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Chinapicksup another classicAmericanpursuit: RV campingChange is coming fast. WhenI talkto U.S.RVsuppliers, they askif I want tobuy threeor four,saysone parkmanager.I want tobuy 1,000. 9A.

Suicide risk higher for collegestudentswhoareveteransRate issix timeshigherfor thosewho servedinthe militarythan thatof theaveragestudentbody,researchersfind. 9A.

Automaticdefense cuts wouldhurt U.S. security,Panetta saysDefense secretarysays Pentagoncan manage$400billionin planned cuts,but anymorewoulddamagenationsmilitarycapabilities.6A.

Idaho to Florida, placestochowdownlikea localMorgan Murphy, author ofOffthe EatenPath,shares10 favoritefamily-ownedrestaurants. 5D.

Batman, super-earningsheroVideogames,comics,animatedhome videos anda sequelfor thebigscreen,the CapedCrusaderisa franchisethat really sells. 6B.

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QIJFAF-05005v(N)L The back-to-school sales tax holidaysthat start today in many states may bepopular with politicians and retailers,but critics say revenue-starved statesshould abandonthem.

Seventeenstatesplan to giveshoppersa break on sales taxes for school-relatedpurchases this season. Massachusettsand Arkansas added a holiday for thefirst time, while Illinois dropped itsholi-daythis year.

Illinois State Sen. Toi Hutchinson, aDemocrat who was chief sponsor of thestates holiday lastyear,says Illinoisjustcannot afford it thisyear.

Massachusetts Gov. Deval Patrick, aDemocrat, acknowledged last week thathis state decided to have a sales taxholiday not because its particularly fis-cally prudent but because its popular,the BostonGlobe reported.

NewYorkwas thefirst state to enact aback-to-school salestax holiday in 1997.Other states soon followed, sometimesto keep residents from crossing statelines to shop in states with tax holidays.National RetailFederation CEO Matthew

Shaysays theholidaysbringpeopleintostores like few other promotions. Stud-ies have shown, however, that the holi-dayssimplyshift thetiming of purchasesconsumers already planned.

The tax holidays can help consumersreap a modest windfall, says Carol Ko-kinis-Graves of tax publisher CCH. Butshe warns consumers to watch out forexceptions, suchas exclusionsfor athlet-ic wear.

The Tax Foundation and the InstituteonTaxationand Economic Policysay theholidays mostly benefit wealthy fam-ilies. Low- and middle-income familiesdont have the discretionary income ortime toshoponlyonthe taxholidays,thegroups contend.

The Tax Foundationsays statesshouldsimplycutsalestaxesiftheywantto giveconsumers a break. Policy think tankITEPsaysstatesshouldinsteadoffersalestax credits to consumerswho needthemthemost. To getthe credits, eligible con-sumers would have to ask for them ontheirtax returns.

A sales taxcredit could be designed totarget the low-and middle-income fam-ilieslawmakers want to help, says ITEPsMatthew Gardner.

The striking thing about sales taxholiday laws, Gardner says, is that pol-icy people all over the ideological spec-trum agreetheyre a dumb idea.

Critics say states shoulddiscontinue taxholidaysTax groups say wealthyare mainbeneficiaries

ByJayneODonnelland OliverSt. JohnUSA TODAY

WEEKEND, AUGUST 57, 2011

Newsline

More than 120 hospitals given top marks bypatients for providing excellent care also have adarker distinction: high death rates for heartattack, heart failure orpneumonia,a USATODAYanalysisof newMedicaredata hasfound.

Experts say the newspapers analysis of datareleased todayby Medicare offers a window intotherelationshipbetweenpatients perceptionsof

the quality of their hospital care and more ob-jective measures, such as hospitals death andreadmissionrates.

This is a very importantfinding, says Donald Ber-wick, director of theCentersfor Medicare & MedicaidServices.

Although patient-survey data offer critical in-sightsintohowit feelsto be a patient atdifferenthospitals, patients perceptions dont tell thewholestory,he adds.

Over thepastdecade, risingcostsanda floodofcomplex therapies haveprompted patients, em-ployers, insurers and the federal government todemand public disclosure of health care data.Armedwith thisevidence,Berwicksays, doctors,insurers and patients themselves can make bet-ter choices aboutwhere to obtainmedicalcare.

The challenge is to measure hospitals accu-rately. Experts stilldebate whatmeasuresto use,says John Wennberg, founding editor of the

Dartmouth Atlas of Health Care and author ofTracking Medicine: A Researchers Quest to Un-derstand HealthCare.

Medicares analysis of more than 4,600 hospi-tals found that 323, or one of every 14, hadabove-average deathrates for heartattack, heartfailure or pneumonia. Two Piedmont MedicalCenter in Rock Hill, S.C., and Southwest Mis-sissippi Regional Medical Center in Macomb had high death rates in all three categories.Thirteen hadlow deathrates across theboard.

