FAQ Directory

No. HEDIS RRU measures are specified for assessment at the plan level, not for measurement of individual physician performance.

Case-mix adjustment considers variations in the health of physicians populations, often defined by age and gender. Severity is a patients degree of illness for a specific mix of conditions (e.g., cancer stages), morbidity or comorbidity. Together, case mix and severity are often called risk. Risk can be either the risk for needing a mix of medical services (utilization and associated costs) or the patients likelihood of achieving a specific level of quality-related outcome.

Risk adjustment may not apply to quality measures, particularly process measures. For quality measures, NCQA requires the organization to demonstrate that it has considered whether to risk-adjust measuresand that it has an explicit methodology if it does and an explicit rationale if it does not. If the organization determines that case-mix and severity adjustment do not apply to a quality measure, it provides documentation that supports the determination. If the organization adjusts measures for case-mix or severity, it provides documentation describing the methodology used.

For Element A, the denominator is all quality measures on which the action is based and the numerator is measures that meet the definition of standardized in the Explanation.

No. Productivity measures are out of scope for the 2008 PHQ standards. Quality, cost, resource use and utilization measures are in scope if the organization takes action based on them.

Factors 1 and 2 are NA if the organization does not change the format of its results from the primary data source. Factors 3 and 4 always apply and are scored irrespective of factors 1 and 2.

No. Changing the referent time period materially alters the measure and would therefore not qualify as a standard measure for Element A.

Patient experience measures endorsed, developed or accepted by the NQF, AQA, AMA PCPI, national accreditors or government agencies may be used, but the organization must follow the measure or instrument specifications as written.

No. Survey prices apply to each discrete survey; NCQA does not apply credit forward to a future survey. Survey pricing reflects the amount and level of resources NCQA dedicates to evaluating an organization and at the time of the Full Certification Survey, NCQA must re-evaluate the organization on all requirements.

NCQA has not made a decision about incorporating the PHQ standards into health plan accreditation. Should NCQA decide to do so, it will put such a proposal out for Public Comment.

NCQA has not decided. All products are periodically evaluated and proposed changes are published for Public Comment before updates are released.

Certification in PHQ, PQ or HQ is valid for two years. Organizations must undergo a survey against the standards at least every two years to maintain their certification status. Provisional Certification is valid for 12 months; it is a temporary option and will not be offered after June 30, 2009.

In measuring physician performance and distinguishing among peers, the organization is required to specify minimum observations or denominators for each measure on which the action is based. Denominators are patient observations, which may include multiple observations for an individual.

Criteria must be defined at the level on which action will be taken.

Note: This applies if the organization uses minimum observations rather than confidence intervals or measure reliability.

NCQA does not prescribe the cost measures an organization selects, though it requires an organization to specify all aspects of its methodology (Element C). In addition, the organization must risk-adjust its measures (Element C, factor 8) and must meet the minimum statistical requirements for measurement error and measure reliability (Element H, factor 2).