Hospitals Face Pressure From Medicare to Avert Readmissions

After years of gently prodding hospitals to make sure discharged patients do not need to return, the federal government is now using its financial muscle to discourage readmissions.

Medicare last month began levying financial penalties against 2,217 hospitals it says have had too many readmissions. Of those hospitals, 307 will receive the maximum punishment, a 1 percent reduction in Medicare’s regular payments for every patient over the next year, federal records show.

One of those is Barnes-Jewish Hospital in St. Louis, which will lose $2 million this year. Dr. John Lynch, the chief medical officer, said Barnes-Jewish could absorb that loss this year, but “over time, if the penalties accumulate, it will probably take resources away from other key patient programs.”

The crackdown on readmissions is at the vanguard of the Affordable Care Act’s effort to eliminate unnecessary care and curb Medicare’s growing spending, which reached $556 billion this year. Hospital inpatient costs make up a quarter of that spending and are projected to grow by more than 4 percent annually in coming years, according to the Congressional Budget Office.

The readmission penalties will recoup about $300 million this year. But the goal is to pressure hospitals to pay attention to what happens to their patients after they walk out the door. The penalties have captured the attention of hospitals, and many are trying to improve their supervision of discharged patients’ recoveries.

“I’ve been doing this for over two decades and talking to hospital leaders about readmissions, and I used to get polite but blank stares,” said Dr. Eric Coleman, a professor at the University of Colorado Anschutz Medical Campus who has devised widely adopted methods to reduce hospitalizations. “Now they’re paying attention.”

With nearly one in five Medicare patients returning to the hospital within a month — about two million people a year — readmissions cost the government more than $17 billion annually.

Hospitals’ traditional reluctance to tackle readmissions is rooted in Medicare’s payment system. Medicare generally pays hospitals a set fee for a patient’s stay, so the shorter the visit, the more revenue a hospital can keep. Hospitals also get paid when patients return. Until the new penalties kicked in, hospitals had no incentive to make sure patients didn’t wind up coming back. The maximum penalty is set to double next October and then reach 3 percent of reimbursements in October 2015. Medicare also is expanding the list of conditions it will assess in setting punishments.

Right now it only evaluates readmissions of heart attack, heart failure and pneumonia patients, counting every rebound, even ones not related to the original reason for hospitalization. The penalties are based on readmission rates in the past and applied to future payments for all Medicare patients.

Researchers say that while some readmissions are unavoidable, many are caused by the short shrift hospitals have given patients on their way out.

Jonathan Blum, principal deputy administrator for the Centers for Medicare and Medicaid Services, said the penalties had helped galvanize hospitals’ efforts to avoid readmissions. “We’ve seen a small but significant reduction,” he said. “That tells me we’ve focused the industry on improvement.”

Medicare’s tough love is not going over well everywhere. Academic medical centers are complaining that the penalties do not take into account the extra challenges posed by extremely sick and low-income patients. For these people, getting medicine and follow-up care can be a struggle.

At Barnes-Jewish Hospital, Dr. Lynch said physicians from all over the Midwest referred their sickest heart patients to his facility for transplants and other major interventions. But those patients can skew his hospital’s readmissions numbers, he said: “The weaker your heart, the more advanced your emphysema, the more likely you are to be readmitted to the hospital.”

Dr. Lynch said Barnes-Jewish set up follow-up appointments for patients who didn’t have their own doctors. But about half of the patients never showed up, he said, even after the hospital made reminder phone calls and arranged for free rides. Sending nurses to see patients at home did not significantly reduce readmission rates either, he said.

“Many of us have been working on this for other reasons than a penalty for many years, and we’ve found it’s very hard to move,” Dr. Lynch said. He said the penalties were unfair to hospitals with the double burden of caring for very sick and very poor patients.

“For us, it’s not a readmissions penalty,” he said. “It’s a mission penalty.”

Various studies, including one commissioned by Medicare, have found that the hospitals with the most poor and African-American patients tended to have higher readmission rates than hospitals with more affluent and Caucasian patients. But the studies also determined that some safety-net hospitals performed better than average, showing that hospitals can overcome the challenges posed by the kinds of patients they treat.

In some ways, the debate parallels the one on education — specifically, whether educators should be held accountable for lower rates of progress among children from poor families.

“Just blaming the patients or saying ‘it’s destiny’ or ‘we can’t do any better’ is a premature conclusion and is likely to be wrong,” said Dr. Harlan Krumholz, director of the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital, which prepared the study for Medicare. “I’ve got to believe we can do much, much better.”

Some researchers fear the Medicare penalties are so steep, they will distract hospitals from other pressing issues, like reducing infections and surgical mistakes and ensuring patients’ needs are met promptly. “It should not be our top priority,” said Dr. Ashish Jha, a professor at the Harvard School of Public Health who has studied readmissions. “If you think of all the things in the Affordable Care Act, this is the one that has the biggest penalties, and that’s just crazy.”

With pressure to avert readmissions rising, some hospitals have been suspected of sending patients home within 24 hours, so they can bill for the services but not have the stay counted as an admission. But most hospitals are scrambling to reduce the number of repeat patients, with mixed success.

A few days after Eda Laurion was discharged from the Banner Del E. Webb Medical Center near Phoenix after treatment for her congestive heart failure in August, a nurse showed up at her house.

“She helped explained the medicines I’m taking, the side effects, what they do for you,” said Ms. Laurion, 91, of Sun City West.

Still, readmissions can’t always be prevented. The nurse, Sue Koner, sent Ms. Laurion back to the hospital after two weeks for dangerously low sodium caused by an undiagnosed kidney problem. However, Ms. Laurion avoided re-hospitalization in October when Ms. Koner deduced that her hallucinations were a reaction to an antibiotic.

Overseeing former patients is expensive and time-consuming, so many hospitals are relying on financing from community health organizations and foundations. Ms. Koner works for Sun Health, a foundation-supported nonprofit. Since Sun Health started its program in November 2011, only nine of 213 patients have been readmitted.

