If information is available to the public–even if it is only available by request–NCQA considers this to be public reporting. Therefore, in this scenario the taking action date is December 1.
FAQ Directory
Here are some of the most frequently asked questions about NCQA’s various programs. If you don’t see what you are looking for in one of the entries below, you can ask a question through My NCQA.
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11.15.2012 Working with Physicians Our organization posts the results of our physician measurement program on our directory on January 1 and any tiered networks or differential benefits are effective that same date. We make the results available to members by request (e.g. the member can call an 800 number to ask about a physicians status in the tiered network) on December 1. Which date _ January 1 or December 1 _ does NCQA consider the action date for the purposes of calculating whether we notify physicians 45 days ahead of action and resolve requests for corrections or changes before taking action?
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 Changing measure specifications With regard to patient experience measures, may we use items from CAHPS-CG but change the referent time period? For example, not rating the last 12 months, but rating the last visit and changing the response categories accordingly?
No. Changing the referent time period materially alters the measure and would therefore not qualify as a standardized measure for Element A. Patient experience measures endorsed, developed or accepted by the NQF, AMA PCPI, national accreditors or government agencies may be used, but the organization must follow the measure or instrument specifications as written.
This applies to the following Programs and Years:
PHQ 201311.15.2012 Measure reliability If a plan demonstrates a different methodology for statistical validity, would the methodology be considered?
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).
This applies to the following Programs and Years:
PHQ 201311.15.2012 HEDIS measures If we use HEDIS measures, will NCQA still look at code?
No. NCQA does not evaluate an organizations code; it reviews the organizations measure specifications and compares them to the original source specification (if applicable). Note that to be considered from a standardized source, the measure must be the version specified for the level measured; e.g. HEDIS physician level measures, not plan level measures.
This applies to the following Programs and Years:
PHQ 201311.15.2012 Certification for information providers May an information provider earn certification for the pieces it provides (e.g., standards, methodology, underlying data), while its customer (i.e., health plan that publishes the information) pursues other pieces (e.g., member communication and complaints, physician communication)?
11.15.2012 Organizational accountability Are organizations responsible for confirming the factors in Element F, or is this the responsibility of an external vendor?
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.
This applies to the following Programs and Years:
PHQ 201311.15.2012 Board Certification Does Board Certification status count as a quality measure?
11.15.2012 Requests for corrections or changes Are organizations responsible for confirming the factors in Element F, or is this the responsibility of an external vendor?
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.
This applies to the following Programs and Years:
PHQ 201311.15.2012 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 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 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.
