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Home / News & IndustryManaged Care Insight and Analysis
Updated: Oct. 14, 2008
NCQA Updates Physician And Hospital Quality Program

The National Committee for Quality Assurance (NCQA) released standards that updated its voluntary Physician and Hospital Quality (PHQ) program, an assessment of how health plans measure and report on the quality and cost of physicians and hospitals.

NCQA launched PHQ in 2006 as a voluntary program to impartially evaluate the measures and methods of physician measurement programs – the first independent effort to do so. Since then, 64 NCQA-accredited health plans have met the PHQ standards.

The revisions reflect demand from employers, consumers, regulators and physicians around the country and changes in the market, NCQA said.

"Patients should expect to have information about quality when choosing physicians and hospitals," said NCQA President Margaret E. O’Kane. "But any effort to compare physicians and hospitals is only as good as its methods and its data. The Physician and Hospital Quality program sets meaningful standards for organizations that develop information about the quality of physicians and hospitals in terms of relevance, validity, transparency and fairness. The updates to this program raise the bar."

In recent years, initiatives to measure physician and hospital performance have proliferated. Health plans, purchasers, consumers and regulators have all sought to sift through data in an effort to identify excelling providers for the purposes of informing patient choice. In some cases, provider quality data is used to actively steer patients to high-performing providers through tiering or other forms of benefit design.

Additionally, organizations ranging from community measurement collaboratives to information providers, such as Web sites, have entered the provider measurement arena; the updated program allows these types of organizations to come forward for PHQ certification as well.

Concerns about the validity of such measurement efforts have grown, as well. Physicians and consumer groups have raised concerns about the transparency of measurement efforts, the accuracy of the data being used and the use of cost measures alone. Regulators around the country are also scrutinizing physician measurement programs; some have cited the need for independent organizations such as NCQA to impartially assess such programs.

The new requirements require the use of standardized, third-party measures endorsed by the National Quality Forum (NQF) when measuring physician performance; if not available, standardized measures from other nationally recognized entities may be used instead. PHQ also emphasizes transparency on key methodological issues, including how patient results are assigned to physicians for measurement purposes, risk adjustment of quality data and the statistical reliability of comparisons among physicians, practices or medical groups.

The update also lays out explicit requirements for provider involvement during the program development process and their right to request corrections or changes to their results and mandates the use of quality measures when acting on measurement results, as opposed to acting on cost alone.

Address: National Committee for Quality Assurance, 1100 13th St. NW, Suite 1000, Washington DC 20005; (202) 955-3500, www.ncqa.org.


  This article was taken from:
The Executive Report on Physician Organizations

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