Dr. Krumholz said hospitals should think of readmissions as a challenge to overcome. “One day, we’ll look back,” he said, “and we’ll be incredulous that one out of every five patients ended up back in the hospital.”

This article was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

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Rosenthal: Big Ten getting too big for its own good?

There's a lesson the empire builders at Big Ten Conference headquarters in Park Ridge would do well to heed if they can be convinced to stop peering out to the distant horizon:

Growth through acquisition is fraught with peril.

"In the business world you acquire new companies and you have to deal with different corporate cultures, different priorities and so forth," Robert Arnott, chairman of Research Affiliates LLC, an investment firm, said in an interview. "Merging them is often very messy and often fails. Here you're merging two teams into an existing conference and it creates risks. … Even college football teams have different cultures, different ways of thinking about how to win and different standards."

There undoubtedly was a logic behind each acquisition as the old Sears sought to expand and diversify its corporate profile. By the time the Chicago-area company's portfolio grew to include Allstate insurance, Coldwell Banker real estate and Dean Witter Reynolds stock brokerage, it was clear the increase in size was in no way matched by an increase in strength.

Rather than an all-powerful Colossus astride many sectors at once, it was reduced to an unfocused blob, bereft of identity, covering plenty of ground but hardly standing tall. Years after shedding its far-flung holdings, Sears has yet to regain its muscle, mojo or market share.

"It's hard to find a better example of a company that lost its mission and focus in the quest for growth," Arnott said.

"(Growth) may be partly a defensive move. It may be ego driven. In the corporate arena, you certainly see that in spades," he said. "When growth is through acquisition, you have to figure out what the real motivation is. Is it synergy, the most overused word in the finance community, or is it ego?"

Adding the University of Maryland and New Jersey's Rutgers University in 2014 will push the Big Ten to 14 schools and far beyond the Midwestern territory for which it's known. But doing so may not achieve what its backers envision.

Rather than spread the conference's brand, it may merely dilute it. The fit may be corrosive, not cohesive.

There is a school of thought that this is but the latest evidence that the Big Ten is not about athletics, academics or even the Midwest. Instead, it is just a television network, the schools content providers and student-athletes talent.

As it is, the overall TV payout is said to give each of the 12 current Big Ten schools about $21 million per year. They point to the Big Ten's lucrative deals with ESPN and its own eponymous cable network, a partnership with News Corp. They note that public schools Rutgers and Maryland are near enough to New York, Baltimore and Washington, D.C., to drive a better bargain with cable carriers.

To Big Ten Commissioner Jim Delany, a New Jersey native, the addition is more the result of a paradigm shift that has redrawn the college sports map over the past decade. Some conferences splinter. Others seize new turf. The result: Idaho's Boise State football team is poised to join the Big East Conference next year.

"Institutions that get together for academics or athletics have got to be cognizant that they are competing for students, they are competing for student athletes, they are competing for research dollars," Delany told reporters.

"When you see a Southern conference in the Midwest or you see a Southern conference in the Plains states or whether you see other conferences in the Midwest or Northeast, it impacts your recruitment. ... It impacts everything you do," he said. "At a certain point you get to a tipping point. The paradigm has shifted, and you decide on a strategy to basically position yourself for the next decade or half-century."

Big has always meant more than 10 in the Big Ten, an intercollegiate entity formed by seven Midwestern universities that now boasts 12 with the bookends of Penn State and Nebraska added in 1990 and last year, respectively. Last week's announcement of adding schools 13 and 14 was just a reminder that the conference has only had 10 member schools for 70 of its 116 years and won't again for the foreseeable future.

Rutgers President Robert Barchi said his school looked "forward as much to the collaboration and interaction we're going to have as institutions as we do to what I know will be really outstanding competition on our field of play."

But make no mistake, the Big Ten was born out of sports, specifically football. A seven-school 1896 meeting at Chicago's Palmer House had Northwestern among those still stinging from a scathing Harper's Weekly critique of college sports abuses, the Tribune reported at the time.

A prohibition on allowing scholarship and fellowship students to compete was shot down. But "a move towards the coordination of Faculty committees" in terms of standards and enforcement passed and the precursor to the Big Ten was born.

Along the way, the conference has added member schools and come to recognize that the Big Ten's image has much to say about how those institutions are perceived. Scandals already are no stranger to the Big Ten. But whether you play in a stadium or on Wall Street, the bigger one gets, the bigger target one becomes.

"Whoever's biggest draws scrutiny," said Arnott, co-author of a research paper, "The Winners Curse: Too Big to Succeed." "That means politicians, regulators, the general public generally don't root for the biggest. They look to take them down a notch, so it's harder to succeed as the largest. It's also harder to move the dial and move from success to success as you get really big."

Everyone talks about becoming too big to fail, but there's also too big to scale, companies that are unable to capitalize on the efficiencies of their increased size ostensibly because they are so big that they cannot be managed adequately.

"People talk about economies of scale. There are also vast diseconomies of scale, mostly in bureaucracies," Arnott said. "The more people you have involved, the more people you have who feel they have to have their views reflected in whatever's done. So you wind up with innovation by committee."

That's deadly. That's why companies break up, citing the need to get smaller so they can grow.

"If you break up companies into operating entities that are more nimble," Arnott said, "the opportunities to grow are no longer hamstrung by centralized bureaucracies that have to pursue synergies that don't exist."

Size matters in all fields of play. Sometimes smaller is better.

philrosenthal@tribune.com

Twitter @phil_rosenthal

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4th quarter: Bears 28, Vikings 10

The Chicago Bears regained their swagger and halted their two-game losing streak by thumping the Minnesota Vikings 28-10 in a critical NFC North matchup Sunday at Soldier Field.
 
With Jay Cutler returning to the lineup after sitting out Monday night's loss at San Francisco because of a concussion, the Bears' offense displayed some long-sought consistency as the quarterback and Brandon Marshall connected repeatedly on key plays.
 
