Current Awareness in Aging Research (CAAR) Report #474--February 12, 2009

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:


I. Reports and articles:

1. US CENSUS BUREAU REPORT: "The Geographic Distribution and Characteristics of Older Workers in Nevada: 2004," by Cynthia Taeuber and Matthew R. Graham (Local Employment Dynamics LED-OW04-NV, February 2009, .pdf format, 12p.).

Scroll to "Nevada."


2. US SOCIAL SECURITY ADMINISTRATION OFFICE OF POLICY REPORT: "Income of the Population 55 or Older, 2006" (February 2009, HTML, .pdf, and Microsoft Excel format, 337p.).



A. "Scientists Discover Key Factor in Controlling the Breakdown of Bone" (Feb. 8, 2009).

B. "Compound Can Distinguish Between Benign Tissue and Localized and Metastatic Prostate Cancer" (Feb. 11, 2009).


4. US GOVERNMENT ACCOUNTABILITY OFFICE REPORT: "Social Security Administration: Service Delivery Plan Needed to Address Baby Boom Retirement Challenges" (GAO-09-24, January 2009, HTML and .pdf format, 40p.).



A. "Medicaid and Medicare Home Health Payments for Skilled Nursing and Home Health Aide Services" (OEI-07-06-00641, 8p.).


Payment policies for home health services create vulnerabilities that may lead to Medicaid and Medicare paying for the skilled nursing and home health aide services. The claims information available to Medicaid payors does not allow them to ensure the appropriateness of payments.

Medicare pays home health providers through the prospective payment system (PPS) for services provided during episodes of care. For Medicaid services, we limited our review to fee-for-service claims. Medicaid is the payor of last resort; therefore, Medicaid should pay for home health services only if Medicare or another payor does not pay for them. During the period reviewed, we identified Medicaid payments amounting to $3.3 million for 68,765 skilled nursing and home health aide claims potentially coverable by Medicare. We reviewed a sample of beneficiaries' case records to determine whether the Medicaid payments were appropriate based on Medicaid and Medicare policies. A companion report entitled "Duplicate Medicaid and Medicare Home Health Payments: Medical Supplies and Therapeutic Services "(OEI-07-06-00640) describes the extent to which both Medicaid and Medicare paid home health providers for the same medical supplies and therapeutic services.

We found that payment policies create vulnerabilities that may lead to Medicaid and Medicare paying for the same services. Medicaid paid nearly $2 million for skilled nursing and home health aide services that were also vulnerable to being paid by Medicare in four of five States. Problems with coordination of care between providers and a lack of clarity in the Medicare coverage policy regarding billing for unskilled and skilled nursing services contributed to vulnerabilities. Claims data do not contain sufficient information to determine the appropriateness of Medicare coverage, limiting States' abilities to prevent Medicaid payments for services covered by Medicare.

CMS could consider methods to better integrate Medicaid and Medicare claims processing to prevent duplicate payments without relying on medical review and provide greater clarity in the CMS "Medicare Benefit Policy Manual" to explain that unskilled services provided during a skilled nursing visit paid under the PPS are included in the PPS payment.

B. "Medicare Payments in 2007 for Medical Equipment and Supply Claims With Invalid or Inactive Referring Physician Identifiers" (OEI-04-08-00470, February 2009, .pdf format, 14p.).


Medicare allowed almost $34 million in 2007 for medical equipment and supply claims with physician identification numbers that had never been issued or had been deactivated by the Centers for Medicare & Medicaid Services (CMS). The $34 million included $5 million for claims with dates of service after the physicians identified on the claims had died. Medicare payments for medical equipment and supplies are authorized only when the items are ordered by physicians and meet coverage requirements. Claims from providers of medical equipment and supplies with invalid or inactive physician identification numbers should not be paid. From May 2005 to May 2008, Medicare accepted claims that included unique physician identification numbers (UPIN), national provider identifiers (NPI), or a combination of both. (Since May 2008, Medicare has only accepted claims that include NPIs.) Both physicians and suppliers must apply for and obtain NPIs from CMS. As of May 2008, suppliers are required to include their own NPIs in the primary provider field on claims, and the referring physician's NPI in the secondary provider field. However, CMS instituted a temporary provision that allows suppliers who cannot obtain referring physicians' NPIs to instead use their own NPIs in the secondary provider field.

We found that Medicare allowed over $6 million in 2007 for claims with invalid referring physician UPINs that had never been issued by CMS. During the same year, Medicare also allowed almost $28 million for claims with referring physician UPINs that CMS had deactivated, including $5 million for claims with a date of service after the physician identified on the claims had died. Medicare also allowed over $300,000 for claims with invalid referring physician NPIs in 2007.

