|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
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
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.