What is NCQA's performance assessment
The National Committee for Quality Assurance
(NCQA) is the leading independent organization providing
information that allows employers and consumers of health
care to distinguish among health plans and physicians
based on quality of care. The American Heart Association/American
Stroke Association (AHA/ASA) and NCQA, have developed
the Heart/Stroke Recognition Program (HSRP) to assess
physician performance in the care of patients with cardiovascular
disease or who have had a stroke, and to recognize those
physicians who demonstrate a high level of performance.
To achieve HSRP Recognition and obtain
3-year recognition, physicians must submit data on outcome
and process measures for a sample of their cardiovascular/stroke
How will the public know which physicians
have obtained recognition?
All BTE rewards-eligible practices and physicians who
obtain recognition with NCQA's Heart Stroke Recognition
Program (HSRP) or the 1-year certification will be promoted
as recognized physicians through NCQA and AHA/ASA web
sites. To identify the physicians in your area who demonstrate
a high level of performance in providing care, click
on the HSRP directory on BTE's
Recognized Physician page. Practices that submit
an application but do not achieve recognition will not
be publicly identified.
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What measures will be used to determine eligibility
Three-year HSRP recognition from AHA/ASA/NCQA requires
submission of process and outcomes measures. For specific
meausres visit NCQA.
How to apply to
What is the application process for NCQA's performance
- Go to www.ncqa.org/hsrp
to review HSRP information and request an application
- Purchase a user license for HSRP through NCQA's
Interactive Survey System (ISS). The ISS allows applicant
physicians to download an Excel worksheet so that
they may complete a self-scoring readiness evaluation.
- Decide whether to apply for 1-year certification
or 3-year recognition
- Submit to NCQA the following:
- A completed HSRP application
- A signed HSRP agreement
- A signed Business Associate addendum
- A completed Survey Tool and HSRP Medical Record
- Any remaining fee due for an application for
a group of physicians.
How do I receive application materials from NCQA?
Visit NCQA's HSRP web site (www.ncqa.org/hsrp)
or call NCQA's Customer Support at 1-888-275-7585 to
request an application packet.
What does it cost to apply for recognition?
Physicians and physician groups seeking recognition
pay the following fees:
Under the new pricing methodology, released June 1,
2005, fee schedule amounts - as shown below - are the
same as they were previously; however, the schedule
is now applied to all of the doctors within a physician
group applying for recognition. This is in contrast
to before, when the fee schedule applied to each separate
medical practice site, generating significant costs
to purchase the survey tool and very high total application
fees. This change to the pricing methodology does not
affect the current HSRP sampling methodology.
($5 surcharge for every MD >200)
The fee schedule includes the price of one (1)
survey tool and applies to all physicians in a group
(e.g., medical practice, group of practices or corporate
entity) and one (1) tool per site is required.
The discounted fee schedule pertains to sponsored
medical groups only (e.g., BTE, health plans, etc.);
it does not apply to multi-site or multi-program applications.
Note: A practice group has twelve (12) months from
its first decision/recognition date to complete the
application process for all sites in its group under
the fee schedule at the time of initial submittal. After
that year ends, the applicant must start over with the
sliding fee schedule in effect at that time.
These fees include access to NCQA's Web-enabled platform,
all materials and the recognition application fee. Please
visit the NCQA
web site for up to date NCQA fee information.
Physicians can apply for group recognition with some
of all of the physicians at the practice site and/or
for individual recognition.
A volume discount for health plans that wish to sponsor
more than ten physicians for recognition may be available
by contacting the NCQA at [email protected].
Physicians who already have achieved recognition in
one of the NCQA Performance Assessment Programs may
obtain a 20% discount if they wish to apply for Recognition
under an additional NCQA Program. Please contact NCQA
Customer Support at 1-888-275-7585.
Will Bridges to Excellence reimburse fees paid to
NCQA for performance assessment?
Practices may be eligible for reimbursement of NCQA
program fees paid
(reimbursement up to 1 NCQA physician fee paid per 10
DCL/CCL patients or 50 POL patients).
Physicians applying for performance assessment must
pay fees established by NCQA for administering the HSRP
program. Physicians who pass NCQA's performance criteria
will be reimbursed by Bridges to Excellence for 1 NCQA
applicant fee per 10 CCL patients.
For example, a group with 4 physicians and 29 qualifying
CCL patients applies to NCQA for the HSRP program, paying
$1,440 in application fees. The practice passes NCQAs
performance criteria and is eligible for rewards through
Bridges to Excellence. With 4 physicians, the practice
paid an average NCQA fee of $360 per applicants ($1,440/4
= $360). With 29 qualifying DCL patients, the practice
qualifies for 2 applicant fee reimbursements (29/10
= 2). The practice will be reimbursed by Bridges to
Excellence a total of $720 ($360 x 2 = $720) for applicant
fees paid to NCQA.
Is there a deadline or required date for submitting
data to NCQA for performance assessment?
You may submit your performance data to NCQA at any
time during the year. After passing NCQA's performance
criteria, Bridges to Excellence will pay the full annual
reward amount during the quarter after a physician or
physician group achieves HSRP Recognition. To receive
Bridges to Excellence rewards certain deadlines may
apply. Please call 1-800-224-7161.
How long will it take to prepare an application?
Applicants should anticipate that it will require 1
- 3 months to identify eligible patients, abstract data
for these patients from medical records and/or administrative
systems, enter data into the self-assessment worksheet
and submit all completed materials and their application
How long will it take for NCQA to process an application?
NCQA will make a decision on an application and notify
the applicant within 28 days of receipt of application
fees, a completed application packet and submission
of responses and supporting documents in the Interactive
Survey System. Application documents and data include
the Application (with physician background information),
Agreement, Business Associate addendum and HSRP Medical
Record Abstraction Worksheet.
How will NCQA know if accurate data has been submitted?
Random audits of applications will occur to ensure
the validity of applicant data. HSRP audits are generally
conducted by mail, but they may also result in onsite
Is the data submitted confidential?
All data is confidential for both physicians and their
patients. All physicians achieving HSRP Recognition
or 1-year certification will be promoted through the
Bridges to Excellence web site. In addition, recognized
physicians will be promoted through the ADA and NCQA
web sites. Physicians who do not achieve recognition
will not be identified. Patient data is confidential
and does not include patient name, address, phone number,
or social security number. Instead, during data collection,
physicians assign an identification number to each patient,
before submitting data to NCQA. To further protect applicants,
applicants and NCQA will execute a business associates
addendum to ensure compliance with the Health Insurance
Portability and Accountability Act of 1996 ("HIPAA").
How long can a practice maintain recognition with
NCQA's HSRP Recognition is valid for three years and
associated rewards through the Bridges to Excellence
Cardiac Care Link program are valid for three years.
Certification through the Bridges to Excellence Cardiac
Care Link program are valid for one year, however there
are no rewards associated with the one year certification.
At the end of the annual or three-year period, a new
application is required.
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