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The Role of the RUC in Medicare's Price-Fixing and Rationing Remains Anechoic

An important part of the noisy and contentious debate about health care reform in the US centers on the role of the government as a provider of health insurance. Some on the left want a government "single-payer" plan to be the only health insurance available. Some left of center want a government "public option" health insurance plan to be available, particularly to those who have trouble obtaining commercial insurance. Some on the right want none of it, and sometimes note that the existing government single-payer plan for the elderly and disabled, Medicare, has important faults that would only become more significant if the plan is extended or duplicated. Yet even critics of Medicare on the right do not seem to want to talk about what may be its worst fault. The latest example, an <a href="http://online.wsj.com/article/SB20001424052970204488304574435464052451436.html">op-ed piece by Dr Scott Gottlieb</a>, appeared in the Wall Street Journal yesterday. Dr Gottlieb's main point was that health care rationing by either government or private insurers is inevitable, but that "government does it in far more byzantine and arbitrary ways." In particular, <blockquote>Consider the $450 billion Medicare program. It provides a model for—indeed its bureaucracy could well end up running—the 'public option' health plan that Mr. Obama wants to offer all Americans under the age of 65. In recent years, Medicare's staff has been aggressively restricting coverage for costly treatments. This often means limiting access to the costliest technologies. To do this Medicare relies on its rationing and pricing systems. </blockquote> Gottlieb then cited several examples, "tortured decisions concerning the use of implantable defibrillators," and "the travails of the pharmaceutical company Spracor and its drug Xopenex, an innovative respiratory medicine that competes with the chemically distinct and much cheaper generic albuterol." Finally Gottlieb decried Medicare's decision making processes applied to costly technologies as "impenetrable." His summation was <blockquote> There's nothing inherently wrong with a program like Medicare seeking value for taxpayers. But it shouldn't make up the rules as it goes. </blockquote> Let me first say that I actually agree with Dr Gottlieb's main points. Any government or private health insurance plan ought to seek value for its money. However, how it does so ought to be rational, based on understanding of medicine and the clinical context, and transparent and accountable to the patients on whose behalf such plans pay. "Covert rationing" (as has been well discussed in the <a href="http://covertrationingblog.com/">Covert Rationing Blog</a>) raises worries that decisions are being made just to save money, not to improve value, and even that decisions are being made without informed consideration of the clinical context, or based on the self-interest of the decision makers, or even that decisions may result from bribery and corruption. But if Dr Gottlieb is so concerned about Medicare rationing care as a result of opaque and unaccountable decision making, why is he not more concerned about how Medicare controls the prices of physicians' services than about its decisions about a few expensive, high-tech and infrequently used treatments? We have written again and again about how Medicare has allowed decisions about what physicians are paid for providing various services to be made de facto by an opaque private committee run by the American Medical Association. This decision-making process has lead to relatively generous payments for procedures, versus miserly payments for "cognitive services," (that is, "evaluation and management services," or for physicians interviewing, examining, and counseling patients, making diagnoses, predicting prognoses, and making decisions about treatment.) The resulting perverse incentives are a major reason that primary care has become increasingly unavailable, and for our expensive patterns of care dominated by high-technology and invasive procedures. More detail quoted from <a href="http://hcrenewal.blogspot.com/2009/06/letter-from-ruc-and-my-reply.html">a previous post </a>appears below. <blockquote>As we have discussed, the US Medicare system determines what it pays physicians using the <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/the-resource-based-relative-value-scale/overview-of-rbrvs.shtml">Resource Based Relative Value System (RBRVS)</a>. This system determines the pay for every kind of medical encounter according to a complex formula that is supposed to account