FAQ Directory

Element G, Request for Corrections or Changes has four factors. 1. Documentation of the substance of the request 2. Investigation of the request 3. Notification of the specific reasons for the final decision 4. Notification of the outcome prior to taking action on measure results NCQA reviews an organizations documentation to determine if it follows its process for handling physician requests for corrections or changes related to the four factors. In response to inquiries from many organizations, NCQA issued a clarification on the expectations of the process (which is scored in Element F) and the file review against that process. See the Corrections, Clarifications and Policy Changes Web page at www.ncqa.org/tabid/120/Default.aspx.

No. The PHQ standards evaluate organizations that measure physician performance; PPC recognizes physician practices that use systematic processes and information technology to enhance quality of patient care. The two programs serve different purposes. In particular, PPC 8: Performance Reporting and Improvement focuses on the practices internal measurement and quality improvement process. It does not address the methodology required in PHQ, but focuses on the QI process.

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 PHQ 1. Under certain circumstances, the organization may use measures from other national or regional performance-based designation programs to satisfy some or all requirements for PHQ 1, Element A. The organization must discuss this in advance with NCQA to determine if the designation program meets the criteria.

No. NCQA does not evaluate an organizations code; it reviews the organizations measure specifications and compares them to the original source specification (if applicable).

Yes. The substance of the standards did not change and the purpose of HIP is to give autocredit.

There is no minimum requirement. If the total number of files is fewer than the requested 40 files, NCQA reviews the entire file universe. For file review elements, NCQA follows its 8/30 methodology. Refer to An Explanation of the 8 and 30 File Sampling Procedure on the NCQA Web site at www.ncqa.org/tabid/125/Default.aspx.

During the application process, the organization lists and briefly explains instances where it feels exemptions apply.

All measures on which an organization bases action are included in the scope of the PHQ Survey, including those that are developed and whose results are calculated as part of a collaborative. The exception is during the first year the standards are in effect (October 1, 2008_September 30, 2009). For surveys that start during that period, the organization may opt to carve out measures from a collaborative. The rationale for this exemption is two-fold. First, organizations will not need to wait until a collaborative undergoes a survey in order to have their own survey. Second, if the collaborative needs to make changes to any measures, methods or processes to meet the standard, it is not within the organizations control to make the changesalthough as a participant, it influences them. This allows time for the collaborative to make changes.

The cost of a PHQ Survey is based on survey and evaluation type. The current pricing table for NCQA PHQ Certification is available from the NCQA Web site at www.ncqa.org/tabid/753/Default.aspx.

If a patient is removed from a measure for not taking prescribed medication or for not following recommended treatment, the measure is not considered standardized. If the patient meets specific exclusion criteria listed in the specifications and is removed from the measure, the measure is considered standardized.

To meet the intent of factor 3, the organization must provide physicians with the results of each applicable measure and an estimate of statistical reliability. The organization determines how it expresses the estimate of statistical reliability (e.g., range, standard deviation, confidence interval, coefficient of variation). The organization should also provide descriptive information with the numbers; the estimate of reliability is a numeric value.

NCQA suggests that organizations submit an application for survey at least 90 days in advance of the date requested for their Initial Survey, but applications may be submitted further in advance than 90 days. Organizations should indicate their preferred survey date and NCQA will accommodate them if possible.