FAQ Directory: Physician and Hospital Quality Certification

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.

  • Email

    Share this page with a friend or colleague by Email.

    We do not share your information with third parties.

  • Print

    Print this page.

11.15.2012 Measure reliability If a plan demonstrates a different methodology for statistical validity, would the methodology be considered?

Element C, Define Methodology requires the organization to have a method for determining measurement error and measure reliability. Element D, Adhere to Key Principles sets requirements for minimum observations or levels of measure reliability or confidence intervalsas applicable for quality and cost, resource use or utilization measures. For calculating measure reliability for PHQ, the organization must use the method described in the Explanation in Element C under the subhead Measurement Error. Measure reliability is defined as the ratio of the variance between physicians to the variance within one physician, plus the variance between physicians. NCQA does not prescribe the method used to calculate confidence intervals because the appropriate method may vary based on the parameter (e.g., mean or proportion).

PHQ 2013

11.15.2012 Collaborative data Must organizations include collaborative data for certification?

If the organization is seeking certification on a program that is part of a collaborative, those measures must be included.

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

11.15.2012 Survey Tool With PQ 2013 evaluating at the program level, are we required to purchase a tool for every certifiable entity, as in PHQ 2008?

No. An organization is required to purchase a separate survey tool for every program it brings forward. One program operated by an organization such as a corporate parent without variation from region to region may be surveyed using a single tool. An organization that brings forward more than one program must purchase and submit a separate tool for each discrete program it brings forward.

There is a pricing option for derivative programs a derivative program is defined as a program that shares common aspects (e.g. an organization uses the same measures and methodology for a single defined group of physicians but takes a different action (reporting vs. network tiering) as another program its organization brings forward for certification. NCQA can review common aspects once to streamline the survey process (thus the discounted price), although these are distinct programs. To receive a discount, the programs must be brought forward at the same time. Please see the pricing exhibit in the survey agreement. If you need additional information, please contact NCQA Customer Support at (888) 275-7585.

PHQ 2013

11.15.2012 Changing measure specifications With regard to patient experience measures, may we use items from CAHPS-CG but change the referent time period? For example, not rating the last 12 months, but rating the last visit and changing the response categories accordingly?

No. Changing the referent time period materially alters the measure and would therefore not qualify as a standardized measure for Element A. Patient experience measures endorsed, developed or accepted by the NQF, AMA PCPI, national accreditors or government agencies may be used, but the organization must follow the measure or instrument specifications as written.

PHQ 2013

11.15.2012 Complaints The concept of "member complaints" pertains to health plans only, but not necessarily to Web sites or collaboratives. How does NCQA evaluate for those entities?

Though an organization may not have members in the way a health plan does, Web sites have users or consumers who might want to submit complaints (e.g., user complaints). Therefore, to meet the intent of Elements C and D, an organization must have policies and procedures to process, register and respond to consumer complaints; and must provide a documented process and evidence for how it handled those complaints.

PHQ 2013

11.15.2012 Taking action on cost measures Is an organization prohibited from using cost efficiency if quality results are not available?

No. The organizations program must consider quality in conjunction with cost, resource use or utilization when taking action. However, if the organization is unable to identify standardized measures of quality for a particular specialty or if there is insufficient data on an individual physician, practice or group the organization can act on cost performance when quality performance is not known. This is allowed in order to maximize the availability of performance information but must be handled in a fully transparent manner so that it is very clear when a physician is designated as high value and when they are purely designated as low cost. Refer to the standards _ specifically the explanation in PQ1 D (on page 51) _ for further explanation.

PHQ 2013

11.15.2012 Physician requests For PQ 2 Element C, 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.

PHQ 2013

11.15.2012 Reapplying for certification When may an organization that fails to be certified reapply?

NCQA does not specify a minimum period after a denial during which an organization may undergo a new review, but the organization must have completed a new cycle of measurement and action in order for NCQA to review it against the standards.

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 Applications for PHQ surveys How long after NCQA receives an application for survey does the survey begin?

NCQA suggests that organizations submit an application for survey at least 180 calendar days in advance of the date requested for their Initial Survey, but preferably applications will be submitted further in advance. Organizations should indicate their preferred survey date and NCQA will accommodate them if possible.

PHQ 2013

11.15.2012 Tools for readiness evaluations Is there a non-Web based tool available for our organization to use for self-assessment?

An organization can use the PDF version of the standards to assess readiness to undergo a survey, but in order to undergo a survey it must purchase and use the Web-based Interactive Survey System (ISS) Tool. To purchase the PDF version of the standards or the Survey Tool, visit the NCQA Web site (www.ncqa.org) or contact Customer Service at 888-275-7585.

PHQ 2013