for physicians' time and effort, physicians' practice expense, and the cost of malpractice insurance. The components of physicians' effort assessed are, in turn, technical skill and physical effort; the required mental effort and judgment; and stress due to the potential risk to the patient.To keep the system, which was started in 1990, current, requires addition of new kinds of encounters, which means encounters involving new kinds of procedures, and updating of the estimates of various components, including physicians' time and effort. To do so, the Center for Medicare and Medicaid Services (CMS) relies almost exclusively on the advice of the RBRVS Update Committee (RUC). The <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/the-resource-based-relative-value-scale/the-rvs-update-committee.shtml">RUC</a> is a private committee of the AMA, touted as an "expert panel" that takes advantage of the organization's First Amendment rights to petition the government. Membership on the RUC is allotted to represent specialty societies, so that the vast majority of the members represent specialties that do procedures and focus on expensive, high-technology tests and treatments. However, the identities of RUC members are secret, as are the proceedings of the group.This opaque and unaccountable process has resulted in increases outstripping inflation in fees paid for procedures, while fees paid for 'cognitive" medicine,' i.e., for primary care, and for services that involve diagnosis, management of acute and chronic disease, counseling, coordination of care, etc, but not procedures, have lagged inflation. The effects of the RUC have been amplified by the unexplained tendency of commercial managed care and health insurance to track the RBRVS system when making their own payments to physicians.For further details about the RUC, see these posts on Health Care Renewal (<a href="http://hcrenewal.blogspot.com/2007/03/on-disparities-between-reimbursement-of.html">here</a>, <a href="http://hcrenewal.blogspot.com/2007/12/is-sustainable-growth-rate-main-problem.html">here</a>, <a href="http://hcrenewal.blogspot.com/2008/05/payments-for-patient-centered-medical.html">here</a>, <a href="http://hcrenewal.blogspot.com/2008/07/can-we-fix-medicare-while-pretending.html">here</a>, and <a href="http://hcrenewal.blogspot.com/2008/12/no-such-ruc-new-england-journal-takes.html">here</a>) and important articles by Bodenheimer et al,(1) and Goodson.(2) By the way, why the US Center for Medicare and Medicaid Services (CMS) relies de facto exclusively on the RUC to control the RBRVS system, and why the AMA made the RUC into a secret organization apparently beholden only to the organization's proceduralist members are unanswered questions. </blockquote>Our most recent posts about the RUC are <a href="http://hcrenewal.blogspot.com/2009/02/what-ruc-again-one-of-worlds-most.html">here</a>, <a href="http://hcrenewal.blogspot.com/2009/06/letter-from-ruc-and-my-reply.html">here</a>, and <a href="http://hcrenewal.blogspot.com/2009/08/sgim-urges-chuck-ruc.html">here</a>. Other bloggers, notably including Dr Robert Centor on <a href="http://www.medrants.com/">DB's Medical Rants</a>, have criticized the RUC. The Society of General Internal Medicine seems to be the only medical society that has criticized the RUC (see <a href="http://hcrenewal.blogspot.com/2009/08/sgim-urges-chuck-ruc.html">this post</a>). Yet even ostensibly conservative and libertarian pundits who decry price-fixing and rationing by Medicare have ignored this vivid and important example of opaque and unaccountable price-fixing and rationing. And ostensibly liberal proponents of public options and single-payer systems have not explained how they would make their rationing more rational, transparent, and accountable, or how simply insuring more patients under Medicare-like programs would not result in even higher costs, poorer access, and worse quality. The lack of discussion of the RUC remains one of the more striking examples of the <a href="http://hcrenewal.blogspot.com/search/label/anechoic%20effect">anechoic effect</a>. Failing to address why our costs are so high, are access is so poor, and our quality is so challenged will make it likely that any supposed reform effort will only make these problems worse. References 1. Bodenheimer T, Berenson RA, Rudolf P. The primary care-specialty income gap: why it matters. Ann Intern Med 2007; 146: 301-306. Link <a href="http://www.annals.org/cgi/content/full/146/4/301">here</a>. 2. Goodson JD. Unintended consequences of Resource-Based Relative Value Scale reimbursement. JAMA 2007; 298(19):2308-2310. Link <a href="http://jama.ama-assn.org/cgi/content/short/298/19/2308">here</a>.

