FAQ Directory: Physician and Hospital Quality Certification

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8.24.2018 What are the requirements for Physician and Hospital Quality Certification?

The standards and guidelines document is the publication that contains the requirements for certification. You can download this document for free through the NCQA eStore.

These standards include:

For Physician Quality:

  • Measures and Methods: Evaluates how an organization measures the quality and affordability of care provided by physicians, including:
    • Use of standard sources.
    • How cost is measured.
    • Defined methodologies.
    • Adherence to key principles.
    • Frequency of measurement.
  • Working with Physicians: Evaluates the transparency of the physician measurement program and how organizations work with physicians to respond to requests for corrections or changes.
  • Working with Customers: Looks at the organization’s level of transparency with customers (consumers and purchasers) regarding the details of its physician measurement program, and whether the organization works with consumers to address complaints.
  • Program Input and Improvement: Ensures that the organization seeks input and feedback on the design of its physician measurement program and on its reporting process, to improve the program’s value to physicians and customers.

For Hospital Quality:

  • Hospital Performance: The organization provides consumers and purchasers with information about how hospitals perform, to help them make decisions based on quality and cost. Organizations are evaluated on:
    • Hospital performance data: How they report payer quality and cost information to customers.
    • Decision support tools: Whether hospital reports support informed decision making.
    • Availability of information to customers: Whether they make hospital performance information available to consumers, purchasers and others.
    • Scope of hospitals: How they report performance information on hospitals in the network.
    • Working with hospitals on reporting: Whether they work with network hospitals on reporting.
    • Information about measurement: Whether they make information available about performance-based payments.
    • Feedback on Customer Reports: Whether they seeks customer feedback, with the goal of improving the usefulness of hospital performance reports.