Marshall wound up with 12 catches for 92 yards. Cutler completed 23 passes of 31 passes for 188 yards and one touchdown and a passer rating of 86.5
 
The Bears improved to 8-3 and will at least continue to share the division lead with the Green Bay Packers (7-3), who play the New York Giants on Sunday night. The Vikings fell to 6-5.

Robbie Gould's 46-yard field goal with 3:57 left in the third period capped the scoring. During the drive, Matt Forte was taken to the locker room with a right ankle injury. His return was listed as questionable.

Forte (14 carries for 42 yards) was injured on a bizarre play. He was tackled by several Vikings and the ball came out belatedly. The fumble appeared to be recovered and returned 51 yards for a touchdown. After a review, the TD was denied and the Bears took over.

Injuries already were a major concern for the Bears. Devin Hester was ruled out for the game in the second quarter after suffering a concussion. Guard Chris Spencer left with a knee injury and guard Lance Louis had to be helped off the field with a knee injury after taking a vicious hit from the Vikings' Jared Allen. Cornerback Charles Tillman missed considerable time with an ankle injury.

The Vikings had pulled to with 25-10 after a 40-yard drive. Quarterback Christian Ponder passed two yards to tight end Kyle Rudolph for a touchdown with 10:44 left in the third period. The score was set up by an interception by Antoine Winfield after a Cutler pass caromed off the hands of Marshall.

The Bears were energized early, taking a 25-3 halftime lead on a 13-yard Cutler TD pass to tight end Matt Spaeth. The score came after  Chris Conte intercepted a Ponder pass and returned it 35 yards to the Vikings' 13 with 1:55 left until halftime, and that was the score at intermission after Gould's 39-yard field goal attempt was blocked on the final play.

Cutler completed 15 of 17 first-half passes for 170 yards and one touchdown. His passer rating was 115.0.

The Bears had 169 yards of total offense, compared to the Vikings' 92. Adrian Peterson was limited to 25 yards on seven carries.

Earlier, a 1-yard touchdown run by Michael Bush, his second of the day, had extended the Bears' lead to 16-3. On the extra point, holder Adam Podlesh took the snap from center and ran in for the two-point conversion for an 18-3 advantage with 4:01 left until halftime.

The Bears had gone up 10-3 on a 47-yard field goal by Gould with 32 seconds left in the first quarter. The drive covered 25 yards in 10 plays. The drive featured a taunting penalty against a feisty Cutler for flipping the ball at the Vikings' A.J. Jefferson.

The Vikings' Walsh had a 30-yard field goal attempt blocked by Julius Peppers with 12 minutes left until halftime.

The Bears' defense got back to its turnover-producing ways early when Peterson fumbled and Charles Tillman recovered at the Vikings' 34. Nick Roach forced the fumble. The Bears converted the opportunity into a 1-yard touchdown by Bush with 7:17 left in the first quarter to take a 7-3 lead. The drive included a 15-yard pass from Cutler to tight end Kellen Davis to the Minnesota 1.

The Bears lost the ball on their opening series when Forte fumbled with 13:07 left in the first period. The fumble was recovered by Chad Greenway at the Bears' 28. The drive resulted in a 40-yard field goal by Blair Walsh.

After dropping two straight, the Bears needed to fend off the Vikings, who entered one game back at 6-4. And the Bears were trying to at least keep pace with the Packers as leaders of the NFC North. The Bears and Vikings will meet twice in three weeks. On Dec. 9, the Bears travel to the Metrodome.

Peterson reportedly missed the team bus to Soldier Field, but hailed a taxi cab in front of the team hotel and made it to the stadium at 10:23 a.m. for the noon start, according to the NFL Network.
 
The Bears have another NFC home game next Sunday against the Seattle Seahawks.
 
fmitchell@tribune.com

Twitter@kicker34

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Saudi telco regulator suspends Mobily prepaid sim sales

(Reuters) – Saudi Arabia‘s No.2 telecom operator Etihad Etisalat Co (Mobily) has been suspended from selling pre-paid sim cards by the industry regulator, the firm said in a statement to the kingdom’s bourse on Sunday.

Mobily’s sales of pre-paid, or pay-as-you-go, sim cards will remain halted until the company “fully meets the prepaid service provisioning requirements,” the telco said in the statement.

These requirements include a September order from regulator, Communication and Information Technology Commission (CITC). This states all pre-paid sim users must enter a personal identification number when recharging their accounts and that this number must be the same as the one registered with their mobile operator when the sim card was bought, according to a statement on the CITC website.

This measure is designed to ensure customer account details are kept up to date, the CITC said.

Mobily said the financial impact of the CITC’s decision would be “insignificant”, claiming data, corporate and postpaid revenues would meet its main growth drivers.

The firm, which competes with Saudi Telecom Co (STC) and Zain Saudi, reported a 23 percent rise in third-quarter profit in October, beating forecasts.

Prepaid mobile subscriptions are typically more popular among middle and lower income groups, with telecom operators pushing customers to shift to monthly contracts that include a data allowance.

Customers on monthly, or postpaid, contracts are also less likely to switch provider, but the bulk of customers remain on pre-paid accounts.

Mobily shares were trading down 1.4 percent at 0820 GMT on the Saudi bourse.

(Reporting by Matt Smith; Editing by Dinesh Nair)

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Rolling Stones mark 50th year with London show

LONDON (AP) — The Rolling Stones are marking their 50th anniversary with a concert in London.

The band says R&B singer Mary J. Blige and rock guitarist Jeff Beck will be joining them on stage Sunday at the O2 Arena. Most of the tickets for the gig had sold out within minutes.

Mick Jagger, Keith Richards, Charlie Watts and Ronnie Wood will also be joined by former Stones members Bill Wyman and Mick Taylor, who will perform again with the band for the first time in more than 20 years.

The Stones are playing again in London on Thursday before going to the U.S. for a show in New York on Dec. 8 and in Newark, New Jersey, on Dec. 13 and 15.

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M.I.T. Lab Hatches Ideas, and Companies, by the Dozens

HOW do you take particles in a test tube, or components in a tiny chip, and turn them into a $100 million company?

