NCQA Cardiac Care Performance Assessment Program

To obtain the rewards available through the Bridges to Excellence Cardiac Care Link (CCL) reward program, eligible physicians must demonstrate that they provide high levels of cardiac care by passing NCQA's cardiac performance assessment program.

Physicians must submit data on blood pressure, lipid and cholesterol testing, aspirin/antithrombotic use, and smoking cessation status for their cardiac patients.

NCQA Program Overview

What is NCQA's performance assessment program?

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 patients.

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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NCQA Measures

What measures will be used to determine eligibility for recognition?

Three-year HSRP recognition from AHA/ASA/NCQA requires submission of process and outcomes measures. For specific meausres visit NCQA.

How to apply to NCQA

What is the application process for NCQA's performance assessment program?

1. Go to www.ncqa.org/hsrp to review HSRP information and request an application packet
2. 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.
3. Decide whether to apply for 1-year certification or 3-year recognition
   
4. 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 Abstraction worksheet
   • 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 NCQA’s 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 to NCQA.

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 reviews.

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?

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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