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Updates to NCQA’s Heart-Stroke Recognition Program and Diabetes Recognition Program

Enhancements align programs with clinical and reporting developments    

NCQA is making a series of updates to the Heart/Stroke Recognition Program (HSRP) and the Diabetes Recognition Program (DRP) which align with current clinical care guidelines and CMS’ transition to ICD-10. The intent is to make the programs align with current practices for patient care. These enhancements include: 

HSRP 2015 Requirements Updates 

With the guidance of NCQA’s Clinical Programs Committee (CPC), NCQA approved numerous changes for the Heart/Stroke Recognition Program (HSRP) for 2015. These changes were made to align the program with recent changes to American Heart Association and American Cardiology Association1,2  guidelines for lipid control and cholesterol measurement. The changes include the addition of two new measures and the removal of the two measures related to lipid treatment.

HSRP 2015 Requirements

Clinical Measures

Criteria

Proposed Points

Blood Pressure Control

75% of patients in sample

30.0

Use of Aspirin or Another  Antiplatelet

80% of patients in sample

20.0

Smoking and Tobacco Use Status and Cessation and Treatment Assistance

85% of patients in sample

20.0

Body-Mass Index (BMI) Screening

Reporting Only

15.0

Statin Therapy for Patients with  Cardiovascular Disease

Reporting Only

15.0

Total Points

100.0

Points Needed to Achieve Recognition (Passing Threshold)

80.0

Patient Eligibility Criteria

Patient Age Range

  • 18 to 75 years of age


Timeline for HSRP 2015 Changes 

  • Monday, September 21, 2015, HSRP 2015 will be available for pre-sale 
  • September 30, 2015, HSRP 2012 Data Collection Tools will no longer be sold after this date
  • November 2, 2015, HSRP 2015 Data Collection Tools and requirements will be released 
  • January 31, 2016, HSRP 2012 submissions will no longer be accepted after this date 

HSRP 2015 is currently available for pre-order for all interested providers and practices who are seeking recognition under the new requirements.

Transitions to ICD-10 for HSRP 2015 and DRP 2015

Beginning Monday, November 2, 2015, all data submissions for DRP 2015 and HSRP 2015 can be made using either ICD-9 or ICD-10 diagnosis codes. NCQA is aligning with the CMS transition to use of ICD-10 codes for diagnoses and conditions but understands the transition is not complete for all practices. These codes will be used to identify the patient samples in DRP and HSRP. Value sets will be provided which will include all eligible ICD-9 and ICD-10 codes for each program’s respective patient populations.

Price Changes to HSRP 2015 and DRP 2015 Recognition Fees 

NCQA has updated the Pricing & Fee Schedule for both programs. The new pricing will be effective for DRP and HSRP submissions received on or after November 2, 2015. The new pricing schedule also applies to organizations that submit payment prior to November 2, 2015, but submit clinician data after that date. Account balances will be adjusted accordingly. NCQA will review submissions when all fees are paid.

Organizations that pay (or have already paid) the current capped fee of $3000.00 AND submit (or have already submitted) clinicians prior to November 2, 2015, may continue to submit clinicians without paying the additional balance for the remainder of the effective 12-month period. However, if the number of clinicians submitted exceeds 100 during the 12-month period, the surcharge will be applied.

Click here to access the new Pricing & Fee Schedule. 

If you have questions, please contact NCQA Customer Support at 888-275-7585, Monday - Friday, 8:30 - 5:00 ET or you may submit an inquiry via the Policy/Program Clarification System (PCS) at http://ncqa.force.com/pcs/login.

New Payment System for Customers

In December 2015, NCQA will release an electronic payment system for clinicians participating in the Diabetes Recognition and Heart Stroke Recognition programs. The new system will allow customers to pay their application fees through a secure web-based portal.
 


1. Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, Fang MC, Fisher M, Furie KL, Heck DV, Johnston SC, Kasner SE, Kittner SJ, Mitchell PH, Rich MW, Richardson D, Schwamm LH, Wilson JA; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Peripheral Vascular Disease. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:2160–2236. 
https://stroke.ahajournals.org/content/45/7/2160.full.pdf

2. Stone NJ, Robinson J, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC Jr, Watson K, Wilson PWF. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;00:000–000. 
https://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437738.63853.7a.full.pdf