Current Awareness in Aging Research (CAAR) Report #575 -- February 17, 2011

CAAR (Current Awareness in Aging Research) is a weekly email report produced by the Center for Demography of Health and Aging at the University of Wisconsin-Madison that helps researchers keep up to date with the latest developments in the field. For more information, including an archive of back issues and subscription information see:

http://www.ssc.wisc.edu/cdha/caar.html

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I. Reports and articles:

1. US DEPARTMENT OF HEALTH AND HUMAN SERVICES, OFFICE OF THE INSPECTOR GENERAL REPORT: "Comparison of Second-Quarter 2010 Average Sales Prices and Average Manufacturer Prices:Impact on Medicare Reimbursement for Fourth Quarter 2010" (OEI-03-11-00030, February 2011, .pdf format, 20p.).

Abstract:

We identified a total of 25 Healthcare Common Procedure Coding System (HCPCS) codes with average sales prices (ASP) that exceeded average manufacturer prices (AMP) by at least 5 percent in the second quarter of 2010. Of these 25 HCPCS codes, 10 had complete AMP data (i.e., AMP data for every drug product that CMS used to establish reimbursement amounts). If reimbursement amounts for all 10 codes with complete AMP data had been based on 103 percent of the AMPs during the fourth quarter of 2010, we estimate that Medicare expenditures would have been reduced by $713,000 in that quarter alone.

By law, the Office of Inspector General (OIG) must notify the Secretary of Health & Human Services (the Secretary) if the ASP for a particular drug exceeds the drug's AMP by a threshold of 5 percent. If that threshold is met, the Secretary may disregard the ASP for the drug when setting reimbursement and shall substitute the payment amount with the lesser of either the widely available market price or 103 percent of the AMP. This is OIG's 19th report comparing ASPs to AMPs. Although OIG has consistently recommended that CMS develop a price substitution policy and subsequently lower reimbursement for drugs that meet the 5-percent threshold, no price substitutions have been made to date. In July 2010, CMS published a proposed rule that, among other things, specified the circumstances under which AMP-based price substitutions would occur. However, the agency has opted not to finalize the price substitution policy from the proposed rule.

The remaining 15 of 25 HCPCS codes also met the 5-percent threshold in the second quarter of 2010 but did not have AMP data for every drug product that CMS used when calculating reimbursement. For 5 of the 15 codes, price reductions may be legitimately warranted because missing AMPs likely had little influence on the pricing comparison results for these codes. We could not compare ASPs and AMPs for an additional 54 HCPCS codes because AMP data were not submitted for any of the NDCs that CMS used to calculate reimbursement. Manufacturers for 16 percent of those drug products had Medicaid drug rebate agreements and were therefore generally required to submit AMPs. OIG will continue to work with CMS to evaluate and pursue appropriate actions against manufacturers that fail to submit required pricing data.

http://oig.hhs.gov/oei/reports/oei-03-11-00030.pdf

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2. US DEPARTMENT OF JUSTICE NEWS RELEASE: "Medicare Fraud Strike Force Charges 111 Individuals for More Than $225 Million in False Billing and Expands Operations to Two Additional Cities" (Feb. 17, 2011).

http://www.justice.gov/opa/pr/2011/February/11-ag-202.html

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3. US GOVERNMENT ACCOUNTABILITY OFFICE REPORT: "Medicare Home Oxygen: Refining Payment Methodology Has Potential to Lower Program and Beneficiary Spending" (GAO-11-56, January 2011, HTML and .pdf format, 53p.).

http://www.gao.gov/products/GAO-11-56

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4. US NATIONAL CENTER FOR HEALTH STATISTICS REPORT: "Detailed 2010 Health Insurance by Selected Demographics from the National Health Interview Survey" (February 2011, .pdf format, 4p.).

http://www.cdc.gov/nchs/data/health_policy/Health_Insurance_Selected_Characteristics_Jan_June_2010.pdf

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5. US NATIONAL INSTITUTES OF HEALTH NEWS RELEASE: "NIH study finds two pesticides associated with Parkinson's disease" (Feb. 11, 2011).

http://www.nih.gov/news/health/feb2011/niehs-11.htm

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6. US SOCIAL SECURITY ADMINISTRATION PERIODICAL: "International Update, February 2011 (February 2011, HTML and .pdf format, 3p.).

http://www.ssa.gov/policy/docs/progdesc/intl_update/2011-02/index.html

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7. WISCONSIN DEPARTMENT OF HEALTH SERVICES REPORT: "Wisconsin Deaths, 2009" (February 2011, .pdf format, 88p.).

http://www.dhs.wisconsin.gov/deaths/index.htm

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8. AARP PUBLIC POLICY INSTITUTE FACTSHEET: "The Employment Situation, January 2011: Unemployment Down but Overall Job Growth Remains Anemic," by Sara E. Rix (February 2011, .pdf format, 7p.).

http://www.aarp.org/work/job-hunting/info-02-2011/fs210-economic.html

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9. BOSTON COLLEGE CENTER FOR RETIREMENT RESEARCH ISSUE BRIEF: "The Impact of Pensions on State Borrowing Costs," by Alicia H. Munnell, Jean-Pierre Aubry, and Laura Quinby (SLP#14, February 2011, .pdf format, 18p.).

http://crr.bc.edu/briefs/the_impact_of_pensions_on_state_borrowing_costs.html

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10. INSTITUTE FOR RESEARCH ON PUBLIC POLICY [MONTREAL, QUEBEC, CANADA] REPORT: "Residential Long-Term Care for Canadian Seniors Nonprofit, For-Profit or Does It Matter?" by Margaret J. McGregor and Lisa A. Ronald (IRPP Study No. 14, January 2011, .pdf format, 48p.).

