For some homeowners, home improvement isn't about return on investment; it's simply about making dreams come true. Architect Steve Straughan recently finished work on a $250,000 home theater room with a 12-foot wide screen and an elaborate sound system. "There's not a home we're doing that doesn't have a home theater," Straughan says. "It's a common request across the board and typically it's a big investment." Most home theaters involve wiring speakers into walls and extensive built-in cabinetry, as well as soundproofing–"it's not something you can take with you" if you move, Straughan points out. Still, a home theater is likely to have broad appeal, so you may recoup a large chunk of your costs at resale. "A home theater makes sense," says realtor Ron Phipps. "A six-car garage does not make sense." In the high-end . market, Straughan also sees demand for wine cellars, massage rooms and yoga rooms.
In the face of growing expenses, PCIP adopted a series of changes to limit program costs. In 2012 federally-administered programs switched to a less expensive provider network and negotiated additional discounts with targeted hospitals that treated large numbers of PCIP enrollees. State-run programs were required to achieve similar cost savings or transition to federal administration; 17 state programs transitioned in mid-2013. The federal PCIP program also consolidated plan options for 2013, eliminating those offering the lowest patient cost sharing. Even with these changes, program expenses were still projected to exceed appropriated funds before the end of 2013. In March 2013, new PCIP enrollment was suspended to ensure sufficient funds to pay claims for people already enrolled. 18 PCIP enrollment peaked at nearly 115,000 in March 2013, then declined below 90,000 six months later.
Figure 1 29 shows a suggested diagnostic algorithm to determine if a patient has IDA. This algorithm is adapted from a clinical guideline, with the primary modification that serum iron, total iron-binding capacity, and transferrin saturation are recommended as follow-up tests in patients with an intermediate ferritin level as a strategy to reduce the need for bone marrow biopsy. 29 If these blood tests are indeterminate, an elevated serum transferrin receptor level is recommended to distinguish IDA from anemia of chronic disease. The choice of a ferritin level of less than 45 ng per mL (45 mcg per L) is to allow for a higher sensitivity, despite the fact that most laboratories' normal range for ferritin includes 45 ng per mL.