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.
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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.
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.
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.
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.
No. The PHQ standards evaluate organizations that measure physician performance; PPC recognizes physician practices that use systematic processes and information technology to enhance quality of patient care. The two programs serve different purposes. In particular, PPC 8: Performance Reporting and Improvement focuses on the practices internal measurement and quality improvement process. It does not address the methodology required in PHQ, but focuses on the QI process.
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.
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.
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.