The Role of the RUC in Medicare's Price-Fixing and Rationing Remains Anechoic

An important part of the noisy and contentious debate about health care reform in the US centers on the role of the government as a provider...

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Searching for the next Olympics host city

Tomorrow morning, the <a href="http://www.olympic.org/uk/index_uk.asp">International Olympic Committee</a> (IOC) will decide the host for the 2016 Summer Olympic and Paralympic games. Competing for the honor are four bid cities: Chicago, Madrid, Tokyo and Rio de Janeiro. In past years, in addition to seeing a surge in searches during the Games, we typically see a significant swell in searches leading up to the announcement about which will be the next IOC host city. Just two years ago, people from across the world <a href="http://www.google.com/insights/search/#q=sochi&date=1%2F2007%2012m&cmpt=q">turned to Google</a> to learn more about Sochi, Russia — the newly announced host of the 2014 winter games. Similar patterns <a href="http://www.google.com/insights/search/#q=olympics&geo=GB-ENG&date=1%2F2005%2012m&cmpt=q">emerged</a> across the United Kingdom as citizens searched to learn more about the London 2012 bid. At Google we've always shared the world's interest in the Olympics, and have expressed that interest through dozens of Google doodles both while the games are occurring (last August, the Beijing Games inspired <a href="http://www.google.com/corporate/timeline/#doodle-2008-summer-games-1-of-16">many doodles</a>) as well as celebrating the naming of host cities (<a href="http://www.google.com/logos/logos07-3.html">Sochi in 2007</a>). Also, last summer the world followed along at home using our Beijing 2008 Summer Games <a href="http://www.google.com/landing/summergames2008/index.html">medal tracker</a> on their iGoogle page or through the Olympic Games onebox on Google.com. As decision day for 2016 approaches, we have Googlers in our offices in Chicago, Madrid, Tokyo (and in Sao Paulo cheering on Rio) who are watching and cheering on their cities along with the rest of the world. With the decision tomorrow, we thought it would be interesting to see what people from the host cities and countries are searching for. We've shared some of the coolest tidbits below. Searches from around the globe for [2016] have reached an <a href="http://www.google.com/insights/search/#q=2016&date=1%2F2009%2012m&cmpt=q">all-time high</a>. Search volume from Spain dwarfs Brazil, the United States and Japan: <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjIaZiJX8NIuHyQ76OcON9Xk_YpH97NavCnRT5BLz0YL7mXooQcRe0SVs4d5aNERBYZ90s9xVkBwYvz4mOtljH5I78F-qKnPBA25QCfpUAwYRbDILvTkeLnRDaz1HhYhBwVctrnYS2SNzE/s1600-h/SPain.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5387759273356313394" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjIaZiJX8NIuHyQ76OcON9Xk_YpH97NavCnRT5BLz0YL7mXooQcRe0SVs4d5aNERBYZ90s9xVkBwYvz4mOtljH5I78F-qKnPBA25QCfpUAwYRbDILvTkeLnRDaz1HhYhBwVctrnYS2SNzE/s400/SPain.png" style="cursor: pointer; display: block; height: 152px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a> In Chicago, searchers are <a href="http://www.google.com/insights/search/#q=madrid%20olympics%2Ctokyo%20olympics%2Crio%20olympics&geo=US-IL-602&date=1%2F2009%2012m&cmpt=q">looking more for info on Rio's bid</a> than Madrid's or Tokyo's, possibly indicating that Chicago residents view Rio's bid as the most competitive: <div> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5mtHg125HICWH4Me2ApPAgxlzMj3LdTYgaucXY81j-qr26UWjqr5hISY2Bdz4TwhpBFd7WSG19NmrDLMW9xH9wPFnIamt2hyeoN8ofWkMPGrsbF_OXqBpGh9EMHXalTOI77rGRMKXEHdS/s1600-h/chicago+searching+competitors.