http://www.irpp.org/pubs/IRPPstudy/2011/IRPP_Study_no1.pdf

More information about IRPP:

http://www.irpp.org/about/index.php

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11. KAISER FAMILY FOUNDATION PRIMER, ISSUE BRIEF:

A. "A Primer on Medicare Financing," by Lisa Potetz, Juliette Cubanski, and Tricia Neuman (February 2011, .pdf format, 20p.).

http://www.kff.org/medicare/7731.cfm

B. "Reaching for the Stars: Quality Ratings of Medicare Advantage Plans, 2011" (February 2011, .pdf format, 11p.).

http://www.kff.org/medicare/8151.cfm

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12. UK HEALTH SERVICE OMBUDSMAN REPORT: "Care and compassion? Report of the Health Service Ombudsman on ten investigations into NHS care of older people," (February 2011, .pdf format, 44p.).

http://www.ombudsman.org.uk/care-and-compassion/home

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13. URBAN INSTITUTE REPORT, WEBCAST:

A. "Unemployment Statistics on Older Americans," by Richard W. Johnson, Corina Mommaerts, Janice Park (Updated Feb. 4, 2011, .pdf format, 11p.).

http://www.urban.org/publications/411904.html

B. "Retirement, Poverty, and Nutrition Assistance," by Sheila R. Zedlewski (February 2011, video running time: 6 minutes, 1 second).

http://www.urban.org/publications/500212.html

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14. PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES ARTICLE ABSTRACT: "Serotonin reverts age-related capillarization and failure of regeneration in the liver through a VEGF-dependent pathway," by Katarzyna Furrer, Andreas Rickenbacher, Yinghua Tian, Wolfram Jochum, Anne Greet Bittermann, Andres Kach, Bostjan Humar, Rolf Graf, Wolfgang Moritz, and Pierre-Alain Clavien (Vol. 108, No. 7, Feb. 15, 2011, p. 2945-2950).

http://www.pnas.org/content/108/7/2945.abstract?etoc

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15. NATURE LETTER ABSTRACT: "Lifespan extension induced by AMPK and calcineurin is mediated by CRTC-1 and CREB," by William Mair, Ianessa Morantte, Ana P. C. Rodrigues, Gerard Manning, Marc Montminy, Reuben J. Shaw, and Andrew Dillin (Vol. 470, No. 7334, Feb. 17, 2011, p. 404-408).

http://www.nature.com/nature/journal/v470/n7334/abs/nature09706.html

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II. Journal Tables of Contents (check your library for availability):

16. Age and Ageing (Vol. 40, No. 2, March 2011).

http://ageing.oxfordjournals.org/content/40/2.toc?etoc

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17. AMEDEO MEDICAL LITERATURE: Note: "AMEDEO has been created to serve the needs of healthcare professionals, including physicians, nurses, pharmacists, administrators, other members of the health professions, and patients and their friends. They can easily access timely, relevant information within their respective fields... All AMEDEO services are free of charge. This policy was made possible thanks to generous unrestricted educational grants provided by AMGEN, Berlex, Eisai, Glaxo Wellcome, Novartis, Pfizer, Roche, and Schering AG."

A. Osteoporosis: Literature for the week of Feb. 14, 2011:

http://www.amedeo.com/medicine/ost.htm

B. Alzheimer's Disease: Literature for the week of Feb. 14, 2011:

http://www.amedeo.com/medicine/ad.htm

C. Parkinson's Disease: Literature for the week of Feb. 14, 2011:

http://www.amedeo.com/medicine/pd.htm

D. Prostate Cancer: Literature for the week of Feb. 14, 2011:

http://www.amedeo.com/medicine/prc.htm

E. Stem Cell Research: Literature for the week of Feb. 14, 2011:

http://www.amedeo.com/medicine/stc.htm

F. Ophthalmology: Literature for the week of Feb. 14, 2011:

http://www.amedeo.com/medicine/eye.htm

AMEDEO Literature Guide:

http://www.amedeo.com/index.htm

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III. Websites of Interest:

18. KAISER FAMILLY FOUNDATION STATEHEALTHFACTS.ORG WEBSITE UPDATES:

A. "Number of Persons Served for Hospital Outpatient Services Under Medicare, 2009 (February 2011).

http://www.statehealthfacts.org/comparetable.jsp?ind=336&cat=6

B. "Number of Medicare Prescription Drug Plans (PDPs), 2011" (January 2011).

http://www.statehealthfacts.org/comparemaptable.jsp?ind=315&cat=6

C. "Medicare Beneficiaries with Creditable Prescription Drug Coverage by Type, February 2010" (January 2011).

http://www.statehealthfacts.org/comparetable.jsp?ind=307&cat=6

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It is not by muscle, speed, or physical dexterity that great things are achieved, but by reflection, force of character, and judgement; and in these qualities old age is usually not only not poorer, but is even richer

Cicero--106-43 B.C.

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Jack Solock
Director--Data and Information Services Center
Social Sciences Research Services
3313 Social Science
University of Wisconsin-Madison
Madison, WI 53706
608-262-9827
jsolock@ssc.wisc.edu
http://www.disc.wisc.edu/
http://www.disc.wisc.edu/reports/cssrindex.html
http://www.ssc.wisc.edu/cdha/pubs/caar/back_iss.html