We recommend that CMS determine why Medicare claims with identifiers associated with deceased referring physicians continue to be paid, implement claims-processing system changes to ensure that NPIs for both referring physicians and suppliers listed on medical equipment and supply claims are valid and active, emphasize to suppliers the importance of using accurate NPIs for both referring physicians and suppliers when submitting Medicare claims, and determine the earliest date to end the provision that allows suppliers to submit claims without referring physician NPIs while maintaining beneficiary access to services. CMS concurred with our recommendations and stated that it has taken steps, incorporating the recommendations from our report, toward correcting the problems we identified.

C. "Comparison of Second-Quarter 2008 Average Sales Prices and Average Manufacturer Prices: Impact on Medicare Reimbursement for Fourth Quarter 2008" (OEI-03-09-00050, .pdf format, 20p.).


Using a revised payment methodology recently implemented by CMS, we identified a total of 31 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 2008. If reimbursement amounts for these 31 codes had been based on 103 percent of the AMPs, Medicare expenditures would have been reduced by $3.5 million during the fourth quarter of 2008.

Pursuant to section 1847A(d)(3) of the Social Security Act (the Act), OIG must notify the Secretary of the Department of Health and 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, section 1847A(d)(3) of the Act grants the Secretary authority to disregard the ASP for that drug and substitute the payment amount for the drug code with the lesser of the widely available market price for the drug (if any) or 103 percent of the AMP. This is OIG's 10th report comparing ASPs to AMPs; however, CMS has yet to make any changes to reimbursement as a result of OIG's findings.

Of the 31 HCPCS codes that met the threshold for price adjustment, 10 had AMP data for every drug product that CMS used to establish reimbursement amounts. Eight of the 10 HCPCS codes were previously eligible for price adjustment under the revised payment methodology, with 3 codes meeting the 5-percent threshold in each of the past six quarters, dating back to the first quarter of 2007. The remaining 21 of 31 HCPCS codes also met the 5-percent threshold in the second quarter of 2008 but did not have AMP data for every drug product that CMS used when calculating reimbursement. We could not compare ASPs and AMPs for 68 HCPCS codes because AMP data were not submitted for any of the drug products that CMS used to calculate reimbursement. Manufacturers for almost one-fifth of these 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 data.


6. US DEPARTMENT OF AGRICULTURE, ECONOMIC RESEARCH SURVEY REPORT: "Declining Orange Consumption in Japan: Generational Changes or Something Else?" by Hiroshi Mori, Dennis Clason, Kimiko Ishibashi, William D. Gorman, and John Dyck (Economic Research Report No. ERR-71, February 2009, .pdf format, 23p.).


7. EUROPEAN COMMISSION EUROSTAT REPORT: "Demographic Outlook" (January 2009, .pdf format, 65p.).,46587259&_dad=portal&_schema=PORTAL&p_product_code=KS-RA-08-013



A. "24 Million Dollars in Zero Real Interest Loans--More Nursing Home Beds and Support from Rudd Labor Government" (Feb. 5, 2009).

B. "Elliot: Older Australians--Heatwave Response" (Feb. 6, 2009).


9. IRELAND CENTRAL STATISTICS OFFICE/AN PHRIOMH-OIFIG STAIDRIMH REPORT: "Irish Life Tables No. 15 2005-2007" (January 2009,.pdf format, 16p.).


10. UK DEPARTMENT OF HEALTH REPORT: "Living well with dementia: A National Dementia Strategy" (February 2009, .pdf format, 100p.).



A. "Incentives to save for retirement: understanding, perceptions and behaviour: A literature review," by Roger Wicks and Sarah Horack (Research Report 562, February 2009, .pdf format, 56p.).

B. "Saving for retirement: Implications of pensions reforms on financial incentives to save for retirement" (Research Report 558, February 2009, .pdf format, 141p.).

C. "Empowering engagement: a stronger voice for older people. The Government response to John Elbournes review" (February 2009, .pdf format, 48p.).


12. AARP FACT SHEET: "Little to Cheer About: Unemployment and the Older Worker--December 2008," by Sara E. Rix (January 2009, HTML and .pdf format, 2p.).



A. "The High Cost of Estate Tax Repeal," by Chye-Ching Huang (January 2009, HTML and .pdf format, 3p.).

B. "Proponents of Estate Tax Repeal Resurrecting Old Misconceptions," by Chye-Ching Huang (February 2009, HTML and .pdf format, 3p.).