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5387759497025262514" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5mtHg125HICWH4Me2ApPAgxlzMj3LdTYgaucXY81j-qr26UWjqr5hISY2Bdz4TwhpBFd7WSG19NmrDLMW9xH9wPFnIamt2hyeoN8ofWkMPGrsbF_OXqBpGh9EMHXalTOI77rGRMKXEHdS/s400/chicago+searching+competitors.png" style="cursor: pointer; display: block; height: 155px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a> Across Tokyo, people are <a href="http://www.google.com/insights/search/#q=%E3%82%AA%E3%83%AA%E3%83%B3%E3%83%94%E3%83%83%E3%82%AF%2C%E3%82%AA%E3%83%AA%E3%83%B3%E3%83%94%E3%83%83%E3%82%AF%E3%80%80%E6%9D%B1%E4%BA%AC&geo=JP-13&date=1%2F2009%2012m&cmpt=q">searching more frequently</a> for information about the Olympics and their city's chances of landing the 2016 games: </div><div> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXDakoErvf6CEuT61K_62eyeYpVjfa4LFLHolgRKeByRzI6LEzuJqGcvbxWglCoui2i1l1bfrlcPvhvobYVuftb3amza4LNk3EWgfapjNasrhjnxtAQNiRLYNEsd0B-6sUqaSMTuZwLUhyphenhyphen/s1600-h/tokyo.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5387759510683185826" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXDakoErvf6CEuT61K_62eyeYpVjfa4LFLHolgRKeByRzI6LEzuJqGcvbxWglCoui2i1l1bfrlcPvhvobYVuftb3amza4LNk3EWgfapjNasrhjnxtAQNiRLYNEsd0B-6sUqaSMTuZwLUhyphenhyphen/s400/tokyo.png" style="cursor: pointer; display: block; height: 150px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a> <div style="text-align: center;">Searches translate to [olympics] and [olympics tokyo], in blue and red, respectively </div> Although Oprah is widely viewed as the most popular full-time Chicago resident in the world, Chicagoans today are <a href="http://www.google.com/insights/search/#q=Olympics%2COprah&geo=US-IL-602&date=today%201-m&cmpt=q">searching more</a> for the Olympics than their favorite talk show host: </div><div> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7zFgFCSb-h72XkoGHIVhyphenhyphenDU-GxIAjjXDxNAaF00UMcXwDZ1RHU6l8uu4bM6OmBgYnRlBaNE8mBDh74qV6BQgbPYpr0gel70VA0g4SRDd518Hd4mLwtYJYI8hQR99D1KUr0h7T0dTXcmM3/s1600-h/oprah.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5387759503032133122" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7zFgFCSb-h72XkoGHIVhyphenhyphenDU-GxIAjjXDxNAaF00UMcXwDZ1RHU6l8uu4bM6OmBgYnRlBaNE8mBDh74qV6BQgbPYpr0gel70VA0g4SRDd518Hd4mLwtYJYI8hQR99D1KUr0h7T0dTXcmM3/s400/oprah.png" style="cursor: pointer; display: block; height: 151px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a> In Brazil, <a href="http://www.google.com/insights/search/#cat=20&q=jogos%20olimpicos&geo=BR&date=3%2F2009%208m&cmpt=date">searches</a> for [jogos olimpicos] (olympic games) have risen 650% over the course of the year. And when looking at Brazilians' interest in [rio 2016] as a search term, <a href="http://www.google.com/insights/search/#q=Rio%202016&geo=BR&date=today%2012-m&cmpt=q">the top related search</a> was for [roda rio] (a 36-meter tall ferris wheel, capable of holding 144 passengers with a gondola for the disabled). The ferris wheel, located on Copacabana, was completed in January of this year as part of the city's Olympic bid campaign. In Spain, search volume for [juegos olímpicos] (olympic games) has <a href="http://www.google.com/insights/search/#q=Juegos%20Ol%EDmpicos&geo=ES&date=1%2F2009%2012m&cmpt=q">more than doubled</a> in the last month alone. </div><div> On Google Trends, [2016 olympic decision] has been <a href="http://google.com/trends/hottrends?q=2016+olympics+decision&date=2009-10-1&sa=X">steadily moving up all day</a>, with the largest volume of searches coming from Chicago and Atlanta: <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgB77Kz0gxVXeiI62Tzb9Iv6YAUFWUj_2fL5d6Z-ng3KxYgCtFEYMqp3n_72R-cHRbNQqb6hUVWYsSGQD5jBkUSfb-TueGtJd_Gg67eP3sqpIpg93JIlrA-6KNM-JEHXPwQjZTDtdQVRsuU/s1600-h/spicy+olympics.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5387760531723082738" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgB77Kz0gxVXeiI62Tzb9Iv6YAUFWUj_2fL5d6Z-ng3KxYgCtFEYMqp3n_72R-cHRbNQqb6hUVWYsSGQD5jBkUSfb-TueGtJd_Gg67eP3sqpIpg93JIlrA-6KNM-JEHXPwQjZTDtdQVRsuU/s400/spicy+olympics.png" style="cursor: pointer; display: block; height: 117px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a> Ultimately, it comes down to the votes of the <a href="http://www.chicagotribune.com/news/chi-olympics-voting-30-sep30,0,4983126.story">106 IOC members</a>. Around the world, hundreds of Googlers, along with many millions of Google users, eagerly await their decision. Whichever city wins, we can't wait for the Games to begin. Posted by Jim Lecinski, Managing Director, U.S. Sales (and proud Chicagoan) </div>

