No. HEDIS RRU measures are specified for assessment at the plan level, not for measurement of individual physician performance.
PHQ 2013
FAQ Directory: Physician and Hospital Quality Certification
Filter Results
11.15.2012 Relative Resource Use (RRU) Measures Are HEDIS RRU measures appropriate for PQ 1 Element B?
11.15.2012 Must-Pass: PQ 1 Element A Is PHQ 1, Element A a must-pass element? If so, is the change permanent?
11.15.2012 Cost, resource use or utilization measures Are there standardized measures for cost, resource use or utilization? If there are none, what measures are plans using?
11.15.2012 Board certification and physician quality Will NCQA accept board certification, maintenance of certification and NCQA Recognition as markers of physician quality, or must there also be measurement of NQF markers?
Board certification alone does not count as a quality measure. The organization may take action based on physician completion of an ABMS or AOA board performance-based improvement module (generally, in conjunction with maintenance of certification) at least every two years. These activities may be used as a quality measurement activity to meet PQ 1 Element A. Under certain circumstances, the organization may use measures from other national or regional performance-based designation programs to satisfy some or all requirements for PQ 1, Element A. The organization must discuss this in advance with NCQA to determine if the designation program meets the criteria.
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 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
11.15.2012 Reapplying for certification When may an organization that fails to be certified reapply?
11.15.2012 Patient experience measures Do the results of Patient Experience of Care surveys, using questions derived from CAHPS-CG, have a role in the evaluation of physician quality?
Yes. Patient experience measures are considered measures of quality. The organization may use items or composites from the CAHPS-CG survey. Measure specifications for the CAHPS-CG survey can be found on the AHRQ website (https://cahps.ahrq.gov/clinician_group/).
PHQ 2013
11.15.2012 Definition of a Program How does NCQA define a program?
The definition of a program is clearly defined in Section 1 of the Policies and Procedures. A physician measurement program includes: 1) A defined group of physicians– the definition must include both physician type (e.g. specialty) and geographic area covered; 2) A defined set of clinical quality, service or patient experience measures– the program may also include a defined set of cost, resource use or utilization measures; 3) A defined methodology for producing measure results; 4) A specific action taken at a specific point in time based on the measure results.
A hospital transparency program includes: 1) A defined group of hospitals– the definition must include both hospital type and location; 2) A defined set of all-payer quality or cost measures whose results are publicly reported at a specific point in time.
Distinct programs are reviewed separately and a certification decision is issued for each. Physician measurement programs and hospital transparency programs are always distinct programs, even when operated by the same legal entity. NCQA reserves the right to determine that programs that are managed in a decentralized manner constitute distinct programs for review.
To the extent that one program is a derivative of another and share common aspects (e.g., an organization uses the same measures and methodology for a single defined physician group but takes two actions [reporting and network tiering]) and the organization seeks verification for both at the same time, NCQA can review common aspects once to streamline the survey process, although these are distinct programs.
PHQ 2013
11.15.2012 Collaborative data Must organizations include collaborative data for certification?
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 Requests for corrections or changes For PQ2: Elements B and C, how can patient experience of care data corrected, when this information is not disclosed to physicians?
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.
PHQ 2013