Dr. Robert Langer, 64, knows how. Since the 1980s, his Langer Lab at the Massachusetts Institute of Technology has spun out companies whose products treat cancer, diabetes, heart disease and schizophrenia, among other diseases, and even thicken hair.

The Langer Lab is on the front lines of turning discoveries made in the lab into a range of drugs and drug delivery systems. Without this kind of technology transfer, the thinking goes, scientific discoveries might well sit on the shelf, stifling innovation.

A chemical engineer by training, Dr. Langer has helped start 25 companies and has 811 patents, issued or pending, to his name. That’s not too far behind Thomas Edison, who had 1,093. More than 250 companies have licensed or sublicensed Langer Lab patents.

Polaris Venture Partners, a Boston venture capital firm, has invested $220 million in 18 Langer Lab-inspired businesses. Combined, these businesses have improved the health of many millions of people, says Terry McGuire, co-founder of Polaris.

Along the way, Dr. Langer and his lab, including about 60 postdoctoral and graduate students at a time, have found a way to navigate some slippery territory: the intersection of academic research and the commercial market.

Over the last 30 years, many universities — including M.I.T. — have set up licensing offices that oversee the transfer of scientific discoveries to companies. These offices have become a major pathway for universities seeking to put their research to practical use, not to mention add to their revenue streams.

In the sciences in particular, technology transfer has become a key way to bring drugs and other treatments to market. “The model of biomedical innovation relies on research coming out of universities, often funded by public money,” says Josephine Johnston, director of research at the Hastings Center, a bioethics research organization based in Garrison, N.Y.

Just a few of the products that have emerged from the Langer Lab are a small wafer that delivers a dose of chemotherapy used to treat brain cancer; sugar-sequencing tools that can be used to create new drugs like safer and more effective blood thinners; and a miniaturized chip (a form of nanotechnology) that can test for diseases.

The chemotherapy wafer, called the Gliadel, is licensed by Eisai Inc. The company behind the sugar-sequencing tools, Momenta Pharmaceuticals, raised $28.4 million in an initial public offering in 2004. The miniaturized chip is made by T2Biosystems,  which completed a $23 million round of financing in the summer of 2011.

“It’s inconvenient to have to send things to a lab,” so the company is trying to develop more sophisticated methods, says Dr. Ralph Weissleder, a co-founder, with Dr. Langer and others, of T2Biosystems and a professor at Harvard Medical School.

FOR Dr. Langer, starting a company is not the same as it was, say, for Mark Zuckerberg with Facebook. “Bob is not consumed with any one company,” says H. Kent Bowen, an emeritus professor of business administration at Harvard Business School who wrote a case study on the Langer Lab. “His mission is to create the idea.”

Dr. Bowen observes that there are many other academic laboratories, including highly productive ones, but that the Langer Lab’s combination of people, spun-out companies and publications sets it apart. He says Dr. Langer “walks into the great unknown and then makes these discoveries.”

Dr. Langer is well known for his mentoring abilities. He is “notorious for replying to e-mail in two minutes, whether it’s a lowly graduate school student or the president of the United States,” says Paulina Hill, who worked in his lab from 2009 to 2011 and is now a senior associate at Polaris Venture Partners. (According to Dr. Langer, he has corresponded directly with President Obama about stem cell research and federal funds for the sciences.)

Dr. Langer says he looks at his students “as an extended family,” adding that “I really want them to do well.”

And they have, whether in business or in academia, or a combination of the two. One former student, Ram Sasisekharan, helped found Momenta and now runs his own lab at M.I.T. Ganesh Venkataraman Kaundinya is Momenta’s chief scientific officer and senior vice president for research.

Hongming Chen is vice president of research at Kala Pharmaceuticals. Howard Bernstein is chief scientific officer at Seventh Sense Biosystems, a blood-testing company. Still others have taken jobs in the law or in government.

Dr. Langer says he spends about eight hours a week working on companies that come out of his lab. Of the 25 that he helped start, he serves on the boards of 12 and is an informal adviser to 4. All of his entrepreneurial activity, which includes some equity stakes, has made him a millionaire. But he says he is mainly motivated by a desire to improve people’s health.

Operating from the sixth floor of the David H. Koch Institute for Integrative Cancer Research on the M.I.T. campus in Cambridge, Mass., Dr. Langer’s lab has a research budget of more than $10 million for 2012, coming mostly from federal sources.

The research in labs like Dr. Langer’s is eyed closely by pharmaceutical companies. While drug companies employ huge research and development teams, they may not be as freewheeling and nimble, Dr. Langer says. The basis for many long-range discoveries has “come out of academia, including gene therapy, gene sequencing and tissue engineering,” he says.

He has served as a consultant to pharmaceutical companies. Their large size, he says, can end up being an impediment.

“Very often when you are going for real innovation,” he says, “you have to go against prevailing wisdom, and it’s hard to go against prevailing wisdom when there are people who have been there for a long time and you have some vice president who says, ‘No, that doesn’t make sense.’ ”

Pharmaceutical companies are eager to tap into the talent at leading research universities. In 2008, for example, Washington University in St. Louis announced a $25 million pact with Pfizer to collaborate more closely on biomedical research.

But in some situations, the close — critics might say cozy — ties between business and academia have the potential to create conflicts of interest.

There was a controversy earlier this year when it was revealed that the president of the University of Texas M.D. Anderson Cancer Center owned stock in Aveo Oncology, which had announced earlier that the university would be leading clinical trials of one of its cancer drugs.  Last month, the University of Texas announced that he would be allowed to keep his ties with three pharmaceutical companies, including Aveo Oncology; his holdings will be placed in a blind trust.

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Walmart protests draw crowds, shoppers largely unfazed

Dozens of local workers, and hundreds nationally, took advantage of Black Friday crowds and camera crews at major retailers like Walmart to call for wage increases.

But there was little evidence that the chanting disrupted holiday shoppers.