Searching for the next Olympics host city

Tomorrow morning, the International Olympic Committee (IOC) will decide the host for the 2016 Summer Olympic and Paralympic games. Competin...

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Now in Google Toolbar for Firefox: advanced in-page translation

Last week was a big one for Google Toolbar: we released the new <a href="http://www.google.com/sidewiki">Google Toolbar with Sidewiki</a> for Internet Explorer and Firefox allowing you to contribute helpful information next to any webpage. But there's more: with the new version of Google Toolbar, our <a href="http://googleblog.blogspot.com/2009/06/toolbar-now-with-advanced-translation.html">advanced in-page translation</a> also became available for Firefox, making it easy to read a webpage in another language with the click of a button. The new version of Google Toolbar for Firefox has several other new features . You can find (almost) everything about the toolbar in our <a href="http://www.google.com/support/toolbar/bin/answer.py?answer=81376&hl=en">help center</a> so we'll just mention two new things. As in Google Toolbar for Internet Explorer, we're now experimenting with displaying high-quality website suggestions and sponsored links as you type your query. Clicking on these will take you directly to the website (try typing "cnn" in the toolbar to see an example). Also, Firefox version 3.5 introduced <a href="http://support.mozilla.com/en-US/kb/Private+Browsing">Private Browsing mode</a> in which in which Firefox will stop recording your browsing history. The new version of Toolbar in Firefox will follow suit and not record your <a href="http://www.google.com/support/websearch/bin/answer.py?hl=en&answer=9016">searchbox history</a> while in Private Browsing mode. It will also turn off PageRank, Web History and Sidewiki. This means that you can confidently surf in private when you prefer. Note that Firefox's Private Browsing mode does not mean complete anonymity; we highly recommend reading <a href="http://support.mozilla.com/en-US/kb/Private+Browsing">Mozilla's support page</a> before using Private Browsing mode. We continue to work on new features to improve your web experience. <a href="http://toolbar.google.com/">Download the latest version of Google Toolbar</a> and try out these new features. Posted by Christian Stefansen, Product Manager, Toolbar Team

Now in Google Toolbar for Firefox: advanced in-page translation

Last week was a big one for Google Toolbar: we released the new Google Toolbar with Sidewiki for Internet Explorer and Firefox allowing you...

