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.