Steven Restivo, a spokesman for Wal-Mart Stores, said the chain had done its "best Black Friday event ever" despite protests organized by the United Food and Commercial Workers International Union in Chicago and other cities.

At a Walmart in Chicago's Chatham neighborhood on the south side, only one of the store's 500 employees took part in the demonstration, the Bentonville, Ark.-based retailer said. "Almost all the folks you'll see protesting today are not Walmart associates," Restivo said. "I guess you can't believe everything you read in a union press release."

According to the union, protests took place in Miami and Washington, D.C., with additional events planned at Midwestern and Southern stores.

Walmart has so far avoided a union presence, which has become cumbersome for competitors like Jewel-Osco and Dominick's Finer Foods. Those chains have been closing stores as Walmart has expanded locally.

Separately Friday, dozens of members of the Workers Organizing Committee of Chicago and its supporters marched from the Loop to the Magnificent Mile to demand a $15 minimum wage and union contracts for downtown workers. Organized on November 15, the union has about 150 members and has received financial support from Service Employees International Union, Action Now and Stand Up Chicago.

Deborah Sims, marching Friday, said she worked at Macy's for 12 years, eventually making $13 an hour, before losing her job during the recession. She was rehired last holiday season, but at $8.50 an hour, with no benefits.

Sims said she expects retailers to turn to younger, less-experienced workers because "$8.25 an hour is going to look good to them."

Macy's did not respond to a request for comment.

Peter Gill, a spokesman for the Illinois Retail Merchants Association, called the demand for a $15 minimum wage dangerous "because people are out looking for jobs and it's tough in this economy."

He explained that if retailers were forced to nearly double the starting hourly wage, "you're going to have to cut the number of employees."

Reuters contributed to this story.

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Flight attendant's husband left gun in bag, attorney says

An American Airlines flight attendant charged with trying to bring a gun onto an airplane at O'Hare International Airport didn't know her husband had left the gun in her bag, her attorney said today.

Sheila A. Schultz, 65, was arrested Friday morning about 9:30 a.m. after the gun was detected in an X-ray machine, police said.

Schultz, of the 1200 block of North Grove Avenue in Palatine, was ordered held today on $10,000 bail after being charged with one felony count of boarding an aircraft with a weapon and one misdemeanor count of having a firearm without a valid gun card.

Schultz was at O’Hare security checkpoint 7A--which directories show is in Terminal 3--when a TSA officer saw the .22 caliber revolver containing live rounds in her carryon bag, according to court documents.

The bag was shared between Schultz and her husband, her attorney, David Studenroth, said today in a hearing before Criminal Court Judge Judge Israel Desierto. Schultz’s husband forgot to take the gun out of the bag after a recent trip to Michigan, according to court documents. Schultz was unaware it was still in there, her attorney, Studenroth said.

Schultz was scheduled to be on a 10:30 a.m. flight to Shanghai, China on Friday.

Schultz has been an AA flight attendant for 44 years, has lived in Palatine for 40 years and has never been arrested, he said.

American Airlines spokeswoman Mary Frances Fagan confirmed Friday that Schultz was a flight attendant for the airline.

Schultz is scheduled to appear in court again on Nov. 30. 

chicagobreaking@tribune.com

Twitter: @ChicagoBreaking

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“Big Bang Theory” actress Mayim Bialik, husband divorcing

NEW YORK (Reuters) – “The Big Bang Theory” actress Mayim Bialik and her husband are divorcing after nine years of marriage, she said in a statement on her Facebook page.

Bialik, who starred in the 1990s sitcom “Blossom,” and Michael Stone have two sons together.

“Divorce is terribly sad, painful and incomprehensible for children,” Bialik, 36, said in the statement. “It is not something we have decided lightly.”

Bialik, a proponent of “attachment parenting” who authored a book on the subject that was published in September, said it “played no role” in the couple’s divorce.

Attachment parenting advocates the nurturing of strong bonds between parents and children, which can include extended breast-feeding and parents and children sleeping in the same bed until the children are as old as 7. A controversial Time magazine cover on the subject in May drew strong reactions across the United States.

“The main priority for us now is to make the transition to two loving homes as smooth and painless as possible,” Bialik wrote in the statement, which was posted to her Facebook page on Wednesday. “Our sons deserve parents committed to their growth and health and that’s what we are focusing on.”

“We will be OK,” the statement concludes.

Bialik is a former child star who appeared in the 1980s television series “Webster” and “The Facts of Life” before landing the title role in the coming-of-age television show “Blossom,” which ran from 1991 to 1995. The show was about a smart teenage girl whose parents have divorced and is learning about life.

The actress attended the University of California, Los Angeles, where she obtained a doctorate in neuroscience.

She met Michael Stone, a fellow graduate student, in calculus class, according to a description of her wedding she previously posted online.

In her most recent role on CBS comedy “The Big Bang Theory,” Bialik plays Amy Farrah Fowler, a neuroscientist who dates one of the two main stars of the show, the socially inept but brilliant physicist Sheldon Cooper.

(Reporting By Chris Francescani; Editing by Alex Dobuzinskis and Bill Trott)

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Chicago shopping frenzy gets early start

Ambitious holiday shoppers skipped dessert on Thanksgiving to get a good spot in line for this Black Friday. (Posted Nov. 23rd, 2012)

Massive crowds negotiated the escalators and the revolving door at Water Tower Place Friday afternoon.

Megan Rohee, 40, was there with her Bay City, Mich., family for their annual Black Friday shopping adventure.

They'd done Walmart the night before and hit Kmart and Target Friday morning.

Still, she said much of Friday was about activity as opposed to spending.

"It's more just people watching. We're doing some shopping, but we don't have a ton of stuff.

"We're two teachers and we are tight, tight, tight," she said.

Still, her family plans to spend a bit more this year.

"It's better than last year. Our insurance went up last year, and we hadn't gotten acclimated to it. This year, we're accustomed to it."

Craig Lightfoot and John Livingston III were on a bag hunt downtown.

In Chicago for a radiology conference, the Melbourne, Austrailia, duo began shopping at 9 a.m.

