disservice to the public."

This debate over UCLA's score comes amid a proliferation of healthcare ratings by outside organizations trying to provide more information to consumers and employers. These scores are also taking on greater importance as some insurers and employers use them as one factor in determining whether a hospital or doctor should be included in a provider network.

Given those stakes, the California Hospital Assn. has called on Leapfrog and other rating organizations to offer more details on how their scores are tabulated and to focus on reliable measures that can assess patient care. Some highly regarded hospitals across the country, such as UCLA, fare well in one ranking and then poorly in the next.

Leapfrog gave an F to one other area hospital, Western Medical Center Anaheim. The hospital said it disagreed with Leapfrog's rating methods and added that it "continuously adds new systems to enhance our patient care."

Cedars-Sinai Medical Center received an A in Leapfrog's June report, but its grade dropped to a C on this latest review, which included more recent data from last year. Thirty Kaiser Permanente hospitals received an A and one got a B from Leapfrog.

Experts urge consumers to use these score cards as one tool in evaluating a hospital and to discuss any specific concerns with their doctor and other medical providers.

Leapfrog estimates that 180,000 Americans die annually from hospital accidents, errors and infections, and it says hospitals need to do more to protect patients from harm. Its hospital safety score is derived from 26 measures of publicly reported data.

Rosenthal said UCLA scores well on healthcare quality and patient outcomes on numerous measures tracked by the federal government and other rating organizations, suggesting that Leapfrog's methods are potentially flawed.

He said a liver transplant patient died during surgery in 2010 from an air embolism, one of several preventable medical errors that Leapfrog and other groups regularly track. Rosenthal said the patient's death was a regrettable mistake, but that error hasn't occurred since then.

Leah Binder, Leapfrog's president and chief executive, said her group's scoring methods are statistically valid and devised by a panel of leading experts in patient safety. She said UCLA scored poorly in several areas of patient care, such as foreign objects left in a patient during surgery and pressure ulcers.

"It isn't just one incident that gave them a score so far below the national average," Binder said. "We see it all the time that a hospital might have a stellar reputation, but behind the scenes they aren't safe for many of their patients."

On pressure ulcers, Rosenthal said, UCLA looked worse than its actual performance because of over-reporting in the hospital billing data that was reviewed by Leapfrog.

Overall, Leapfrog gave an A or B to 1,468 hospitals, or 56% of the 2,618 reviewed nationwide. The group issued a C to 1,004 hospitals, or 38%. At the bottom, 146 hospitals, or 6%, were labeled D or F.

Leapfrog reviewed 246 hospitals in California. The ratings are available online at http://www.hospitalsafetyscore.org.

chad.terhune@latimes.com

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Much talk, little action on 'fiscal cliff' as Congress returns

WASHINGTON — Congress returned to a lame-duck session with no signs of quick compromise to ease the nation's budget deadlock, and the White House rolled out a strategy Monday to marshal popular support for raising taxes on the wealthiest tier of income earners.

Closed-door talks by senior aides produced no clear progress despite President Obama's private phone call over the weekend to House Speaker John A. Boehner (R-Ohio) in an effort to forge a deficit reduction deal in the five weeks before current tax rates expire, which would lead to tax increases for most Americans.

Familiar lines began to form as both sides jockeyed to avoid the so-called fiscal cliff, the combination of $500 billion in automatic federal tax increases and spending cuts that economists warn could send the nation back into recession next year.

But the battle assumed new contours as some senior Republican lawmakers distanced themselves from their party's strict anti-tax pledge and Obama took his case public. He warned that the threat of a tax hike on ordinary Americans could dampen winter holiday spending and create a crisis in consumer confidence.

"The president has called on Congress to take action and stop holding the middle class and our economy hostage over a disagreement on tax cuts for households with incomes over $250,000 per year," the White House said in a statement.

Obama got a boost from billionaire investor Warren Buffett, who said wealthier Americans, including himself, should pay more taxes. He dismissed Republican arguments that such tax increases would hamper investment.

"In recent years, my gang has been leaving the middle class in the dust," Buffett wrote in an op-ed for the New York Times. "Let's forget about the rich and ultrarich going on strike and stuffing their ample funds under their mattresses if — gasp — capital gains rates and ordinary income rates are increased."

The broad outline of a deal could be seen, although any accord appeared far from imminent.

Over the last week, three top Republican lawmakers — Sen. Lindsey Graham of South Carolina, Sen. Saxby Chambliss of Georgia and Rep. Peter T. King of New York — all indicated they were willing to raise some taxes in exchange for an agreement from Democrats to curb spending. They broke publicly with conservative stalwart Grover Norquist, the influential president of Americans for Tax Reform.

