June 30, 2008

NCQA Updates Physician and Hospital Quality Program

The National Committee for Quality Assurance today 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 issued today reflect demand from employers, consumers, regulators and physicians around the country and changes in the market.

"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.

Consumers applauded the update. "We encourage our members to pay attention to cost and quality when they select their health care providers," said John Rother, AARP's Group Executive Officer for Policy and Strategy. "Consumers need to be confident that the information they use to make their decisions in choosing doctors and hospitals is objective, reliable, and fair. The standards that NCQA is releasing should reassure the public that the information offered by certified health plans is based on appropriate methodology and is fully transparent."

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.

Plans supported the changes. "Our members need and deserve reliable information on the quality and cost of their care to make informed, confident decisions to improve their health," said Jeffrey Kang, M.D., Chief Medical Officer, CIGNA. "The Physician and Hospital Quality seal demonstrates our commitment to developing that information fairly, equitably, and in a way that's meaningful to the individuals we serve. CIGNA is proud to have been among the first plans in the nation to earn that distinction from NCQA and we look forward to continuing our efforts under the updated standards."

The new requirements require the use of standardized, third-party measures endorsed by the National Quality Forum (NQF) when measuring physician performance. Where 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.

The first surveys under the new standards will occur in October. For more information, visit www.ncqa.org.

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes physicians in key clinical areas. NCQA's Healthcare Effectiveness Data and Information Set (HEDIS(R)) is the most widely used performance measurement tool in health care. NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health care choices. For more information, visit http://www.ncqa.org/.