FAQ Directory

No. The organizations program must consider quality in conjunction with cost, resource use or utilization when taking action. However, if the organization is unable to identify standardized measures of quality for a particular specialty or if there is insufficient data on an individual physician, practice or group the organization can act on cost performance when quality performance is not known. This is allowed in order to maximize the availability of performance information but must be handled in a fully transparent manner so that it is very clear when a physician is designated as high value and when they are purely designated as low cost. Refer to the standards _ specifically the explanation in PQ1 D (on page 51) _ for further explanation.

PHQ 2013

Organizations are responsible for reporting NCQA WHP performance measure results exactly as specified if they are seeking AWPR status. Organizations must submit performance measure results to NCQA and attain a score of 50% or higher on WHP 12, Element A.

In order to retain AWPR status, organizations must annually submit performance measure results. Organizations that are NCQA Accredited in Wellness and Health Promotion and want to upgrade to AWPR status must submit measure results by the next annual reporting date (April 15) in any year during the accreditation cycle.

Organizations typically complete the WHP Performance Measures Reporting Tool, an Excel workbook. They send the workbook to an NCQA-Certified Auditor to have their measure results audited before submission. The auditor completes the audit worksheet in the Reporting Tool and locks the workbook, the returns the workbook to the organization, which subsequently submits the tool to NCQA.

WHP 2013

Although patient factors such as noncompliance may affect measure performance rates, an integral role of the physician is to work continuously with patients to educate them on the importance of a specific process or meeting a specific target/goal.

PHQ 2013

For Element F, the organization must demonstrate that it has a process to verify that it has followed the specifications outlined in Element C (e.g., sample sizes, attribution, statistical validity). If the organization uses a vendor to administer the survey, this process may be performed by the vendor, but documentation demonstrating how the element is met must be included for the PHQ Survey.

PHQ 2013

No. An organization is required to purchase a separate survey tool for every program it brings forward. One program operated by an organization such as a corporate parent without variation from region to region may be surveyed using a single tool. An organization that brings forward more than one program must purchase and submit a separate tool for each discrete program it brings forward.

There is a pricing option for derivative programs a derivative program is defined as a program that shares common aspects (e.g. an organization uses the same measures and methodology for a single defined group of physicians but takes a different action (reporting vs. network tiering) as another program its organization brings forward for certification. NCQA can review common aspects once to streamline the survey process (thus the discounted price), although these are distinct programs. To receive a discount, the programs must be brought forward at the same time. Please see the pricing exhibit in the survey agreement. If you need additional information, please contact NCQA Customer Support at (888) 275-7585.

PHQ 2013

The definition of a program is clearly defined in Section 1 of the Policies and Procedures. A physician measurement program includes: 1) A defined group of physicians– the definition must include both physician type (e.g. specialty) and geographic area covered; 2) A defined set of clinical quality, service or patient experience measures– the program may also include a defined set of cost, resource use or utilization measures; 3) A defined methodology for producing measure results; 4) A specific action taken at a specific point in time based on the measure results.

A hospital transparency program includes: 1) A defined group of hospitals– the definition must include both hospital type and location; 2) A defined set of all-payer quality or cost measures whose results are publicly reported at a specific point in time.

Distinct programs are reviewed separately and a certification decision is issued for each. Physician measurement programs and hospital transparency programs are always distinct programs, even when operated by the same legal entity. NCQA reserves the right to determine that programs that are managed in a decentralized manner constitute distinct programs for review.

To the extent that one program is a derivative of another and share common aspects (e.g., an organization uses the same measures and methodology for a single defined physician group but takes two actions [reporting and network tiering]) and the organization seeks verification for both at the same time, NCQA can review common aspects once to streamline the survey process, although these are distinct programs.

PHQ 2013

Element C, Define Methodology requires the organization to have a method for determining measurement error and measure reliability. Element D, Adhere to Key Principles sets requirements for minimum observations or levels of measure reliability or confidence intervalsas applicable for quality and cost, resource use or utilization measures. For calculating measure reliability for PHQ, the organization must use the method described in the Explanation in Element C under the subhead Measurement Error. Measure reliability is defined as the ratio of the variance between physicians to the variance within one physician, plus the variance between physicians. NCQA does not prescribe the method used to calculate confidence intervals because the appropriate method may vary based on the parameter (e.g., mean or proportion).

PHQ 2013

Yes. Patient experience measures are considered measures of quality. The organization may use items or composites from the CAHPS-CG survey. Measure specifications for the CAHPS-CG survey can be found on the AHRQ website (https://cahps.ahrq.gov/clinician_group/).

PHQ 2013

For Element F, the organization must demonstrate that it has a process to verify that it has followed the specifications outlined in Element C (e.g., sample sizes, attribution,statistical validity). If the organization uses a vendor to administer the survey, this process may be performed by the vendor, but documentation demonstrating how the element is met must be included for the PHQ Survey.

PHQ 2013

Though an organization may not have members in the way a health plan does, Web sites have users or consumers who might want to submit complaints (e.g., user complaints). Therefore, to meet the intent of Elements C and D, an organization must have policies and procedures to process, register and respond to consumer complaints; and must provide a documented process and evidence for how it handled those complaints.

PHQ 2013

At this time, there are no standardized (i.e., endorsed) measures of cost, resource use or utilization at the physician level.

PHQ 2013

No. An organization that measures its physicians every two years can meet the requirement by seeking feedback and assessing the program every two years.

PHQ 2013