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.
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11.17.2008 Standardized measures What counts in the denominator for standardized measuresall measures on which action is taken, or all quality measures on which action is taken?
11.17.2008 Quality measures What criteria does NCQA use to determine what constitutes a quality measure vs. another kind of measure?
11.17.2008 Pay for Performance The draft program did not pertain to pay-for-performance programs, whose goal is QI at the practice, not public disclosure. Why was this added to "taking action?"
In the draft standards released for Public Comment in March 2008, NCQA included pay-for-performance but did not use that specific term; instead, we referred to payment strategies. Specifically, NCQA defined the Scope of Review for the majority of elements in PHQ 1 as: NCQA evaluates all measures the organization uses for measuring physician performance for the purpose of taking action.
In the Explanation, NCQA defined taking action as follows.
Publicly reporting physician performance on quality or cost or resource use
Using physician performance on quality or cost or resource use measures as a basis for network design (such as tiering), benefit design or payment strategies
NCQA defined payment strategies in Element M, Using Measure Results as follows.
The organization uses reimbursement to provide incentives for improvement among its physicians, practice sites or medical groups, or uses payment to reward performance.
In the final standards, NCQA used the term pay-for-performance and specifically narrowed the scope of programs included.
11.17.2008 Measure requirements Regarding standardized measures, will the requirement of 70% of measures being standardized increase over time or will it be held constant?
11.17.2008 Delegating PHQ 2 to an NCQA-Certified HIP PHQ has no delegation oversight standard, but information distributed by NCQA in response to HIP Certification indicates that a delegation agreement with an NCQA-Certified HIP is required to receive automatic credit in PHQ 2. Must a health plan show an agreement that meets the six factors typically required by other NCQA delegation standards?
11.17.2008 HEDIS measures If we use HEDIS measures, will NCQA still look at code?
11.17.2008 Requests for corrections or changes What does NCQA look for in file review with regard to requests for corrections or changes?
Element G, Request for Corrections or Changes has four factors. 1. Documentation of the substance of the request 2. Investigation of the request 3. Notification of the specific reasons for the final decision 4. Notification of the outcome prior to taking action on measure results NCQA reviews an organizations documentation to determine if it follows its process for handling physician requests for corrections or changes related to the four factors. In response to inquiries from many organizations, NCQA issued a clarification on the expectations of the process (which is scored in Element F) and the file review against that process. See the Corrections, Clarifications and Policy Changes Web page at www.ncqa.org/tabid/120/Default.aspx.
11.17.2008 Survey Pricing If we go through provisional certification and are then required to go through full certification within 12 months, does our organization get a reduced price?
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.
11.17.2008 Measure specifications Expand on the minimum denominator criteria for quality measures. Do you mean minimum observations per measure? Or minimum observations per provider? Or is that already in the requirements?
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.
11.17.2008 Measure reliability If a plan demonstrates a different methodology for statistical validity, would the methodology be considered?
Element C, Measurement Methodology requires the organization to have a method for determining measurement error and measure reliability. Element H, Principles for Use of Results 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 and measure reliability. 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).
11.17.2008 Survey pricing How much does the PHQ Survey cost?
The cost of a PHQ Survey is based on survey and evaluation type. The current pricing table for NCQA PHQ Certification is available from the NCQA Web site at www.ncqa.org/tabid/753/Default.aspx.