Current Report Articles
Federal Focus

Federal Focus (Sept. 18, 2020) – Report on Cost to U.S. of PhRMA Strategies to Circumvent Generic Competition
A report commissioned by the Coalition for Affordable Prescription Drugs describes one tactic – "product hopping" – that name-brand drug manufacturers used to circumvent generic competition by tweaking product formulations, costing the U.S. health system an estimated $4.7 billion annually for just five products. Product hopping is described in the report as a strategy used to extend the patent life of brand name products without making clinically significant changes.

CMS Reminds Hospitals of HCAHPS Submission Deadline
Wednesday, Oct. 7, is the submission deadline for the Hospital Consumer Assessment of Healthcare Providers and Systems patient perspectives on care survey data for second quarter 2020 discharges (April 1 – June 30). On March 27, the Centers for Medicare & Medicaid Services announced that all providers are excepted from the reporting of Hospital Inpatient Quality Reporting Program measure data for the October 2020 submission deadline; however, all participating hospitals are encouraged to submit data if they can.

CMS Announces ACO Investment Model Report
The Centers for Medicare & Medicaid Services published a summary of a study about the Accountable Care Organization Investment Model operated under the Shared Savings Program. According to the report, the net savings to the Medicare program was $108.4 million in 2016, $153.4 million in 2017 and $119.7 million in 2018. According to CMS, "ACOs were successful in reducing total Medicare spending and related utilization without decreasing the quality of care they provided."

CMS Releases NOFO for CHART Model
The Centers for Medicare & Medicaid Services released the Notice of Funding Opportunity for the Community Health Access and Rural Transformation Model, a program under the Centers for Medicare & Medicaid Services Innovation Center. Applications are due by Feb. 16, 2021. The CHART Model will consist of 15 lead organizations that represent rural communities for the purpose of working closely with key model participants to drive health care delivery system redesign.

CMS Releases 2022 MA Advance Notice
The Centers for Medicare & Medicaid Services released Part I of the calendar year 2022 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part C and Part D Payment Policies. The notice includes information about the Part C CMS-Hierarchical Conditions Categories risk adjustment model. CMS also released Part I of the notice to provide plans with earlier notification of proposed payment changes. The earlier notification is being made available to help plans deal with the uncertainty associated with the COVID-19 pandemic.

CMS Selects Hospitals for OQR CY 2022 Validation
The Centers for Medicare & Medicaid Services selected hospitals for validation of chart-abstracted measures for the calendar year 2022 annual payment update determination. The list of hospitals and associated validation resources are available on QualityNet.

TJC Posts Specifications Manual Version 2020B2
The specifications manual for The Joint Commission National Quality Measures, version 2020B2, and associated release notes have been posted to TJC's website. Key changes made to the manual include updates to the measure information forms for SUB-2a and TOB-2a denominator populations and a clarification to these algorithms related to the denominator populations. Version 2020B2 is effective with discharges July 1 through Dec. 31, 2020. 

MLN Connects Provider eNews Available
The Centers for Medicare & Medicaid Services issued updates to MLN Connects Provider eNews. eNews includes information about national provider calls, meetings, events, announcements and other MLN educational product updates. The latest issue provides updates and summaries of the following:

Commonwealth Fund Releases 2020 Scorecard on State Health System Performance
The Commonwealth Fund released the 2020 Scorecard on State Health System Performance. The report ranks states based on various metrics, including a composite ranking. The composite ranking is based on how well each state performs in avoidable use/cost, healthy lives, income disparity, prevention treatment and access/affordability. The report also ranks states based on commercial payment rates.

UnitedHealthcare Announces Laboratory Test Registry Protocol
UnitedHealthcare announced that effective Jan. 1, 2021, "in-network, freestanding and outpatient laboratory claims for most laboratory testing services must contain your laboratory's unique test code." UHC also states that claims must match a corresponding laboratory test registration. The new laboratory test registry protocol applies to Medicare Advantage, UHC commercial and UHC community plan networks. To ensure compliance, UHC recommends that labs should register their lab tests before Dec. 1. FAQs are available on both the tool and the protocol. UHC also have begun hosting a series of webinars beginning this week.