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Celebrating National Cyber Security Awareness Month 2009

Internet security and online safety are topics that leave many people scratching their heads. While many companies and organizations work to make the Internet a safer place, it can be difficult to know what to do as an Internet user beyond creating numerous passwords for your various online accounts and steering clear of that email from a "long lost relative" who wants you to immediately wire thousands of dollars to him. Here's the good news: even though security can become quite technical and complicated, there are simple steps you can take that can make a big difference in helping to keep your information safe. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTZFMbaxT3ayX0qxf6OBqTgqof5HdRoGzq9ZGC-HfkBOHzlRdpr3O10XkDYVdrWlYXK0TPQc4GvWZqXiahVSxFtxUXDbbfIOxDpqDODrAln2UQwcbf1DeGWWiEtRTYpQ9WoVoArlzyNFXc/s1600-h/security1" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5387683125021756898" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTZFMbaxT3ayX0qxf6OBqTgqof5HdRoGzq9ZGC-HfkBOHzlRdpr3O10XkDYVdrWlYXK0TPQc4GvWZqXiahVSxFtxUXDbbfIOxDpqDODrAln2UQwcbf1DeGWWiEtRTYpQ9WoVoArlzyNFXc/s400/security1" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 300px; height: 250px;" /></a> This month, Google joins the National Cyber Security Alliance (NCSA), governmental agencies, corporations, schools and non-profit organizations in recognizing <a href="http://www.staysafeonline.info/content/about-ncsam">National Cyber Security Awareness Month</a>. Throughout October, we'll be raising awareness of important Internet security and safety issues that will teach you how to be an informed web user. Keep an eye on our various <a href="http://www.google.com/press/blogs/directory.html#tab1">product blogs</a>, as we'll be sharing tips that are tailored to users of Google products and services. To kick off the series, visit our newly created <a href="http://www.youtube.com/user/GoogleCyberSecurity">Google Cyber Security Awareness Channel</a> on YouTube to watch a variety of online safety videos created by individuals and groups with an interest in cyber security. The web is a great platform for all kinds of things — finding information, interacting with others and even running your business. Practicing good cyber security habits can help keep it that way. Join us this month by brushing up on your cyber security awareness and sharing the tips you like with others.<div> </div><div>Update on 10/22/2009: We're excited to hear that the U.S. House of Representatives today <a href="http://clarke.house.gov/2009/10/house-passes-rep-yvette-d-clarkes-h-res-797-supporting-goals-and-ideals-of-national-cybersecurity-aw.shtml">unanimously passed a resolution</a> formally supporting the goals and ideals of National Cyber Security Awareness Month 2009. Rep. Yvette D. Clarke’s resolution signals the government's willingness and commitment to help better protect the nation's online and information security. Posted by Eric Davis, Head of Anti-Malvertising</div>

Celebrating National Cyber Security Awareness Month 2009

Internet security and online safety are topics that leave many people scratching their heads. While many companies and organizations work to...

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Refine your search results with new Search Options

