| Evaluation Requirement | Summary | Why is this requirement important? |
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PQ 1: Element A:Standard Quality Measures
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Does the organization use measures from standardized sources to assess the quality of its individual physicians, practices or medical groups?
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Determines whether an organization uses widely accepted measurements based on clinical evidence.
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PQ 1: Element C:Define Methodology
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Has the organization addressed important issues relating to its methods for measuring physician quality and cost?
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An organization should address key issues in its physician measurement methods to achieve valid and reliable results.
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PQ 1: Element D:Adhere to Key Principles
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How does the organization use results of physician quality and cost measurement?
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Establishes key principles for an organization to follow when it uses findings from its physician quality and cost measurement programs.
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PQ 1: Element E:Frequency
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Does the organization uses measure results that reflect recent physician performance by measuring at least every two years?
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Confirms how often an organization measures performance of physicians in its provider network.
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PQ 1: Element F:Verifying Accuracy
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How does the organization verify that its methods for measuring physician performance are applied correctly every time?
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Confirms that the organization’s methods for measurement are accurately and uniformly applied every time it measures physician quality or cost.
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PQ 1: Element G:Results Reflect Data Beyond a Single Payer
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To make data more representative and to reduce redundant measurement, does the organization use data from other sources that are representative of a physician''s performance or does the organization participate in a multi-payer collaborative for quality or cost, resource use or utilization measurement?
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An organization can improve the quality of its physician data and make the measurement process more efficient by using performance information from other sources or collaborating with other payers.
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PQ 2: Element A:Transparency of Measures and Methods
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Do physicians have an opportunity to understand the program including its measures, methods and actions and contribute data to help make their own results as accurate as possible?
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Physicians need to be able to interpret and use information to ensure their results are representative of their performance.
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PQ 2: Element B:Opportunity to Correct
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Does the organization provide its physicians, practices or medical groups the opportunity to request corrections or changes and receive a timely response?
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Physicians need to know that an organization follows a fair process for handling requests for corrections or changes.
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PQ 2: Element C:Requests for Corrections or Changes
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What is the organization’s process for responding to a physician’s request for corrections or changes to data?
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Assesses that an organization follows a fair process for handling requests for corrections or changes.
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PQ 3: Element A:Transparency of Measures and Methods
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Does the organization prominently place key information in clear, understandable language near information it publishes on physicians?
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Information an organization makes available to consumers should be clear and useful to consumers.
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PQ 3: Element B:Transparency with Customers
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Does the organization make measurement methodology available to customers (i.e. current and prospective consumers and purchasers)?
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An organization should make information about physician quality and cost measurement processes available to its customers.
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PQ 3: Element C:Policies and Procedures for Complaints
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Does the organization have a process for registering and responding to oral and written consumer complaints about its physician measurement activities?
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An organization should have a method for accepting, processing and resolving member complaints about its physician quality measurement process.
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PQ 3: Element D:Handling Complaints
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Does the organization follow its process for registering and responding to oral and written consumer complaints about its physician measurement activities?
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An organization should follow a fair process for responding to consumer complaints about its physician measurement activities.
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PQ 4: Element A:Seeking Input During Development
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Does the organization seek input into the development of its physician measurement and reporting activities, including measure selection, methodology for reporting differences in performance and reporting format from consumer representatives, physicians, practices or medical groups (or their representatives) and purchasers?
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Physicians, consumer groups and purchasers should have the opportunity to play an active role in developing physician measurement programs.
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PQ 4: Element B:Feedback on Reports
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Does the organization seek public feedback about the usefulness of physician quality reports?
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An organization should use feedback to improve the usefulness of its reports.
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PQ 4: Element C:Program Impact
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Does the organization assess the program by identifying areas for improvement and implementing changes in areas identified for improvement?
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To maximize the impact of its physician measurement program, the organization should regularly assess how effective the program is in achieving predetermined objectives.
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