More information about CBPP:


14. EMPLOYEE BENEFITS AND RESEARCH INSTITUTE ARTICLE: "Retirement Plan Participation: Survey of Income and Program Participation (SIPP) Data, 2006," by Craig Copeland (EBRI Notes, Vol. 30, No. 2, February 2009, .pdf format, 14p.).



A. "Revisiting 'Skin in the Game' Among Medicare Beneficiaries: An Updated Analysis of the Increasing Financial Burden of Health Care Spending From 1997 to 2005," by Tricia Neuman, Juliette Cubanski, and Anthony Damico (Data update, February 2009, .pdf format, 7p.).

B. "Medicare and HIV/AIDS" (fact sheet updated in February 2009, .pdf format, 2p.).



A. "Federal Taxes and the Elderly," by Rudolph G. Penner (October 2008, .pdf format, 5p.).

B. "The Economic Recovery Package Will Help Poor Older Adults, but More Could Be Done," by Sheila R. Zedlewski (February 2009, .pdf format, 6p.).

C. "Unemployment Rate Soars for Older Men with Limited Education," by Richard W. Johnson and Corina Mommaerts (February 2009, .pdf format, 4p.).


17. EUROPEAN NETWORK OF ECONOMIC POLICY RESEARCH INSTITUTES REPORT: "Measuring The Sustainability Of Pension Systems Through A Microsimulation Model: The Case Of Italy," by Flavia Coda Moscarola (ENEPRI Research Report 66, January 2009, .pdf format, 16p.).


Many countries have recently enacted radical reforms to their pension systems to recover longterm financial sustainability. One measure has been to introduce an actuarially fair pension rule. A system that grants actuarially fair benefits is not only fair across individuals and generations, i.e. it grants equality of treatment, but is also sustainable in the long run. In this paper, we take Italy as a case study and use a microsimulation model--an instrument able to monitor actuarial fairness of the pension rules in a less conventional approach--to analyse the phasing-in of the reforms and their ability to recover the long-term sustainability of the system.


18. PUBLIC LIBRARY OF SCIENCE (PLOS) ONE ARTICLE: "Confusion and Conflict in Assessing the Physical Activity Status of Middle-Aged Men," by Dylan Thompson, Alan M. Batterham, Daniella Markovitch, Natalie C. Dixon, Adam J. S. Lund, and Jean-Philippe Walhin (PLoS ONE 4(2): e4337. doi:10.1371/journal.pone.0004337, XML, HTML, and .pdf format, 8p.).



A. "Protection of synapses against Alzheimer's-linked toxins: Insulin signaling prevents the pathogenic binding of A{beta} oligomers," by Fernanda G. De Felice, Marcelo N. N. Vieira, Theresa R. Bomfim, Helena Decker, Pauline T. Velasco, Mary P. Lambert, Kirsten L. Viola, Wei-Qin Zhao, Sergio T. Ferreira, and William L. Klein (Vol. 106, No. 6, Feb. 10, 2009, HTML and .pdf format, p. 1971-1976). This article is available free of charge.

B. "Apolipoprotein E e4 is associated with disease-specific effects on brain atrophy in Alzheimer's disease and frontotemporal dementia," by Federica Agosta, Keith A. Vossel, Bruce L. Miller, Raffaella Migliaccio, Stephen J. Bonasera, Massimo Filippi, Adam L. Boxer, Anna Karydas, Katherine L. Possin, and Maria Luisa Gorno-Tempini ((Vol. 106, No. 6, Feb. 10, 2009, p. 2018-2022).



A. "Effects of Care Coordination on Hospitalization, Quality of Care, and Health Care Expenditures Among Medicare Beneficiaries: 15 Randomized Trials," by Deborah Peikes, Arnold Chen, Jennifer Schore, and Randall Brown (Article abstract, Vol. 301, No. 6, Feb. 11, 2009, p. 603-618).

B. "Referring a Patient and Family to High-Quality Palliative Care at the Close of Life: 'We Met a New Personality . . . With This Level of Compassion and Empathy'," by Joan M. Teno, and Stephen R. Connor (Clinician's Corner abstract, Vol. 301, No. 6, Feb. 11, 2009, p. 651-659).

C. "The Elusive Quest for Quality and Cost Savings in the Medicare Program," by John Z. Ayanian (Editorial extract, Vol. 301, No. 6, Feb. 11, 2009, p. 668-670).