Veterans Affairs hospitals performed well, ac-cording to data released for the first time thisyear. Ten hospitals had lower death rates thanaverage for heart failure; two were lower forheartattacks;and fivefor pneumonia.

AllVA hospitalswereas good asor betterthanthe national rate for heart attack and heart fail-ure.

Contributing: Anthony DeBarrosandLuke Kerr-Dineen

Deathsplagueeven tophospitalsPatients, performancediverge, data showBy SteveSternbergand ChristopherSchnaarsUSA TODAY

Somewherein theAtlanta area today,a personwho has crossed paths with Georgia Tech isgetting a phone callabout YellowJacketsfootball.

Maybe its an alum, an employee or a contrac-tor.Maybe itsa GeorgiaTech parent, thepurchas-er of an item through the schools website orsomeone who has attended a Yellow Jacketsbasketballgame.

Thecall is comingfrom Georgia Techscampus from a line inthe athleticcomplex.It soundsasif its coming from someone with Georgia Techathletics. Theyre selling Georgia Tech footballtickets. And if you tell them about your friendswho like Georgia Tech football, theyll make sureyour friends geta call,too.

Thecaller doesnt work forGeorgia Tech. He or

sheworksfor theAspire Group,an Atlanta-basedfirm that has been hired by Georgia Tech andother schools seeking to join the latest trend incollege sports: a push to boost revenue by beingdramatically more aggressive and sophisticatedin salesand marketingactivities.

Aspire specializes in selling tickets, but othercompanies and consultants and athletic pro-grams, on their own are reshaping a collegesportsindustry thathasa history ofnotbeing aggressive,(of)lettingpeople cometo them,saysBill Sutton,a professor at the University of Central FloridasDeVos Sport Business Management GraduateProgram and a consultant whose clients includecollege athletic departments. For years andyears, if you put up enough billboards and sentoutenough brochures, peoplewouldshowup atcollege games.

COVER STORY

Marketers reshape howcollege teams sell ticketsIn scramble for revenue,push for sales intensifies

By SteveBerkowitzUSA TODAY

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8/4/2019 Medicare Piece Real

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Patients fill Maimonides Medical Center in

Brooklyn every day, but that doesnt mean theylike it.One in five complain that their rooms are

sometimes or never clean, that help may belate in coming and that the nightly commotionmakes it hard to sleep. Fewer than half giveMaimonides high scores for patient satisfaction.Just over half say they would recommend it toothers, lower than the 67% average for hospitalsnationwide.

Yet, by measures that arguably matter more what percentage of patients survive killer condi-tions, such as heart attacks, heart failure andpneumonia Maimonides ranks among the besthospitalsin the USA.

Medicare data released today shows that Mai-monides isone of13 ofmorethan4,700hospitalsnationwidewithbelow-averagedeathrates forallthree conditions: 11.2% for heart attacks, com-pared with a national average of 15.9%; 7.3% forheart failure, compared with 11.3%; and 6.8% forpneumonia,compared with11.9%.

Hospital officials say they cant help but beupsetby the patient dissatisfactionnumbers.We wouldntbe humanif wewerentdisheart-

ened by them, says Sheila Namm, Maimonidessenior vicepresidentof professional affairs.

Theres a flip side tothe perception gap, aswell.A USATODAYanalysisof theMedicare data foundthat more than 120 hospitals well-liked by pa-tients have death rates for heart attacks, heartfailure or pneumonia that are signficantly worsethan thenational average. Ineachcase,the hospi-tals were recommended by two-thirds of theirpatients or received patient satisfaction scores of9 or10 ona 10-pointscale.

Yale cardiologist Harlan Krumholz, who helpedfine-tune Medicares approach so that the hospi-

tals are rated fairly, says personal experience canonly tell so much about the quality of medicalcare.

You can judge how it feels to be in the hospi-tal,Krumholzsays. Butyou cant judgewhethertheyre doing everything well on the medicalside.

Judging on concretemeasures

Over thepast five years,rising healthcostsandconcerns about patient safety have propelled thepush to track and publicly report patient satis-faction and more concrete measures of patient

care.Experts say the goal of this approach to qualityimprovement is nothing less than a sweepingtransformationof medicine, one in which doctorsandhealthfacilities willbe judgedon theirperfor-mance and rewarded when they do a good job.Theeffort gainedmomentum with thepassageinMarch2010 ofthe Affordable Care Act, says Caro-lynClancy, director of theU.S. Agencyfor Health-careResearchand Quality.

Earlier this year, Medicare phased in a longplanned pay-for-performanceprogramfor kidneydialysis centers. Similar programsare planned forhospitals, inpatient rehabiltation centers, hos-pices and cancer hospitals, says Tom Valuck, oftheNationalQuality Forum, a consortiumof med-ical groups, hospital organizations, health plansand others that has endorsed Medicares ap-proach to measuringquality.

