Menu

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.

Filter Results
  • Save
  • Email
  • Print

12.12.2008 Patient experience measures Are all questions related to patient perception considered quality measures?

Yes. NCQA considers all patient experience results to be measures of quality.

12.12.2008 Organization accountability Are organizations responsible for confirming the factors in Element D, or is this the responsibility of an external vendor?

For Element D, 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.

12.12.2008 Survey measures How is Element A scored for non-NQF endorsed surveys? Is each question a measure or, if measures roll up to a composite, is the composite considered one measure?

Non-NQF endorsed patient experience surveys are counted as one measure for the entire survey. CAHPS-CG questions or composites count as separate measures.

12.12.2008 Measure specifications Since NQF does not publish the actual code sets for all its measures, how does NCQA determine whether an organization is following the measure specifications as written?

NCQA recognizes that some NQF-endorsed or AQA-approved specifications may require additional specifications to implement in specific contexts. Organizations may supplement endorsed specifications as long as they follow all endorsed specifications, and if supplementation does not alter the intended numerator, denominator and exclusion criteria for the measure.

12.12.2008 Requests for corrections or changes For Elements F and G, how can patient experience of care data corrected, when this information is not disclosed to physicians?

The plan is not required to disclose member-specific results, nor is it expected that a physician can correct member responses. At a minimum, the physician must be given the methodology (e.g., sampling, attribution) and survey questions and, upon request, be allowed to confirm that the patients in the universe from which the sample was drawn are his or her patients, given the methodology.

12.12.2008 Composite measures How does NCQA review Element A if a measure used to take action is a combination of a quality measure and a measure that is not in scope, where the quality measure is standardized?

For PHQ 1, Element A, NCQA determines whether individual quality measures (used on their own or in a composite with other criteria) meet the element as defined by the hierarchy of standardized measures. The organization may use additional criteria (e.g., board certification status) to determine performance designation, in combination with quality measures, but the additional criteria remain out of the scope for this element. The organization receives credit for the standardized quality measure.

12.12.2008 Taking action on collaborative and organization results How does the survey process work if an organization takes action on measure results from a collaborative and from its own measurement?

All measures on which the organization bases action are included in the scope of a PHQ Survey, including those developed and whose results are calculated as part of a collaborative and those calculated directly by the organization.

NCQA evaluates the organizations activities in one of two ways.

1.Evaluate the collaborative onceif the collaborative opts to undergo a PHQ surveyand apply the survey results to all participants

2.Evaluate the measures, methods and processes of the collaborative when each participant organization is surveyed

The organizations scores on any element are based on the performance of both the collaborative and the organization. The organization must meet the element for all measures, including the collaborative measures it uses. For example, for Element C: Methodology, NCQA evaluates the organizations methodology for each measure directly. It may evaluate the collaboratives methodology either once during a survey of the collaborative or for each organization during the organizations survey. Regardless of the process, all measures must meet the requirements of Element C in order to meet the element.

When a collaborative undergoes a survey directly, the process is streamlined for all involved (the collaborative, the organization and NCQA). In addition, the process may be more cost-effective, since NCQAs pricing is designed to reflect economies of scale.

12.12.2008 Principles for use of results Does Element H, factors 1 and 2, apply to all patient experience surveys?

Yes. Factor 1 applies because patient experience results are considered measures of quality.

12.12.2008 Notice for providing results Does a 45-day notice period apply when measurement is more frequent than annual (e.g., quarterly)?

The 45-calendar-day notice period for providing results and an opportunity for a physician to request a correction or change applies to each cycle of measurement and action an organization takes, regardless of frequency (e.g., biannual, annual, semiannual, quarterly); however, if an organization recalculates results without changing its methodology or measures, it does not need to provide the methodology again as long as it supplies information on how to obtain that methodology.

The exception to the minimum 45-calendar-day notice period for action is if the action involves only pay-for-performance activities that are not publicly reported (e.g., an action that is only between the organization and the physician). In this instance, the organization may provide the results and methodology concurrent with additional or bonus payment. The organization must still provide a process for the physician to request corrections or changes.

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.

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 Risk adjustment How is risk adjustment defined for quality measures?

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.