|
The organization measures the quality of its individual physicians, practice sites or medical groups using measures based on nationally-recognized evidence-based or consensus-based clinical recommendations or guidelines.
|
The organization’s methodology addresses:
-
the specifications used to calculate each performance measure
-
how it attributes patients to physicians, practice sites or medical groups
-
the minimum number of observations for each episode or measure and physician, practice site or medical group
-
how it considers statistical error in reporting actual performance differences among physicians, practice sites or medical groups
-
for quality, how it employed or considered case-mix and severity adjustment to make fair comparisons
-
for cost or resource use, how it employed case-mix and severity adjustment to make fair comparisons
-
for cost or resource use, how it includes or excludes outlier cases in the measurement
-
for cost or resource use, the definition of episodes of care.
|
The organization employs a process that includes the following to verify that its measurement methodology is accurately applied when conducting annual measurements:
-
how it verifies or audits the measurement process
-
who verifies the measurement process
-
how it makes corrections
-
how it updates any reports it makes available to physicians or customers.
|
The organization works with its physicians, practice sites or medical groups on quality and cost or resource use measurement activities at least 45 days prior to acting on measure results, including:
-
soliciting input from physicians, practice sites or medical groups about ongoing measurement activities that the organization could use to meet measurement requirements of these standards
-
providing its chosen measures and the measurement methodology to physicians, practice sites or medical groups
-
providing results and estimates of statistical reliability for comparative information to each physician, practice site or medical group
-
providing physicians, practice sites or medical groups the opportunity to obtain a full explanation of their individual results before they are used
-
providing physicians, practice sites or medical groups information on how it uses the results
-
having a process by which physicians, practice sites or medical groups can provide additional information or data to request corrections or changes
-
having a process for consideration of requests for corrections or changes and for communicating the outcome with explanation of the reasons back to physicians, practice sites or medical groups prior to taking action on the results.
|
The organization uses results of physician measurement in accordance with the following principles:
-
reporting to customers only results with a minimum number of 30 observations or that represent performance differences with at least a 90% confidence level
-
providing customers with information on how it uses results
-
taking action on cost or resource-use results only in conjunction with quality results.
|
The organization makes its measurement methodology available to:
-
current members
-
current purchasers
-
prospective members
-
prospective purchasers
|
The organization prominently places the following information in clear, understandable language near information it publishes on physicians:
-
how customers may obtain a complete inventory of all measures it uses to evaluate physicians, practice sites and medical groups for the purpose of taking action
-
how customers may obtain information on the number or percentage of physicians, practice sites and medical groups for which it has results for each measure it reports for factor 1
-
where its physician performance ratings are found
-
that physician performance ratings are only a guide to choosing a physician; that patients should confer with their existing physicians before making a decision; and that such ratings have a risk of error and should not be the sole basis for selecting a doctor
-
how the customer may register a complaint about the organization's physician rating system with the organization and also with NCQA
-
how customers may obtain information on the percentage of total payments in the aggregate to physicians, practice sites and medical groups based on performance.
|
The organization annually seeks to improve its physician performance reports by:
-
seeking feedback on the usefulness of reports from current members
-
seeking feedback on the usefulness of reports from current purchasers
-
seeking feedback on the validity and usefulness of reports from physicians, practice sites or medical groups
-
making available to physicians and current customers information on its process to seek and use feedback
-
analyzing the feedback and identifying opportunities for improvement, if applicable.
|
To make data more representative and to reduce redundant measurement the organization:
-
participates in a multipayor collaborative for quality or cost or resource-use measurement or
-
uses data from other sources that are representative of a physician's performance.
|
The organization’s responses to physician requests for corrections or changes contain the following information:
-
documentation of the substance of the request
-
investigation of the request
-
notification of the specific reasons for the final decision
-
notification of the outcome prior to taking action on measure results.
|
The organization has a process for registering and responding to oral and written member complaints about its physician measurement activities that include:
-
documentation of the substance of complaints and action taken
-
investigation of the substance of complaints
-
notification to members of the disposition of complaints and the right to appeal, as appropriate
-
standards for timeliness.
|
The organization follows its process for registering and responding to oral and written member complaints about its physician measurement activities including:
-
documentation of the substance of complaints and actions taken
-
investigation of the substance of complaints
-
notification to members of the disposition of complaints and the right to appeal, as appropriate
-
standards for timeliness.
|