The newspapers analysis relies on the Medi-care patient-satisfaction survey called HCAHPS,for the Hospital Consumer Assessment of Health-

care Providers, begun in 2006. A year later,Medi-care launched its analysis of heart attack andheart failure death rates, which first appeared in

USATODAYandon HospitalCompare,a Medicarewebsite (www.hospitalcompare.gov).

Medicaredatabase expanded

Medicares database, which covers patients 65and older hospitalized between July 2007 andJune 2010, has since been expanded to includepneumoniaand hospital readmissions,a measureof how many patients land back in the hospitalwithin 30 daysof theirdischarge.This year,for the

first time, Medicare also included Veterans Ad-minstration hospitals. All death and readmissionrateshavebeen statistically adjustedso thehospi-tals canbe compared fairly, despitedifferences insize,patientpopulationand otherfactors.

Consumers grapple with a simpler question,says John Wennberg,foundingeditor of the Dart-mouth Atlas of Health Care: How do we makehealth care decisions based on information wetrust?

JudithHibbard, of theUniversityof Oregon, andan expert on how patients perceive health care,says the answer is to factor in all kinds of in-formation when making important health carechoices, just as a person does when buying ahouse or a car. Patients are good at judgingwhich places are clean, whether people respon-ded to their needs and whether theyre gettingadequate pain relief, she says,buttheres lots ofinformation thats not captured in patient surveydatathat peopleshouldalso payattentionto.

Contributing: Anthony Debarros andLuke Kerr-DineenuPrestigehospitals sometimes fallshort,1A

Database can help patients fill perception gapMedicare data usesconcrete measuresto gauge performanceBy SteveSternbergand ChristopherSchnaarsUSA TODAY

Visitusatoday.com to seehospitaldeaths database

To searchhospital deathratesin your area,go tohttp://www.usatoday.com/yourlife/health/hospitals-compare.htm

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A storyThursdayabout anexhibiton last yearsrescue of Chilean miners misstatedthe exhibitslocation.It ison display atthe NationalMuseumof Natural History in Washington, D.C.

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Jonesat1-800-872-7073or e-mailaccuracy@usatoday.com.Pleaseindicatewhether

yourerespondingto contentonlineor inthe newspaper.

Corrections & Clarifications

SAN ANGELO, Texas A Texasjury convicted polygamistsect lead-er Warren Jeffs of child sexual as-sault on Thursday, in a case stem-ming from two young followers he

took as brides in what his churchcalls spiritual marriages.

The head of the FundamentalistChurch of Jesus Christ of Latter DaySaints (FLDS) stood stone-faced astheverdictwas read.Jeffs,who actedas his own attorney, stood mostlymute for his closing argument, star-ing at the floor, for all but a fewseconds of the half-hour he was al-lotted. At one point, he mumbled, Iamat peaceandsaidno more.

Jeffs, 55, had claimed his religiousrights were being trampled on andthat God would seek revenge if thetrial continued. He now faces up tolife in prison. The sentencing phaseof the trial started after the verdict,and Texas Attorney General GregAbbottsaidit couldtake threedays.

Prosecutorsused DNA evidence toshow Jeffs fathered a child with a15-year-old girl andplayed anaudiorecordingof what they said washimsexually assaulting a 12-year-old.They also playedaudiorecordingsin

which Jeffs was heard instructingyoungwomenon howto pleasehimsexually.

The FLDS, which has at least10,000 members nationwide, is aradical offshoot of mainstream Mor-monism and believes polygamybrings exaltationin heaven. TheyseeJeffs as Godsspokesmanon earth.

Police had raided the groups re-mote West Texas ranch in April2008, finding women dressed in

frontier-style dresses and underagegirlswho wereclearlypregnant.

Prosecutors said the case hadnothing to do with Jeffs church orhisbeliefs.

You have heard the defendantmake repeated arguments about re-ligious freedoms, lead prosecutorEric Nichols said. Make no mistake,this case isnot aboutany people, thiscase is not about any religion. It isabout one individual, Warren SteedJeffs, andhis actions.

Jeffs represented himself after fir-ing seven attorneys in the sixmonthsleadingto thetrial. Hebrokehis courtroom silence with an ob-jection markedby a nearlyhourlongspeech defending polygamy, and

twice threatened the judge and thecourt with warnings of punishmentfromGod.

He refused to cross-examine thestates witnesses,and delayed givingan opening statementuntil he beganpresentinghisown defense.The lonedefense witness Jeffs called, churchelder JD Roundy, spent about 10minutes on the stand Thursday dis-cussing FLDS history afterfour hoursof testimonythe previousevening.

Jury convicts Jeffs of child sexual assaultPolygamist leadermay face sentenceof life in prisonBy WillWeissertThe AssociatedPress

ByTonyGutierrez,AP

Before theverdict: Warren Jeffs,right,is ledintocourtin Texas.