Here are some of the most frequently asked questions about NCQA’s various programs. If you don’t see what you are looking for in one of the entries below, you can ask a question through My NCQA.
No. Practices may demonstrate the same evidence if:
Practices must provide information about how the letter, phone script or other method is modified for each service reminder.
PCMH 2017
KM 20 G requires evidence-based guidelines on appropriate use of services, which could include a prompt at the point of care to consider appropriateness of laboratory test ordering, avoidance of MRI as a first-line diagnostic test for back pain, appropriateness of antibiotics use, or appropriateness of specific referrals.
NCQA encourages practices to look at ABIM’s Choosing Wisely website for more information on overuse/appropriateness (www.choosingwisely.org).
PCMH 2017
A measure evaluating completed mammograms qualifies as a care coordination measure if the practice is evaluating the rate of mammography results received (numerator) to mammography’s ordered (denominator). For QI 02A, NCQA wants to evaluate gaps in communication or coordination between members of the care team (providers and patients). Measuring the practice’s mammography rates does not meet the intent of a care coordination measure, but measuring timely receipt of results of a referral meets the intent.
PCMH 2017
Practices may only count well-child visits for different age groups as distinct preventive care measures if the measures are aimed at assessing completion of age-specific screenings and tests (e.g. autism screen at 2-year check-up, adolescent depression screen), according to evidence-based guidelines. Assessing patient access to well visits for two different pediatric age groups would not be considered two different measures.
PCMH 2017
No. Using only this age group does not meet the requirements. Identification of poorly controlled or complex patients can include older patients (e.g., >65 years) who also meet other high-risk criteria such as co-morbid conditions, frequent hospitalizations, mental health problems or frailty.
PCMH 2017
No. The requirement to provide new information applies to all new medications prescribed to a patient, especially for patients identified in Concept CM as needing care management. Patients may have multiple comorbidities and medications, so it is crucial that they receive information about all medications prescribed to them
PCMH 2017
Measures of care coordination address communication regarding patient referrals and care transitions.
For example, a practice refers a patient to another provider or a community resource. A care coordination measure might assess whether the referral was completed (i.e., the practice receives the referral report, follows up with the resource or patient to assess use or patient experience).
PCMH 2017
Practices should provide a report that demonstrates they update patient problem lists based on visits, transfer of information from other providers or information from the patient. As patient problem lists are expected to be updated at least annually, practices will want to monitor their rate on a periodic basis. Practices define the reporting period and frequency that allows meaningful evaluation of data.
PCMH 2017
