FAQ Directory

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.

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.

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.

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.

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

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

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

A quality measure is one of clinical performance or patient experience, where one can generally identify the direction of good, with a clear definition of what is better performance or worse performance.

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)

No. NCQA does not evaluate an organizations code; it reviews the organizations measure specifications and compares them to the original source specification (if applicable).

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.

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.