FAQ Directory

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

The organization may take action based on physician completion of an ABMS or AOA board performance-based improvement module (generally, in conjunction with maintenance of certification) at least every two years. These activities may be used as a quality measurement activity to meet PHQ 1. Under certain circumstances, the organization may use measures from other national or regional performance-based designation programs to satisfy some or all requirements for PHQ 1, Element A. The organization must discuss this in advance with NCQA to determine if the designation program meets the criteria.

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 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).

All measures on which an organization bases action are included in the scope of the PHQ Survey, including those that are developed and whose results are calculated as part of a collaborative. The exception is during the first year the standards are in effect (October 1, 2008_September 30, 2009). For surveys that start during that period, the organization may opt to carve out measures from a collaborative. The rationale for this exemption is two-fold. First, organizations will not need to wait until a collaborative undergoes a survey in order to have their own survey. Second, if the collaborative needs to make changes to any measures, methods or processes to meet the standard, it is not within the organizations control to make the changesalthough as a participant, it influences them. This allows time for the collaborative to make changes.

Each hospital must receive results. Either the organization must provide results to each hospital or it may have a written agreement with the national network stating that it will provide results to hospitals. If the national network provides results to each hospital, it must provide documentation (e.g., reports, materials) to the organization that it has met the requirements.

Yes. Assumption of appropriate quality in this context is permitted.

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.

To achieve certification, the organization must score at least 50% on Element A, Measuring Physician Performance. The 50% score threshold requires that at least 50% but fewer than 60% of the measures used by the organization to measure physician quality for taking action meet the element (i.e., are standardized). To achieve full points (100%), at least 70% of the measures used by the organization to measure physician quality for taking action must meet the element (i.e., must be standardized)

To meet the intent of factor 3, the organization must provide physicians with the results of each applicable measure and an estimate of statistical reliability. The organization determines how it expresses the estimate of statistical reliability (e.g., range, standard deviation, confidence interval, coefficient of variation). The organization should also provide descriptive information with the numbers; the estimate of reliability is a numeric value.

NCQA suggests that organizations submit an application for survey at least 90 days in advance of the date requested for their Initial Survey, but applications may be submitted further in advance than 90 days. Organizations should indicate their preferred survey date and NCQA will accommodate them if possible.

If a patient is removed from a measure for not taking prescribed medication or for not following recommended treatment, the measure is not considered standardized. If the patient meets specific exclusion criteria listed in the specifications and is removed from the measure, the measure is considered standardized.