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Using NCQA DRP and HSRP Recognition to Meet PCMH 2014 Requirements

Frequently Asked Questions

Some clinicians in our practice have earned NCQA DRP or HSRP Recognition. How many clinicians must be NCQA Recognized before our site receives automatic credit in PMCH 2014?

Practices with four or more clinicians, where 75 percent or more of the clinicians have earned NCQA DRP or HSRP Recognition, can receive automatic credit for some elements and factors in the PCMH 2014 survey if their Recognition status is current when the Survey Tool is submitted to NCQA.

For practices with fewer than four clinicians: If there are two clinicians at a practice site, both must have current DRP or HSRP recognition; if there are three clinicians, two must have current recognition.

How do NCQA reviewers know which clinicians in our office are NCQA Recognized?

Complete the ISS Survey Tool tab labeled “Organizational Background, Recognized Clinicians” for each practice site. List clinicians’ recognition status and the effective dates. This information can also be provided in the survey’s “Notes” section, at the pertinent elements; or, in the “Notes” section, enter “Refer to the Recognized Clinician Listing,” to support responses.

Which PCMH 2014 elements have automatic credit if our practice has the required number of NCQA-Recognized clinicians?

Four factors carry automatic credit; other factors have additional requirements. 
  1. 3E: Implement Evidence-Based Decision Support, factor 2. 
  2. 6A: Measure Performance, factor 3. 
  3. 6F: Report Performance, factor 1 (but only for the 6A: Measure Performance element portion). 
  4. 6F: Report Performance, factor 3 (but only for the 6A: Measure Performance element portion). 
Factors with additional requirements: 
  • Recognition may be used as a baseline for goals in 6D: Implement Continuous Quality Improvement, factor 1. Additional documentation is required to demonstrate the practice’s analysis of performance. 
  • Practices may use the process and data from NCQA Clinical Recognition programs to establish comparative data for 6E: Demonstrate Continuous Quality Improvement, factor 2. Practices must compare at least two sets of DRP or HSRP data. Additional documentation is required to demonstrate the practice’s actions to improve performance. 
  • NCQA DRP or HSRP Recognition satisfies 6F: Report Performance, factor 4 for the 6A: Measure Performance element portion. Additional documentation is required to demonstrate that the practice communicates (e.g., letter, e-mail, mass mailing) that the information is available publicly. 
  • NCQA DRP or HSRP Recognition satisfies the same requirements when group DRP or HSRP Recognition is achieved, in addition to 6F: Report Performance, factor 2, but only for the 6A: Measure Performance element portion.