"We're chasing bags for the wives," Lightfoot said.

He plans to shell out more money for gifts this year.

"The kids are getting older and I'm spending more," he said.

Livingston, who'd picked up handbags for his daughter at Barney's and was scouting for more for his wife, said the family's shopping budget is out of his hands.

"My wife sets the budget from the other side of the world," Livingston said.  "At this point, it's infinite."

The Henri Bendel handbag and accessory store offered doorbusters this year to drive traffic.

"We wanted to see if we could get a lift in our business," store manager Kristen Koch said. "We found it drove a lot of self purchases.

"It seem like everyone is looking for the best deal," Koch said. "They might be spending the same amount as last year, but they're getting more."

Mary Jane and Steve Day, both 62 and from Peoria,y strategized for their Black Friday excursion to Woodfield Mall after spending Thanksgiving with family in Rolling Meadows.

"She woke me up 6:52 (a.m.), " he said.

Looking for luggage, the Days started by shopping online, then called stores to buy over the phone. The first physical stop for the retirees wasn't until 9 a.m. at the Macy's store.

"This isn't bad," said Steve Day. "There's not that many people in the streets."

And though the Macy's store had been opened since 12 a.m., Mary Jane Day said: "We're too old to get up that early."

For Shelly Wright's first Black Friday experience, she and friend Megan Valentine got to the mall at 6:30 a.m. The Chicago women dropped a load of bags at the car three hours later, and said they would probably shop until lunch time.

Wright, 32, moved to the country three years ago from her native Canterbury, England. She said with a laugh: "This is kind of a grand, cultural experience."

Valentine, 28, said she's been Black Friday shopping for years. She said sales were better last year than this, though the crowds were more manageable.

"I expected it to be a lot worse but we weren't the first drove of people," Valentine said. "A lot of stores staggered their open times."

The frenzy is not created equal for all retailers.

Even if they don't have specials or promotions, small and independent businesses can be subject to a shopping center's early opening hours.

At Woodfield, Candy World owner Parul Patel manned her shop alone starting at midnight Friday without any specials.

The store's customer base is made up of children and teenagers, and the merchandise is at a low price point. This means business was normal, if not slow during some parts of the night, Patel said.

To fill some of the time, she read a newspaper, topped off candy containers and people-watched. The mall was busier than usual, but Patel said: "Nobody is here, you can see."

This year was the first mandatory 12 a.m. opening for the metro area's largest shopping center. Of Woodfield Mall's nearly 300 businesses across 2.2 million square feet, only about 20 stores didn't open at that time, according to the  mall's general manager, Marc Strich.

Retailers and customers had asked for the early hours, Strich said. Last year, the mall held a "volunteer" midnight opening, and about 20 stores participated.

As is typical, stores other than big-box retailer are required to be open when the mall is, Strich said, though he declined to talk about whether there were any fined or punishments for those that aren't.

Sears opened Thursday at 8 p.m., while Nordstrom's didn't open until 9 a.m. Friday, Strich said.

Amanda Lewkowicz, the store manager at PJ's Avon Beauty Center, said it didn't initially want to open at midnight after disappointing sales last year.

"We didn't want to be open at midnight because it didn't pick up until 5 a.m. last year," Lewkowicz said. "We felt it didn't benefit us."

The store is a rare brick-and-mortar outlet for Avon beauty products, which is typically sold through catalogs and sales representatives. That "destination" business model for PJ's Avon means customers typically seek them out, Lewkowicz said.

Being independently owned also requires its own promotional efforts, which included emailing its customer list and cold-calling others.

"(Other stores) do commercial advertising. We can only do so much," Lewkowicz said.

Jessica Foch had only sold one pack of cigarettes by noon at the smoke shop on Division Street in Wicker Park, in spite of her boss's insistence that a Black Friday special on hookahs would bring in throngs of shoppers.

The 24-year-old store manabger admitted that 25 percent off a $300 hookah is a pretty big discount but said she didn't expect to see them fly off the shelf.

"People don't go to little shops like this on Black Friday. They go to Target and Kmart," she said.

With pink hair, sparkly black nail polish and fingerless gloves, Foch said she once worked for Wal-Mart and hates the way people treat each other on Black Friday

She plans to spend at least $100 on her boyfriend and give generously to friends. But she won't be shopping today.

"I know somebody who got punched in the face for a toaster," she said, "a toaster."

The line may seem impressive outside St. Alfred's -- a streetwear clothier in Wicker Park -- but that's because the tiny shop is only letting in one person at a time, apparently to avoid a run on the Michael Jordan sneakers out Friday.

"But we don't even want them," said Armin Hajdarovic, 17, bundled up outside the store with a half a dozen friends as it began to snow.

The crew of Northsiders was waiting to get inside to buy shirts at 20 percent off.

Asked who they were shopping for, the group said: themselves, of course.

By 9:30 a.m. on Black Friday, still a half hour before Yorktown Shopping Center in Lombard would open on any other weekday, Santa was in his green armchair and lines had queued at Caribou Coffee for those refueling, some after an entire night of shopping.

At the food court, three sisters sipped from cartons of orange juice, their daughters having awakened them hours before dawn for a 4 a.m. excursion. One, Patricia Baker, 54, of Maywood, had made an 8 p.m. jaunt to Target Thursday and a midnight run to Anna's Linens.

Now, she and her sisters, Donna Holliday, 48, of Bellwood, and Carolyn Baker, 56, of Lombard, and their daughters had spread their J.C. Penney, Forever 21, Victoria's Secret and Bath and  Body Works bags across several tables, taking a break before heading to Chicago Premium Outlets in Aurora.

The sisters hadn't been able to get together for Thanksgiving dinner on Thursday, so shopping signified bonding time.

"I'm just hanging with my sisters and nieces," said Holliday. "Just hangin'."

Baker added that she lets her daughter, Jahanna Baker, 19, and nieces, Azia and Amber Welch, both 17, do most of the shopping while she and her sisters chat at the follow. 