"It's fair to ask my party to put revenue on the table," Graham said on ABC's "This Week." "I will violate the pledge, long story short, for the good of the country — only if Democrats will do entitlement reforms."

A framework for a compromise had emerged after the Nov. 6 election. Boehner proposed a two-step process that would put a down payment on deficit reduction this year and set targets for undertaking a comprehensive overhaul of taxes and entitlement spending in 2013.

In the days since, however, talks have become "slow," according to one congressional aide. Republicans insist that new revenue must come from economic growth, which they believe would be produced by revamping the tax code to lower all tax brackets — an approach Democrats reject as "fairy tale" economics.

Democrats are unwilling to discuss cuts to Medicare, Medicaid or other government programs unless Republicans put upfront revenue on the table, aides said.

Frustrations over the standoff have grown, and one lawmaker, Sen. Bob Corker (R-Tenn.), proposed his own solution Monday — capping itemized deductions at $50,000 in exchange for changes to Medicare and cuts to other government programs.

Such an approach is in line with proposals being discussed, though Obama has promised the tax increases would hit incomes only above $250,000 for couples or $200,000 for singles.

No talks among the principal players are scheduled this week, even though both sides say they want to avoid brinkmanship as they push toward a Christmas deadline. All tax rates expire on Dec. 31, which would result in automatic tax increases; spending cuts are set for Jan. 2.

Aides to the president acknowledged they didn't hold high hopes after Obama spoke to Boehner over the weekend. But they didn't go so far as to echo Senate Republican leader Mitch McConnell of Kentucky, who used the word "impasse" Monday in discussing the long pursuit of a grand budget deal.

"We remain confident we can achieve an agreement," White House Press Secretary Jay Carney said. "We remain hopeful and optimistic we can reach a deal."

Staff negotiations continue, and the White House's Council of Economic Advisers said Monday the automatic tax increases would not only hurt the rest of the holiday shopping season, but they could also trim consumer spending by about $200 billion in 2013. Overall, the council warned, economic growth could drop by 1.4 percentage points.

That's no small matter, said the council's chairman, Alan Krueger, given the role retail sales play in the economy. The American economy has grown at an average annual rate of just over 2% since the recovery began in 2009.

The report is broadly consistent with forecasts by the Congressional Budget Office and leading private economists, and it comes after retailers amassed a record $59.1 billion in sales from Thanksgiving through Sunday, up from $52.4 billion a year earlier, according to estimates from the National Retail Federation.

But the White House report warned that "the hard-earned rise in consumer confidence will be at risk if the middle-class tax cuts are not soon extended with a minimum of political drama."

Publicly and behind closed doors, White House officials expressed hope that the political environment would improve over the coming week.

Obama will meet with business leaders at the White House this week in an attempt to build support for his agenda.

On Friday, the president plans to travel to Montgomery County in Pennsylvania to visit a local business that "depends on middle-class consumers during the holiday season," the White House said. The business, Rodon Group, is the sole American manufacturer for K'NEX Brands, a construction toy company whose products include Tinkertoy, K'NEX and Angry Bird building sets.

lisa.mascaro@latimes.com

christi.parsons@latimes.com

Times staff writer Don Lee contributed to this report.

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India: 2 policemen suspended, magistrate transferred for arrest of 2 women over Facebook post

NEW DELHI – An Indian official says two senior policemen have been suspended for arresting two women over a Facebook post criticizing the shutdown of Mumbai for the funeral of a powerful politician.

Maharashtra state Home Minister R.R. Patil said Tuesday the policemen were suspended indefinitely and the magistrate who registered the case against the women has been transferred to another district.

Police also arrested nine men who vandalized a medical clinic run by the uncle of one of the women, Patil said.

One of the women had posted a Facebook comment complaining that Mumbai had come to a standstill after the death of rightwing leader Bal Thackeray. Her friend “liked” the post.

Their arrest last week was seen as a misuse of Internet laws and an attempt to curb freedom of expression.

Social Media News Headlines – Yahoo! News

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Berry's ex says he was threatened before fight

LOS ANGELES (AP) — Halle Berry's ex-boyfriend claims the actress's fiance threatened to kill him during a Thanksgiving confrontation that left him with a broken rib, bruised face and under arrest.

Gabriel Aubry's claims are included in court filings that led a judge Monday to grant a restraining order against actor Olivier Martinez, who is engaged to the Oscar-winning actress.

Aubry, 37, was arrested on suspicion of misdemeanor battery after his confrontation with Martinez on Thursday, but he states in the civil court filings that he was not the aggressor and that he was threatened and attacked without provocation. Martinez told police that Aubry had attacked first, the filings state.

A representative for Martinez could not be immediately reached for comment.

Aubry's filing claims Martinez threatened him the day before the fight at an event at his daughter's school that he and the actors attended. Aubry, a model, has a 4-year-old daughter with Berry and the former couple have been engaged in a lengthy custody battle.

