FAQ Directory: Physician and Hospital Quality Certification

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11.15.2012 Noncompliant patients and physician ratings Has NCQA made recommendations or looked at the effect of noncompliant patients on physician ratings?

Although patient factors such as noncompliance may affect measure performance rates, an integral role of the physician is to work continuously with patients to educate them on the importance of a specific process or meeting a specific target/goal.

PHQ 2013

11.15.2012 Pricing for Derivative Programs How does NCQA determine which pricing tier it places a derivative product in?

NCQA prices a program and any programs it qualifies as derivative programs using the pricing tier that includes the total number of physicians measured in all the programs an organization brings forward. No individual physician is counted more than once for the purposes of determining which pricing tier is used, but the total of all physicians in all programs determines the tier used for every program.

PHQ 2013

11.15.2012 Attribution Do the NQF or HEDIS provider-level measurement specifications define attribution? For example, to whom to attribute performance: the diagnosing MD, prescribing MD, provider with most encounters and so on? If not, does this not result in variation?

Neither NQF nor HEDIS provider-level measures specifications require a specific attribution method, although HEDIS measures provide options for an organization to consider. While this might result in variation from one organization to another, there is currently no single industry standard method for attribution.

PHQ 2013

11.15.2012 Following Standardized Measure Specifications Does a program have to use the most recent version of a measure to count it as a standardized measure in Element A?

Yes. The organization must follow the most current measure specifications from the measure steward, even if the NQF endorsement has not been updated.

PHQ 2013

11.15.2012 Working with Physicians Our organization posts the results of our physician measurement program on our directory on January 1 and any tiered networks or differential benefits are effective that same date. We make the results available to members by request (e.g. the member can call an 800 number to ask about a physicians status in the tiered network) on December 1. Which date _ January 1 or December 1 _ does NCQA consider the action date for the purposes of calculating whether we notify physicians 45 days ahead of action and resolve requests for corrections or changes before taking action?

If information is available to the public–even if it is only available by request–NCQA considers this to be public reporting. Therefore, in this scenario the taking action date is December 1.

PHQ 2013

11.15.2012 Timing for Program Input In the Element B explanation under the head Feedback Timeframe requires the organization to seek feedback annually and Element C _ Program Impact requires the organization annually asses the program. Does the organization have to carry out these activities annually if its measurement cycle is every two years?

No. An organization that measures its physicians every two years can meet the requirement by seeking feedback and assessing the program every two years.

PHQ 2013

11.15.2012 Standardized Measure Specifications For Element A, if the organizations correction process allows elimination of non-compliant patients from the measure result at the request of the physician, even when those patients are in the standardized measure specification, is the measure still considered to be standardized?

No. To meet the definition of a standardized measure, the organization must follow the measure speciation exactly, including all numerator and denominator inclusions and exclusions.

PHQ 2013

11.15.2012 HEDIS measures If we use HEDIS measures, will NCQA still look at code?

No. NCQA does not evaluate an organizations code; it reviews the organizations measure specifications and compares them to the original source specification (if applicable). Note that to be considered from a standardized source, the measure must be the version specified for the level measured; e.g. HEDIS physician level measures, not plan level measures.

PHQ 2013

11.15.2012 Frequency of re-measurement For plans using patient experience measures, must re-measurement occur every two years to meet Element E?

Yes. Plans that use patient experience measures must measure at least every two years to receive credit for this element.

PHQ 2013

11.15.2012 Publically Reporting Performance-Based Payments Element A. requires that the organization must publicly report information on the percentage of total payments based on performance. Does this require that the information be published or is it acceptable to make it available and notify customers that it is available?

For Element F, 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.

PHQ 2013

11.15.2012 Credit for Performance-Based Designation Programs as Quality measures Does use of Performance-Based Designation programs _ such as NCQA, BTE Recognition programs and Meaningful Use count as quality measures?

Yes, refer to Appendix 4: Performance-Based Designation Programs for the level of credit received for each program.

PHQ 2013

11.15.2012 Differentiating Between Programs If an organization measures and takes action on both primary care and for specialty care practitioners where the methodology and actions are the same but the measures vary by specialty, is this one or more program?

In general, if an organization has a measure set in which a subset of the measures apply only to some specialties (broadly including primary care as a specialty), where the methodology and actions are the same (e.g. public reporting in the same manner regardless of specialty), NCQA treats that as one program. However, if there is more than one action (e.g. public reporting, P4P), we may count them as two programs (a public reporting program and P4P program).

PHQ 2013