21. NEW ENGLAND JOURNAL OF MEDICINE PERSPECTIVES: "Reforming Medicare's Physician Payment System," by Gail R. Wilensky (Vol. 360, No. 7, Feb. 12, 2009, HTML and .pdf format, p. 653-655). This article is available free of charge.



A. "Dementia," by Alistair Burns and Steve Iliffe (BMJ 2009;338:b75, Feb. 5, 2009).

B. "Alzheimers disease," by Alistair Burns and Steve Iliffe (BMJ 2009;338:b158, Feb. 5, 2009).


II. Working Papers:

23. UNIVERSITY OF WISCONSIN CENTER FOR DEMOGRAPHY AND ECOLOGY: "Mid-life Work Experiences and First Retirement," by James M. Raymo, John R. Warren, Megan M. Sweeney, Robert M. Hauser, and JeongHwa Ho (CDE Working Paper No. 2008-14, January 2009, .pdf format, 41p.).


In the rapidly changing context of retirement, it is important to reevaluate theoretical and empirical linkages between individual life histories and patterns of work in later-life. In this study, we use data from the Wisconsin Longitudinal Study to examine relationships between multiple measures of mid-life work experiences and the timing and nature of first retirement. We show that employment stability, occupational mobility, self-employment, and union membership across the life course are all associated with the timing of first retirement. We also demonstrate that characteristics of mid-career employment are associated with the relative likelihood of retiring for health reasons and reemployment following retirement. Consistent with earlier research, we find that these relationships between work histories and retirement outcomes are mediated to some extent by pre-retirement differences in economic circumstances and private pension eligibility. Importantly, however, several aspects of work histories remain significantly related to retirement timing and pathways even after controlling for a wide array of established correlates.


24. MAX PLANCK INSTITUTE FOR DEMOGRAPHIC RESEARCH: "Do only new brooms sweep clean? A review on workforce age and innovation," by Katharina Frosch (WP-2009-005, February 2009, .pdf format, 29p.).


The relationship between age and creative performance has been found to follow a hump-shaped profile in the arts and sciences, and in great technological achievement. Accordingly, accelerating workforce aging raises concern about whether future capacity to innovate is endangered. This paper provides a review of existing studies exploring age effects on innovative performance, both at the individual and the macro levels. Empirical evidence confirms the hump-shaped relationship between workers ages and innovative performance, with the highest levels of performance seen between ages 30 and 50, depending on the domain. Industrial invention in knowledge-intensive fields, and great invention in general, seem to be a young mans game. Yet in more experience-based fields, innovative performance peaks later, and remains stable until late in the career. Moreover, the quality of invention remains rather stable at older ages. However, individual-level evidence has to be interpreted with caution due to the presence of selectivity biases and unobserved heterogeneity. Studies at the levels of firms, regions, and countries address some of these issues. Results of these studies have indicated that young professionals drive knowledge absorption, innovation, and technological progress, whereas more experienced workers are more relevant in mature technological regimes. Apart from integrating the existing empirical evidence on different levels of aggregation, a strong focus is on methodological issues and conceptual challenges. This review therefore provides a sound basis for further studies on the impact of workforce aging on innovative performance. In addition, promising directions for future research are proposed.


25. VIENNA [AUSTRIA] INSTITUTE OF DEMOGRAPHY: "Agglomeration and population aging in a two region model of exogenous growth," by Theresa Grafeneder-Weissteiner and Klaus Prettner (VID Working Paper 01/2009, February 2009, .pdf format, 33p.).


This article investigates the effects of introducing demography into the New Economic Geography. We generalize the constructed capital approach, which relies on infinite individual planning horizons, by introducing mortality. The resulting overlapping generation framework with heterogeneous individuals allows us to study the effects of ageing on agglomeration processes by analytically identifying the level of trade costs that triggers catastrophic agglomeration. Interestingly, this threshold value is rather sensitive to changes in mortality. In particular, the introduction of a positive mortality rate makes the symmetric equilibrium more stable and therefore counteracts agglomeration tendencies. In sharp contrast to other New Economic Geography approaches, this implies that deeper integration is not necessarily associated with higher interregional inequality.



A. "Estate Taxation with Warm-Glow Altruism," by Carlos Garriga, and Fernando Schez-Losada (No. 2009-4A, January 2009, .pdf format, 22p.). Links to an abstract and full text are available at:

B. "Generational Policy and the Macroeconomic Measurement of Tax Incidence," by Juan Carlos Conesa, and Carlos Garriga (No. 2009-3A, January 2009, .pdf format, 34p.). Links to an abstract and full text are available at:


27. URBAN INSTITUTE: "The Disappearing Defined Benefit Pension and Its Potential Impact on the Retirement Incomes of Boomers," by Barbara Butrica, Howard Iams, Karen E. Smith, Eric Toder (Discussion Paper, January 2009, .pdf format, 50p.).