The proceedings have been confidential, but Aubry states a major aspect of the case was Berry's wish to move to Paris and take her daughter with her. The request was denied Nov. 9, Berry's court filings state, and Aubry shares joint custody of the young girl.

Aubry claims Martinez told him, "You cost us $3 million," while he was punched and kicked him in the driveway of Berry's home. Aubry had gone to the home to allow his daughter to spend Thanksgiving with her mother, the filings state. Aubry claims Martinez threatened to kill him if Aubry didn't move to Paris.

Berry was not in the driveway during the confrontation and neither was their daughter, the documents state.

Photos of Aubry's face with cuts and a black eye were included in his court filing.

A judge set a hearing for Dec. 17 to consider whether a three-year restraining order should be granted. Aubry has a Dec. 13 court date for the possible battery case, which has not yet been filed by prosecutors.

___

Anthony McCartney can be reached at http://twitter.com/mccartneyAP .

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The New Old Age Blog: New Efforts to Close Hospitals' Revolving Doors

In the past, the only thing a patient was sure to get after a hospital stay was a bill. But as Medicare cracks down on high readmission rates, hospitals are dispatching nurses, transportation, culturally specific diet tips, free medications and even bathroom scales to patients deemed at risk of relapsing.

Robert Wood Johnson University Hospital in New Brunswick, N.J., has nurses visit high-risk patients at their home within two days of leaving the hosital. Teresa De Peralta, a nurse practitioner who runs the program, said they frequently find that patients don’t realize a drug they were prescribed in the hospital does the same thing as one they have already been taking.

“When medications are changed, they don’t want to throw things out, they think it’s a waste,” Ms. De Peralta said. “We actually go through the cupboards and painstakingly write out in big letters what they should be taking during the day.”

Many hospital officials say their efforts to keep patients healthy after discharge have been spurred by new financial penalties Medicare started imposing in October on places with too many readmissions. Increasingly, hospitals are no longer leaving to patients the responsibility for setting up follow-up appointments or filling new prescriptions.

And hospitals are not assuming that personnel in nursing homes and other facilities know how to properly care for their patients and follow the hospital discharge instructions.

Patients taking the wrong dose or mixing medicines that react badly often end up back in the hospital. A survey of 377 elderly patients at Yale-New Haven Hospital, published this year in The Journal of General Internal Medicine, discovered that 81 percent of the patients either didn’t understand what all their prescriptions were for; were prescribed the wrong drug or the wrong dose; were taken off a drug they needed, or never picked up a new prescription.

Dr. Leora Horwitz, the study’s leader, said patients who were called a week after their discharge and were asked what changes to their medication they were supposed to make “overwhelmingly” couldn’t tell them.

A big part of reducing readmissions is making sure that patients understand early warning signs that their health is deteriorating. Sun Health Care Transitions, a foundation-supported program in Sun City, Ariz., gives scales to some patients with congestive heart failure because small weight gains indicate they are retaining water, a sign that their heart isn’t pumping adequately.

“We have them keep a log,” said Jennifer Drago, a Sun Health vice president. “We want them to be looking for a two-pound daily weight gain, or five pounds over the week.”

Patients whose weight creeps up are quickly sent back to their doctor. Debra Richards, director of case management at Banner Del E. Webb Medical Center, one of the hospitals Sun Health is assisting, said, “That program has helped us quite a bit.”

Shady Grove Adventist Hospital in Rockville, Md., has started taking patients’ cultural backgrounds into consideration when doling out advice about maintaining their health. For example, the hospital encourages Salvadoran patients to substitute olive oils for the palm oils their cuisine traditionally calls for, to roast or bake meat instead of frying it and to use sugar substitutes when making horchata, a popular Central American drink.

When Hackensack University Medical Center sent staff members to teach caregivers how to take care of their patients, one place “didn’t even know what a low-salt diet was,” even though that’s a critical part of keeping heart failure patients from retaining fluids, said Dr. Charles Riccobono, chief quality and safety officer at the New Jersey hospital.

Aurora Health Care, a Milwaukee-based health system, now places its own nurse practitioners in several nursing homes to watch over Aurora’s discharged patients. Aurora says readmission rates of those patients have decreased, in some months by as much as half.

Dr. Eric Coleman, a Denver geriatrician whose ideas on reducing readmissions have been adopted by a number of hospitals and Medicare, said that while some hospital changes are “exciting and new,” others are “relabeling old wine in new bottles.”

“Yesterday we had ‘discharge planning’ and today we have a ‘rapid response transition team,’ and content-wise they’re doing the same thing,” Dr. Coleman said. “But it’s a nice thing to report out to the board of trustees.”

Jordan Rau is a reporter for Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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