In May, we launched <a href="http://googleblog.blogspot.com/2009/05/more-search-options-and-other-updates.html">Search Options</a>, a side panel that lets you filter, refine and generate different views of your search results. We've received lots of positive feedback, and we're seeing more and more people using Search Options every day. Today, we're announcing nine new Search Options tools: past hour, specific date range, more shopping sites, fewer shopping sites, visited pages, not yet visited, books, blogs and news. These features have been rolling out gradually and will be available globally in English by the end of the day. You can try them yourself by searching Google and clicking "Show options" in the blue bar just under the logo. Past hour and Specific date range: With these tools you can choose to see only the most recent results in our index, or see results from a specific time period. This can be particularly helpful when you're looking for the freshest information, or if you have some idea of when the information you're looking for may have been published to the web. <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_qB4ZkZT6eK-zn4f2ZsisieKCG79PdzXDKEUb3gBd1aDhkCKtSrOTUREeCg-zsxvAZvHQOKupHiZC06-GbQP-qDadmgI4ltN5ACrrGJ8T3P1mshNZ618qvdgcNW44w6Xx79jdFFUkpKSj/s1600-h/SO1.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5387654271004070642" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_qB4ZkZT6eK-zn4f2ZsisieKCG79PdzXDKEUb3gBd1aDhkCKtSrOTUREeCg-zsxvAZvHQOKupHiZC06-GbQP-qDadmgI4ltN5ACrrGJ8T3P1mshNZ618qvdgcNW44w6Xx79jdFFUkpKSj/s400/SO1.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 270px;" /></a>Click on the image for a larger version </div>More shopping sites and Fewer shopping sites: Now you can choose "More shopping sites" to show additional commercial pages and display prices from those pages right in the search results. If you're doing product research and are not quite ready to make a purchase, you can choose to see "Fewer shopping sites" to filter out many of the commercial sites. Visited pages and Not yet visited: Rediscover pages you've visited before by clicking "Visited pages," or filter out the websites you've seen by clicking "Not yet visited." This can be particularly helpful when you're researching something you've already explored and you want to return right where you left off. To use this option you'll need to be signed in to your Google Account and have <a href="http://googleblog.blogspot.com/2007/04/your-slice-of-web.html">Web History</a> enabled. Books, Blogs and News: Click on these filters to see results only from these sources. Putting these filters together, along with videos, forums, and reviews, allows you to quickly switch between different source types right on the search results page. We hope you get a chance to try out these powerful new ways to refine your search results. Please visit our <a href="http://www.google.com/support/websearch/bin/answer.py?answer=142143">help center</a> to learn more about Search Options and leave us feedback. And stay tuned for more! Posted by Nundu Janakiram, Product Manager, and Patrick Riley, Software Engineer

Refine your search results with new Search Options

In May, we launched Search Options , a side panel that lets you filter, refine and generate different views of your search results. We'v...

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Surfacing forum posts in search results

Today, we introduced a new search feature that makes it easier for you to find forum posts or discussions related to what you're searching for. This new addition to Google search results applies to sites that tend to have a large number of posts on a specific topic. When several different discussions on a site are relevant to your query, we indent them under the primary result and include the date of each post. So for instance, if you search for [<a href="http://www.google.com/search?q=getting+from+rome+to+florence&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a">getting from rome to florence</a>] you will see, below the third result, a list of relevant discussions on various ways to get between these cities. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJOxl3eqY0Nx68H4S8yuwL6ImiY3oba9s80tLmuKNh1A4qH2JORzush7rrrABv2VEhcNNECA_NF5iqu6kyN_3NZKxdtQqJm7AWko6fl-D2GD9HPkCF7lnhkW4puvZv1vCvyYUaT5vcG5fN/s1600-h/search1.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5387449568174270866" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJOxl3eqY0Nx68H4S8yuwL6ImiY3oba9s80tLmuKNh1A4qH2JORzush7rrrABv2VEhcNNECA_NF5iqu6kyN_3NZKxdtQqJm7AWko6fl-D2GD9HPkCF7lnhkW4puvZv1vCvyYUaT5vcG5fN/s400/search1.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 118px;" /></a> It's always nice to know what others are saying about the best ways to get around (by boat or train) and how recent those comments are — especially if it's your first time traveling to Italy. We hope this feature gives you a deeper view into the relevant content available on sites throughout the web — even when that content spans multiple pages or discussions. At the same time, the main search results are diverse as always — so if you can't pinpoint a useful comment there's a list of relevant sites there to help. Posted by Johanna Wright, Director of Product Management and Devin Mullins, Software Engineer

Surfacing forum posts in search results

Today, we introduced a new search feature that makes it easier for you to find forum posts or discussions related to what you're searchi...