"My income has become more secure," said Carolyn, a nurse. "The fear has died down. My work hours are more steady." She plans to spend a couple thousand dollars more this year, including a new stove she bought for herself.

Holliday, too, says she has been working more hours this year and plans to spend a couple  hundred dollars more .

"I buy what I like," she said, "as long as I'm not broke."

At the courtyard in front of Von Maur at Yorktown, three generations of shoppers sat on a bench with bags from the Gap, Justice, Claire's and Aeropostale around their feet.

Kathy Zuehlke, 69, had driven in from Rantoul, in central Illinois, to go shopping with her daughter, Lisa Salgado, 43, and granddaughter Alicia Salgado, 14, both of Rockford.

It was the first time Alicia had joined the decade-long tradition, which Kathy views as "a chance to get together because we're all spread out across Illinois."

They followed a system, scouring the circulars from three newspapers before plotting a course that took them to Target on Thanksgiving evening, back at a relative's house to nap for a few hours and on to Kohl's, Best Buy, Toys "R" Us and Yorktown.

They had budgeted about as much for gifts this year as the last, about $300 to $500 for Lisa and $800 to $900 for Kathy, who says she has several grandchildren to spoil.

They pay in cash, however, so as not to overspend.  The deals they snagged on Black Friday, including 60 percent off most apparel, helped them stay within budget, too.

In Chicago's rapidly gentrifying Logan square neighborhood, most shops and restaurants were closed Black Friday, but not Torres-Omar Jewelry.

The tiny shop, near the Blue Line stop, was offering double discounts on watches.

Bob Garza -- dressed as Santa Claus and handing out fliers for the jewelry store and candy canes as CTA riders exited the train station -- said he usually delivers groceries for Mariano's but the shop is closed through the weekend so he got out his Santa outfit to make a little extra cash.

Tomorrow, Santa will be handing out Chamber of Commerce fliers on Belmont.

"The economy is bad right now," he said. "There's work out there. You just have to create it."

Across the street at the jewelry store, Jose Torres, the store's owner, said they've been in the same location since 1980 and stay open Black Friday because their regular customers expect it.

"We're always open," he said. The store was quiet, but Torres said traffic to the store looked better than last year.

Just before 7 a.m. the door busters and the crowds had dwindled at the Target in Schaumburg. Store leader Aaron Stephenson said that while the store was still busy, the crowd had died down a bit. "This is what I consider normal busy for a weekend," said Stephenson.

This is the Minneapolis-based Target's first year offering staggered door busters, the first at 9 p.m. on Thanksgiving, when the store opened and the second, at 4 a.m. Friday. Beyond consumer electronics, housewares had been popular according to Stephenson and by early morning some had also disappeared, including a Dyson Vacuum, a Farberware 18-piece cook set and a Pyrex 20-piece set.

The stack of PlayStation 3 and XBox 360's also were gone and toys, including Legos, he said, flew off the shelves. There are plenty of still good deals, Stephenson added. "We still have quite a few big TVs," he said.

In a form of subtle protest, several people who roamed Yorktown Shopping Center in Lombard as early as 4 a.m. started buying when they usually did -- on Friday morning -- and refused to give into retailers that opened their doors on Thursday evening.

"I boycotted anything midnight or earlier," said Chrissy Wojdyla, 29, of Downers Grove. "I will not shop there. I think it's ruining Thanksgiving tradition and infringing on my family." Moving Black Friday hours up to Thanksgiving, she added, "takes people away from their families." 

Instead, Wojdyla, her sister, Mary Steele, 26, and their mother, Patti Wojdyla, 54, dedicated their Thanksgiving Day to family and food, withholding themselves from any kind of shopping until they met at Yorktown at 4 a.m. Friday.

"Four a.m. is early enough!," said Patti, of Glen Ellyn. "Why would anyone want to do it on Thanksgiving evening? You're full. You're tired."

Steele, also of Glen Ellyn, said that caring for her young kids all day had made Thanksgiving too tiring to shop. 

Plus, she said, "when you start on Thanksgiving Day, it's not even Black Friday. We enjoy our 4 a.m. Friday tradition."

So they all got sleep on Thursday, ranging from 1 to 6 hours , and woke up to glam themselves out with glitter, tiaras and garland necklaces for their early morning of shopping. Steele wore a paper crown that read "Happy Holidays." |

For their efforts to keep with Yorktown's "bling" theme, Lynette Steinhauser, the assistant marketing director at the mall, rewarded them with $10 gift cards to Von Maur, which prompted a profusion of delighted thank-yous. 

Outside of J.C. Penney, Ramiro Carrizales, 44, waited with his wife, Lorena Carrizales, 40, in a seven-people-deep crowd for the store to open at 6 a.m.

They were looking for good clothing deals for their kids, specifically Mickey Mouse-themed items, but the couple, who lives in Forest Park, adamantly stuck to early Friday morning shopping hours instead of venturing out on Thursday evening. 

On Thanksgiving, said Ramiro, "I wanted to spend time with family. I didn't want to go out."

Post-Thanksgiving shopping also is a ritual for Elk Grove's Krys Slattery, Chris Duncker and Gina Wirth -- a decade-long tradition among friends.

Each year, they finish Thanksgiving dinner with their families and embark upon a 12-hour pilgrimage to knock-out the bulk of the Christmas shopping by visiting several stores in and around Woodfield Mall in Schaumburg. They power-up with coffee and breakfast at Panera and then wind-down the spree at Olive Garden for lunch. 

"We're constantly laughing," said Duncker.  "It's not just about the deals for us really, It's all about the experience, we love it," added Wirth. 

On Thanksgiving night they were in the Target on Higgins Road in Schaumburg.  Each with carts, a list and Target's "door buster" circular holding folded in their hands. All three giggled and called out to each other, squealing with delight when they spied a good deal.

After picking-up some blue sequined slippers for her teenage daughter, Slattery held them up for Wirth and Duncker to inspect.  "Do you think she'll like these?" she said.

