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.
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
Save your favorite pages and receive notifications whenever they’re updated.
You will be prompted to log in to your NCQA account.
Save your favorite pages and receive notifications whenever they’re updated.
You will be prompted to log in to your NCQA account.
-
Email
Share this page with a friend or colleague by Email.
We do not share your information with third parties.
Share this page with a friend or colleague by Email.
We do not share your information with third parties.
-
Print
Print this page.
Print this page.
11.17.2008 Quality measures What criteria does NCQA use to determine what constitutes a quality measure vs. another kind of measure?
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 Exemption process for surveys Can you confirm the process for exemption for PHQ 1?
11.17.2008 Measure specifications Expand on the minimum denominator criteria for quality measures. Do you mean minimum observations per measure? Or minimum observations per provider? Or is that already in the requirements?
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.
This applies to the following Programs and Years:
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.
This applies to the following Programs and Years:
11.17.2008 Delegating PHQ 2 to an NCQA-Certified HIP PHQ has no delegation oversight standard, but information distributed by NCQA in response to HIP Certification indicates that a delegation agreement with an NCQA-Certified HIP is required to receive automatic credit in PHQ 2. Must a health plan show an agreement that meets the six factors typically required by other NCQA delegation standards?
11.17.2008 Small physician sample size If only a small percentage of available physicians in any specialty within a market have sufficient NQF measures available, may there be an assumption of appropriate quality, thus allowing members access to higher benefits with a larger number of physicians?
11.17.2008 Relative Resource Use (RRU) Measures Are HEDIS RRU measures appropriate for PHQ 1 Element B?
11.17.2008 Certification time limits How long does certification last?
Certification in PHQ, PQ or HQ is valid for two years. Organizations must undergo a survey against the standards at least every two years to maintain their certification status. Provisional Certification is valid for 12 months; it is a temporary option and will not be offered after June 30, 2009.
This applies to the following Programs and Years:
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.
This applies to the following Programs and Years:
11.17.2008 Survey Pricing If we go through provisional certification and are then required to go through full certification within 12 months, does our organization get a reduced price?
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.