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Translate your website with Google: Expand your audience globally

How long would it take to translate all the world's web content into 50 languages? Even if all of the translators in the world worked around the clock, with the current growth rate of content being created online and the sheer amount of data on the web, it would take hundreds of years to make even a small dent. Today, we're happy to announce a new <a href="http://translate.google.com/translate_tools">website translator gadget</a> powered by Google Translate that enables you to make your site's content available in 51 languages. Now, when people visit your page, if their language (as determined by their browser settings) is different than the language of your page, they'll be prompted to automatically translate the page into their own language. If the visitor's language is the same as the language of your page, no translation banner will appear. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgA6NbLCcTEaDZ9_JYnlIsONYSJcSv3WSUY9aCQYv8SN-lTMEIiet-FN_OSFMow_r55e8wJsoSRsyzWdRTQXNB0LCo6_rz759qV_PPvrzPgQB0uoMnxSR84dkSgAMWrJjYRF2eB-Mi0uA_a/s1600-h/t1.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5387372684702551298" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgA6NbLCcTEaDZ9_JYnlIsONYSJcSv3WSUY9aCQYv8SN-lTMEIiet-FN_OSFMow_r55e8wJsoSRsyzWdRTQXNB0LCo6_rz759qV_PPvrzPgQB0uoMnxSR84dkSgAMWrJjYRF2eB-Mi0uA_a/s400/t1.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 144px;" /></a> After clicking the Translate button, the automatic translations are shown directly on your page. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQCHqiVuuBC4cDhsF_Ze6hUWIUsq42y6YNU5X8AVJ8GPFA0tvRhTSFe1A0DLU4zCCN5B0AdFbJ7MYK2nzuP1Q8IIe0xPK0CAVFU55wjpcqkV6dmxGhL6_YjSHi_3wUFwnQof0l11b9a8Iz/s1600-h/t2.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5387372690304581426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQCHqiVuuBC4cDhsF_Ze6hUWIUsq42y6YNU5X8AVJ8GPFA0tvRhTSFe1A0DLU4zCCN5B0AdFbJ7MYK2nzuP1Q8IIe0xPK0CAVFU55wjpcqkV6dmxGhL6_YjSHi_3wUFwnQof0l11b9a8Iz/s400/t2.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 144px;" /></a> It's easy to install — all you have to do is cut and paste a short snippet into your webpage to increase the global reach of your blog or website. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZWXck9PAMBArNcDV-xO1ODla1Pj8dx-em8t-_HLWv1L5_UhqNMKp58uClQ8YLzlB7jMrZQ6VjOHH8XrP97yEDjvpA6v4r7A7JlaMxvzavBch-P1S4o_fTIX00wrYv6IzdNvLlX8YxqWr0/s1600-h/t3.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5387372699114096914" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZWXck9PAMBArNcDV-xO1ODla1Pj8dx-em8t-_HLWv1L5_UhqNMKp58uClQ8YLzlB7jMrZQ6VjOHH8XrP97yEDjvpA6v4r7A7JlaMxvzavBch-P1S4o_fTIX00wrYv6IzdNvLlX8YxqWr0/s400/t3.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 244px;" /></a> Automatic translation is convenient and helps people get a quick gist of the page. However, it's not a perfect substitute for the art of professional translation. Today happens to be International Translation Day, and we'd like to take the opportunity to celebrate the contributions of translators all over the world. These translators play an essential role in enabling global communication, and with the rapid growth and ease of access to digital content, the need for them is greater than ever. We hope that professional translators, along with translation tools such as <a href="http://googleblog.blogspot.com/2009/06/translating-worlds-information-with.html">Google Translator Toolkit</a> and this <a href="http://translate.google.com/translate_tools">Translate gadget</a>, will continue to help make the world's content more accessible to everyone. Posted by Jeff Chin, Product Manager

Translate your website with Google: Expand your audience globally

How long would it take to translate all the world's web content into 50 languages? Even if all of the translators in the world worked ar...

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