No. An organization that measures its physicians every two years can meet the requirement by seeking feedback and assessing the program every two years.
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11.15.2012 Timing for Program Input In the Element B explanation under the head Feedback Timeframe requires the organization to seek feedback annually and Element C _ Program Impact requires the organization annually asses the program. Does the organization have to carry out these activities annually if its measurement cycle is every two years?
11.15.2012 Use of patient experience data collected from external organizations Is the use of patient experience data considered part of the program in the following circumstances: 1. The organization incorporates third-party performance information data with its own and then takes action on it (i.e., integrates the third-party data with its own to develop a composite that it reports or uses as the basis of action, such as payment or network or benefit design) 2. The organization provides a link for members on a third-party site so the member can review that information?
For scenario 1, the data must be considered as part of the program being reviewed for PHQ because the organization has incorporated the data with its own or tailored the data and then used the data as a basis for its own action (e.g., reporting, payment or network or benefit design). For scenario 2, if _ as part of its program _ the organization simply provides a link to an external source of performance information on physicians without altering that data and represents it as such, and the organization does not take any action based on the data (e.g., pay any incentive or use data for network or benefit design) then it is not considered part of the program.
This applies to the following Programs and Years:
PHQ 201311.15.2012 Must-Pass: PQ 1 Element A Is PHQ 1, Element A a must-pass element? If so, is the change permanent?
11.15.2012 Frequency of re-measurement For plans using patient experience measures, must re-measurement occur every two years to meet Element E?
11.15.2012 WHP Performance Measure Reporting What is the process for reporting performance measure results for Accredited With Performance Reporting (AWPR) status?
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.
This applies to the following Programs and Years:
WHP 201311.15.2012 Attribution Do the NQF or HEDIS provider-level measurement specifications define attribution? For example, to whom to attribute performance: the diagnosing MD, prescribing MD, provider with most encounters and so on? If not, does this not result in variation?
Neither NQF nor HEDIS provider-level measures specifications require a specific attribution method, although HEDIS measures provide options for an organization to consider. While this might result in variation from one organization to another, there is currently no single industry standard method for attribution.
This applies to the following Programs and Years:
PHQ 201311.15.2012 Defining "Taking Action" Is there a new definition of taking action in the 2013 PHQ Standards?
Yes. In prior versions of PHQ, NCQA required organizations to include all programs that met the definition of taking action in the survey, NCQA had a narrower definition. Because under PHQ 2013 organization chooses which programs to include or exclude in a PHQ survey, NCQA has broadened the definition so that if it chooses, an organization may opt to have programs certified that may not have been required under the prior PHQ.
For PHQ 2013, NCQA has defined taking action as: 1) Publicly reporting performance on quality or cost, resource use or utilization; 2) Using performance on quality or cost, resource-use or utilization measures as a basis for network design (such as tiering) or benefit design; 3) Using performance on quality or cost, resource-use or utilization measures to allocate rewards under a systematic, pay-for-performance program; 4) Reporting performance on quality, cost, resource use or utilization to physicians to support referral decisions.
If an organization is interested in certification for a program that includes actions not include an action defined above, it should contact NCQA to determine eligibility.
This applies to the following Programs and Years:
PHQ 201311.15.2012 TDD/TYY requirements May organizations use State Relay services in lieu of offering TDD/TTY services?
11.15.2012 Automatic credit for NQF endorsed surveys Does an organization that uses the NQF-endorsed CAHPS-CG survey receive automatic credit? If not, what is the organizations accountability for confirming factors in the measurement methodology?
An organization does not receive automatic credit for using CAHPS-CG for an NCQA Survey. For Element C, the organization must follow the aspects of the survey methodology outlined in the endorsed specification, and must specify how it will address all other aspects of methodology required by the element.
This applies to the following Programs and Years:
11.15.2012 Tools for readiness evaluations Is there a non-Web based tool available for our organization to use for self-assessment?
An organization can use the PDF version of the standards to assess readiness to undergo a survey, but in order to undergo a survey it must purchase and use the Web-based Interactive Survey System (ISS) Tool. To purchase the PDF version of the standards or the Survey Tool, visit the NCQA Web site (www.ncqa.org) or contact Customer Service at 888-275-7585.
This applies to the following Programs and Years:
PHQ 201311.15.2012 Taking action on cost measures Is an organization prohibited from using cost efficiency if quality results are not available?
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.
