No. HEDIS RRU measures are specified for assessment at the plan level, not for measurement of individual physician performance.
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11.17.2008 Relative Resource Use (RRU) Measures Are HEDIS RRU measures appropriate for PHQ 1 Element B?
11.17.2008 Working with hospitals on reporting For PHQ 2, Element E, are plans required to share results, explain how they are used and get feedback from hospitals ONLY if they report the results in a format different from the primary data source. Is this NA if we only provide links to the data?
11.17.2008 Physician requests For PHQ 1 Element G, could a collaborative manage the process?
Yes. PHQ requirements do not prohibit a collaborative from managing a request for corrections or changes made by physicians, but the organization remains accountable and responsible for responding to complaints from consumers and to requests for changes from physicians or hospitals based on actions taken by the organization.
11.17.2008 Methodology for evaluation of cost measures What constitutes an acceptable methodological approach to evaluation of cost?
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).
11.17.2008 PHQ and HP Accreditation When will the PHQ standards be folded in to the health plan accreditation standards?
11.17.2008 Board certification and physician quality Will NCQA accept board certification, maintenance of certification and NCQA Recognition as markers of physician quality, or must there also be measurement of NQF markers?
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.
11.17.2008 Adding new products/product lines to existing PHQ Distinction If a plan was initially PHQ Certified in HMO only and now wants to add PPO, is the certification process separate?
NCQA no longer conducts surveys under the 2006 PHQ standards. If an organization had distinction for its HMO under the 2006 standards and seeks certification for its PPO, the PPO must be reviewed against the 2008 standards. Under the 2008 PHQ standards, if a plan manages both products (e.g., HMO and PPO) the same, NCQA can survey both products together. The organization should contact NCQA to discuss its options, including a possible option to upgrade (i.e., apply some results from its 2006 survey to a 2008 survey). Note: An Upgrade does not extend the expiration date of the Distinction; that date transfers to the new certification status.
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 Surveyors for PHQ certification What organizations will conduct surveys now or in the future? Only NCQA or, for example, would Licensed HEDIS Audit Organizations conduct them?
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 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 Taking action on cost measures Is an organization prohibited from using cost efficiency if quality results are not available?
Yes. The organization may not take action based on cost, resource use or utilization results alone. This is a must pass requirement for certification and is consistent with the Consumer-Purchaser Disclosure Project Patient Charter.
The organization is required to consider quality in conjunction with cost, resource use or utilization when it takes action. To the extent that the organization develops and presents a composite score or rating using cost, resource use or utilization and quality measures, it must disclose the specific measures for each category and their relative weight when it determines the composite or rating.