Why is NCQA redesigning the PCSP Recognition program?
We support continuous improvement.
First and foremost, the redesign responds to your feedback. Practice staff, clinicians and Certified Content Experts (CCE) recommended many of the changes. They told us to improve the process, to cut back the paperwork, to simplify reporting. They told us they wanted more time to concentrate on care.
We also considered the changing payment climate. Recent changes in federal law—the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)—will change payments to reward value-based care. Our redesigned process aims to align reporting requirements with expected MACRA changes, to eliminate duplication of work.
The following feedback about the current PCSP Recognition Program helped shape the redesign:
- The current recognition process can be too difficult for smaller practices.
- There needs to be less emphasis on process and more emphasis on performance.
- There is too much documentation required.
- Practices want more and ongoing interaction with NCQA representatives.
- Practices should demonstrate ongoing quality improvement and ongoing implementation of PCSP principles.
- There should be more education and guidance for practices.
- It requires practices to use two separate, complicated tools.
The redesigned program—to be launched October 28, 2019—includes ongoing, sustained recognition status with Annual Reporting instead of the current program’s three-year recognition cycle.
The process offers:
- Flexibility. Practices take the path to recognition that suits their strengths, schedule and goals.
- Personalized service. Practices get more interaction with NCQA and are assigned an NCQA representative who works with them throughout the recognition process and is a consistent point of contact.
- User-friendly approach. Requirements remain meaningful, but with simplified reporting and less paperwork.
- Continuous improvement. Annual Reporting to NCQA helps a practice maintain continuous quality improvement. By reviewing your progress more often, we hope to keep performance improvement at the top of your priorities list.
- Alignment with changes in health care. The program aligns with current public and private initiatives and can adapt to future changes.
What does the redesigned process look like?
The new Recognition process has three parts:
- Commit. The practice completes a self-assessment before committing to transformation and the recognition process. When the practice commits, it works with the assigned NCQA representative to establish an evaluation plan and schedule.
- Transform. Practices gradually transform, building on successes. During this time, they show their progress by submitting evidence to NCQA through a new system designed to reduce paperwork and administrative hassles. Along the way, NCQA conducts virtual reviews—online check-ins—with the practice to gauge progress and to discuss next steps in the evaluation. The virtual reviews, which are conducted online via screen sharing technology, provide practices with immediate and personalized feedback on what is going well and what needs to improve.
- Succeed. The practice continues to implement and enhance its PCSP model to improve how it meets the needs of patients. Each year, the practice shows that its ongoing activities are consistent with the PCSP model of care. Annual Reporting includes attesting to certain policies and procedures and submission of key data. This process will sustain the practice’s recognition. Better yet, it’s designed to foster continuous improvement. That means the practice succeeds in strengthening its transformation, and as a result, patient care.
How will the Recognition program change, fundamentally?
The underlying principles of PCSP remain the same. Evidence shows that the PCSP model of care can result in reduced costs and healthier and more satisfied patients. The redesigned process focuses more on performance and quality improvement and aligns with many other major national initiatives that impact practices, such as MACRA.
The Recognition process is changing. NCQA recognizes the practice for showing it is transforming to deliver better care and better outcomes for patients. See more about what’s changing.
How does the redesign align with MACRA?
MACRA changes how eligible clinicians get paid under Medicare—transitioning from volume to value—and takes a big step forward for health care quality. CMS rules detail how Medicare will implement MACRA’s Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APM).
On the MIPS track, clinicians will get bonuses or penalties based on their performance in four measure areas: Quality, Cost, Improvement Activities and Promoting Interoperability.
Clinicians in practices that earn NCQA Recognition will automatically get full credit in the CPIA category. And evidence shows operating as a PCSP can lead to better performance in other categories.
How will the redesign help practices save time?
One goal of the redesign is to reduce required documentation making it easier for practices to show how they meet PCSP recognition requirements. The online reporting platform and virtual reviews are designed to reduce paperwork and reduce the amount of time practices spend showing their progress. And because practices will check in with NCQA up to three times during the initial process, any unforeseen reporting deficiencies are less likely than in the prior process. The virtual reviews provide practices with feedback as they continue to transform, giving them a chance to make course corrections. Finally, Annual Reporting to sustain recognition mean that practices submit vital quality improvement data annually, but no longer have to spend as much time gathering documentation to renew recognition status.
How does the new online system work?
Many recognized practices said that the current process of using two complicated tools (systems) could be improved. In response, NCQA designed a new online system that:
- Creates one location for practices to house survey-related documentation and information, as well as practice-site demographics and contact information.
- Supports collaboration between practices and their consultants.
- Allows better sharing of evidence to save time.
The application and recognition process will merge on a new software platform that encourages practices, consultants and NCQA to communicate. Reviews will take place on line throughout the recognition process. After practices earn initial recognition, they report annually to confirm that they continue to meet requirements.
When will the new online system be released?
The new online system will launch with the new program on October 28, 2019.
Will the redesigned program incorporate new requirements?
Yes. NCQA released a new PCSP Standards & Guidelines document with updated requirements. In addition, requirements are updated annually. Historically, NCQA updated requirements every three years. NCQA is releasing the updated PCSP at the same time it is launching its new recognition process. Practices that have achieved PCSP Level 3 recognition may transition directly to Succeed, the sustaining part of the new recognition process.