28. CENTRE OF POLICY STUDIES AND THE IMPACT PROJECT (MONASH UNIVERSITY) [CLAYTON, VICTORIA, AUSTRALIA] REPORT: "Population Ageing and Structural Adjustment," by James Giesecke and G.A. Meagher (General Paper No. G-181, January 2009, .pdf format, 48p.).


The future effects of population ageing on the Australian economy have been widely canvassed in recent years, most notably in the two Intergenerational Reports produced by the Australian Treasury and in the Economic Implications of an Ageing Australia report produced by the Productivity Commission. These reports are mainly concerned with the effect of ageing on the governments budgetary position. On the income side, they focus on how ageing affects labour supply and gross domestic product. On the expenditure side, they focus on how ageing affects various spending categories including education, health and aged care. This paper provides a complementary analysis in that it considers how the structure of the economy is likely to be affected by these influences. In particular, it analyses the effects on 64 skill groups, 81 occupations and 106 industries. The effects are modelled by comparing two economies: a basecase in which population ageing takes place, and an alternative (counterfactual) economy in which the age structure of the population

-- insofar as it affects workforce participation rates and hours worked per week - remains unchanged. In the interests of transparency, the total effect of population ageing is decomposed into:

-- a scale effect due to age-related shifts in total hours of employment (with the skill composition of employment unchanged

-- a skill effect due to age-related shifts in hours of employment distinguished by skill (with total hours of employment unchanged),

-- a taste effect due to age-related shifts in the commodity composition of household final consumption, and

-- a public effect due to age-related shifts in government final consumption. The simulations are conducted using the MONASH applied general equilibrium model of the Australian economy. They generate results for each year from 2004-05 to 2024-25, but the analysis concentrates on explaining the deviations in the levels of selected variables in the basecase (ageing) simulation from their values in the counterfactual (no ageing) simulation in the final year, i.e., 2024-25. Results are reported separately for each of the four effects and for all four taken together (the total effect). The paper pays particular attention to the implications of the analysis for economic policy.


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

29. American Journal of Epidemiology (Vol. 169, No. 4, Feb. 15, Vol. 169, No. 5, Mar. 1, 2009 ).

Vol. 169, No. 4:

Vol. 169, No. 5:

30. American Journal of Public Health (Vol. 99, No. 3, March 2009). Full text of this journal is available in the ProQuest Research Library and the EBSCO Host Academic Search Elite Database. Check your library for availability of these databases and this issue.

31. Family and Consumer Sciences Research Journal (Vol. 37, No. 3, March 2009). Full text of this journal is available in the ProQuest Research Library. Check your library for availability of this database and issue.

32. Journal of Aging and Health (Vol. 21, No. 2, April 2009). Full text of this journal is available in the ProQuest Research Library. Check your library for availability of this database and issue.


33. 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. 11, 2009:

B. Alzheimer's Disease: Literature for the week of Feb. 11, 2009:

C. Parkinson's Disease: Literature for the week of Feb. 11, 2009:

D. Prostate Cancer: Literature for the week of Feb. 11, 2009:

E. Stem Cell Research: Literature for the week of Feb. 11, 2009:

F. Ophthalmology: Literature for the week of Feb. 11, 2009:

AMEDEO Literature Guide:


IV. Funding Opportunities/Employment Opportunities:

34. AGEWORK.COM: AgeWork has updated its employment page with listings through Feb. 12, 2009.


V. Conferences:

35. CONFERENCEALERTS.COM CONFERENCES IN AGING: has added the following conferences to its Gerontology section:

26th Annual Minnesota Geriatric Care Conference (Mar. 25, 2009, in Rochester, Minnesota)

Emotions, Stress and Aging (Jun 25, 2009 in Geneva, Switzerland)

International Workshop on the Socio-Economics of Ageing (Oct. 30, 2009 in Lisbon, Portugal)

For information on these and other aging related conferences see:


36. INTUTE: SOCIAL SCIENCES: Intute has updated it's Sociology conferences page with a new conference:

An Aging Society: Are We Prepared?--Oxford, UK, Mar. 7, 2009).

Scroll to or "find in page" "An Aging Society" (without the quotes).


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.


Jack Solock
Director--Data and Information Services Center
Social Sciences Research Services
3313 Social Science
University of Wisconsin-Madison
Madison, WI 53706
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