FAQs: Physician and Hospital Quality Certification

What is Physician and Hospital Quality Certification?

NCQA’s Physician and Hospital Quality Certification program evaluates how well organizations measure and report the quality and cost of physicians and hospitals. NCQA looks at measurement processes and methodology, transparency, collaboration and the balance between quality/cost when using the information to make decisions.

How does Physician and Hospital Quality Certification help our organization?

Health plans increasingly use physician quality information for value-based contracting, pay-for-performance programs, provider networks, physician tiering and more. Because payers make decisions based on these data, how data are measured is important.

The NCQA Certification process helps ensure that health plans and provider networks make decisions based on sound methodology, and assures patients and physicians that those decisions are transparent and that quality is not sacrificed to cost.

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.

Where can I find the Standards and Guidelines?

Find the standards and guidelines document, the survey tool and the application in the NCQA eStore.

What organizations are eligible for Physician and Hospital Quality Certification?

In general, any organization that operates a physician measurement program or hospital transparency program is eligible for certification. This includes, but is not limited to:

• Health plans.
• Provider networks.
• Collaborative measurement organizations.
• Information providers.

Organizations that meet these criteria are also eligible:

• Operate a physician measurement program or hospital transparency program, as defined in the standards.
• Are responsible for responding to complaints from consumers and to requests for change from physicians or hospitals based on the organization’s actions.
• Comply with applicable federal, state and local laws and regulations, including requirements for licensure.
• Operate without discrimination based on sex, race, creed or national origin.

Note: There are other eligibility criteria. Refer to the standards and guidelines document available in the NCQA eStore.

How do we earn Physician and Hospital Quality Certification?

Organizations must go through a survey and submit documentation to NCQA. The survey score determines certification. See a step-by-step process.

What does Physician and Hospital Quality Certification cost?

Price varies by organization and is based on number of physicians and number of programs. Contact NCQA for pricing information.

How long does it take to earn Physician and Hospital Quality Certification?

Once the survey is submitted, an organization receives its certification decision within 60–90 days.

How do we start?

If you do not currently have Physician and Hospital Quality Certification and are interested in learning more, contact NCQA. If you have a current certification and want to talk to someone about current status or about renewing, submit a question through My NCQA.