Information for Practices Seeking First-Time Recognition
My practice is not yet recognized but wants to become recognized under PCSP 2016. Is that an option?
Yes. If you are currently preparing to come through recognition, you may do so under PCSP 2016. Once your three-year recognition concludes, you will transition to the new process. Practices that still want to earn recognition using the 2016 standards must submit their survey by December 31, 2019. After that date, practices must use the 2019 edition of the standards and enroll in Q-PASS.
To learn more about the PCSP 2016 Standards & Guidelines watch videos outlining each of the standards.
Key dates to know:
| Date | Milestone |
| 10/25/2019 | Last Day to Purchase Corporate & Single Site ISS Survey Tools |
| 10/28/19 | Q-PASS Launches |
| 11/15/2019 | Last Day to Submit Corporate Application |
| 11/22/19 | Last Day to Submit Corporate ISS Survey Tool |
| 12/13/2019 | Last Day to Submit Single Site Application |
| 12/31/2019 | Last Day to Submit Single Site ISS Survey Tool |
Remember: The new process and platform are only available to practices seeking recognition under PCSP, 2019 Edition.
Our practice is in the process of pursuing PCSP 2016 recognition. Should we hold off until the redesign is released?
No! Practices currently pursuing PCSP 2016 recognition will earn the three-year recognition and then move to the new process. They may choose to transition to Annual Reporting prior to their three-year expiration but must achieve Level 3 recognition in order to transition directly to Annual Reporting.
Information for Currently Recognized Practices
My practice is currently recognized. What are my options for moving to the new process?
Currently recognized practices have the option to renew under PCSP 2016 standards using the ISS survey tool prior to December 31, 2019.
If you would like more information about transitioning to the new process after October 28, 2019, please see the links below:
Succeed: Sustaining Your Recognition
What is expected during Annual Reporting?
Practices use the online platform to submit documentation that supports Annual Reporting requirements; NCQA reviews documentation and notifies practices of their recognition status. Recognition is based on a practice’s overall performance across seven categories. Practices must meet the minimum number of requirements for each category. NCQA will select practices randomly for audit to validate submitted documentation and data.
Will the standards for documentation and reporting change every year? How far in advance will practices be notified about information they must submit?
NCQA expects to introduce new requirements when needed to strengthen your transformation. Reporting updates may include new requirements that align with the most up to date PCSP Standards & Guidelines or may modify or eliminate existing requirements. We expect to base many of these updates, like the redesign, on your feedback and the latest research that works. Annual reporting updates will be available within six months before they are scheduled to take effect.
How will NCQA collect PCSP practice quality data? How about through a data feed, rather than a document upload?
NCQA expects to introduce an optional path for practices to report electronic clinical quality measures directly or through a third party (e.g., EHR vendor, health information exchange, qualified clinical data registry) in the future.
For the Annual Reporting requirements, may practices choose different requirements to report on from year to year?
Some requirements will apply to all practices, but in some cases, practices will choose from a set of reporting options. Practices may change what they report from year-to-year, as long as it is within the set of options.
Pricing and Payment
What is the price for the Redesigned recognition process?
The price varies by the number of clinicians within your practice, and the number of practices within your organization. Recognition is earned at the specialty level at each practice site. If a practice includes more than one specialty, each specialty within that practice site seeking recognition must complete an evaluation to earn recognition, as they will be recognized as different entities. Similarly, if a specialty group practices at multiple sites, each specialty at each site would earn a recognition. Review the new pricing structure.
When is payment due?
For practices seeking recognition for the first time, the recognition fee is due at enrollment. Thereafter, recognition fees are due when the practice conducts its Annual Reporting.
What methods of payment are accepted?
For your convenience, NCQA accepts payment electronically with either your credit card or a check.
Additional Questions
How does NCQA plan to support and promote the use of Certified Content Experts (CCE) in practices?
NCQA’s new process and platform are designed to include CCEs. CCEs who act as consultants will be able to monitor, review and assist practices throughout the transformation and recognition process using our new online platform.
I’m a consultant who works with many practices. How can I access the new online system?
Consultants will have one login that will let them access the surveys of all practices for which they are designated an authorized user.
What if a practice misses the Annual Reporting date or does not meet requirements?
If a practice misses the Annual Reporting date or does not meet requirements, its recognition status will be suspended. The practice has the opportunity to correct deficiencies or submit missing annual reporting data within 90 days of the reporting due date, to have the suspension lifted.
If the practice does not complete reporting requirements by the end of the 90-day period, it loses recognition status. Even then, recognition may be reinstated if within 9 months the practice corrects deficiencies, submits reporting and participates in a limited review process with an evaluator. If it does not, the practice must start the recognition process from the beginning.
What if a practice has more clinicians than it indicated when it paid the recognition fee?
Practices state the number of clinicians when they commit to pursuing recognition and pay the recognition fee. At the end of transformation, NCQA will reconcile what the practice paid with how many clinicians are associated with the practice. If there are more clinicians in the practice, the practice pays the difference to NCQA.
Will requirements still be released every three years?
One goal of this new program is to adapt to the needs of the health care system more quickly and efficiently. Therefore, NCQA may make relatively small updates to standards each year, instead of making many changes every three years. NCQA will release updates at least six months before they take effect, to give practices time to comply.