This year Slattery was lucky. Target was opening earlier than ever -- at 9 p.m. so her mother cooked Thanksgiving dinner.

The trio weren't alone, the Target on Higgins Road in Schaumburg was swarmed, many pushing carts piled high with merchandise, from 50-inch televisions, to game consoles, tablet computers, MP3 players, apparel and cameras, which manager Brett Thiele said sold out in an hour.

The scene was similar at Yorktown Shopping Center in Lombard. 

Laura Maxey and six of her closest friends shrieked when they saw the black bags. They had carved out a spot in front of the information booth at Yorktown, standing for 5 1/2 hours at the head of a 250-person line, until the mall officially opened at 5 a.m. Friday and the staff began handing out goodie bags filled with multicolored totes and $10 gift cards to stores throughout the mall.

"We pretty much just slept over at the mall," said Laura, 14, of Lombard. "We wanted to be first."

Their parents had dropped the friends, plus two older brothers, off at the mall shortly before midnight, and they rushed to the booth to claim their spots -- only the first 200 people in line would receive gift bags, with another 50 turned away -- before taking turns to embark on a shopping rotation that included Victoria's Secret, American Eagle and PacSun. At Charlotte Russe, they picked up $15 jeans.

The friends said they were at the mall for the joy, the deals and the once-a-year feel of Black Friday, and they were hardly the only ones caught up in the retail frenzy.

"I got a suitcase thrown at my head!" said Melanie Malczewski, 14, of Lombard, recalling her experience at Victoria's Secret, though she was smiling broadly at the memory later that morning.

Lynette Steinhauser, assistant marketing director at Yorktown, said that this, her 14th Black Friday at the mall, "is the busiest it's ever been." About half of the stores had been open since midnight, she said, with nearly all the rest the turning on their lights when the mall officially opened at 5 a.m. Steinhauser compared the foot traffic at 5: 30 a.m. on Black Friday to what it feels like on a Saturday afternoon.

"Everyone is in a really happy mood," she said. "And festive!"

Black Friday, which for years kicked-off the holiday shopping season for retailers and consumers, has bled into Thanksgiving, with retailers including Target, Sears and Toys R US opening on Thursday night aiming to boost their bottom lines by enticing consumers to shop early and often.  

Holiday shopping is crucial for retailers -- it accounts for up to 40 percent of their yearly sales. That's why it's called "Black Friday" as for years they've used the day to go from red to black -- or turn a profit.  

This year, retail watchers are expecting holiday shoppers to oblige.  Consumers are expected to spend, on average, $586.1 billion this year on gifts for friends and family, just over a 4 percent increase from last year. Experts are saying this pick-up in spending is conservative, but a glimpse at popular hotspots for early Black Friday shopping, it wasn't apparent.  

This year a handful opened earlier than ever, Walmart set an 8 p.m. opening and Sears followed suit.  Target opted for an opening scheduled an hour later at 9 pm.

Despite some criticism around the increasingly early open times, shoppers in Schaumburg were out in full-force last night.  A Deloitte survey found that 60 percent of consumers plan to shop over Thanksgiving weekend, aiming to take part in sales that offer merchandise at prices the dip below 50 percent off. 

Experts said that this year, as in most years, low-priced flat screen televisions would move fast.  So would deeply discounted Android-powered tablet computers. 

The line to get into the Sears at Woodfield Mall stretched along the building by 7 p.m., an hour before opening time.  

Manager April Buehler said the line outside the store looked larger than last year, and about a mile away at Target, Thiele said this year the store was filled with more families, instead of the hardcore, deal-hunter that typically shows up when the store opens early on Friday morning.  "It's a lot more casual shopper, which I'm excited about," said Thiele. "It's not necessarily people that had to get up super early and be dedicated, just people going out with families. Grandparents and grandkids," he said. 

Carol and Russel Freitas fall into the deal-hunter category.  It's date night for the Palatine couple of 26 years when they head out to shop each year after dinner, leaving their two teenaged sons behind to tackle the stores.  They said they love it.

They waited patiently in line for more than an hour, hoping to snag one of Sears' hot door busters, a 32-inch flat screen for less than $100. 

As it turns out, they waited in vain.  By the time the store opened, they were in the first third of the line, but the Sears employee had run out of TV vouchers when she got to the Freitas' in line.  "It's okay," said Carol Freitas, "There's other stuff on our list, we're going to head to the boys' department to get shirts for my son."

Shortly before Sears opened, about 12 feet away from the Freitas, there was a small, but growing crowd of suspected "line jumpers,"  who stood about 12 feet away staring at the line.

At close to 9:30 at Target, some shoppers could be seen pushing carts stockpiled with 32 inch flat screen for $147.  Alex Gackle  from Fargo, N.D., left his grandmother's dinner with his dad and brother-in-law to buy  another of the Minneapolis-based retailer's most sought-after deals: They bought  four televisions. One for himself, another for his grandmother, one for her caretaker and the fourth for his father.  They waited in line for more than an hour and things were calm, said Gackle.  That changed when Target's doors opened, said Gackle. "That's when people started getting crazy and rushing toward things."

By 10:30 a long line of shoppers were still waiting to get inside the Toys R Us in Schaumburg.  Customers said they were told that shoppers would be allowed in the store every 10 minutes in increments of 50.

After 10 p.m. the temperature had dropped and Laura Saul stood in a sweater with her two daughters and their cousin to get into Toys R Us.  The item of the evening -- "Monster High" dolls for her 10-year-old daughter, Emily.  She pointed to Emily and said, giggling, "She conned us to do this."  Saul's old daughter, Lauren, who stood nearby, was not in such good spirits, "I could be sleeping," she said.

The trio from Elk Grove shopping at Target said over the years they've seen it all -- fights and shoving matches.  As the 10 p.m. hour approached at Target, they thought things were pretty calm.  At Target People get angry, but this is fun for us," said Wirth.  "Even if we don't get what we want, we don't care."

Sally Ho, Julie Wernau and Erin Chan Ding contributed to this story.

crshropshire@tribune.com | Twitter: @corilyns

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