Frequently Asked Questions

What is Physician Office Link?

Physician Office Link (POL) is the product of collaboration between NCQA (www.ncqa.org) and Bridges to Excellence (www.bridgestoexcellence.com), a broad- based initiative to improve health care by rewarding quality. Bridges to Excellence (BTE) financially rewards physician practices that meet POL standards, showing that they use information systematically to enhance the quality of patient care.

NCQA's role in Physician Office Link is to:

• Develop and publish specifications for POL standards
  
• Evaluate physician practices that apply for rewards
  
• Publicly recognize those practices that meet the standards
  
• Inform BTE which practices have met the POL standards and are thus eligible for reward payments.

What is Bridges to Excellence?

Bridges to Excellence is a program designed to create significant leaps in the quality of care by recognizing and rewarding health care providers who demonstrate that they have implemented comprehensive solutions in the management of patients and deliver safe, timely, effective, efficient, equitable and patient-centered care. The initiative is comprised of three individual programs: Diabetes Care Link, Cardiac Care Link and Physician Office Link. Physicians who demonstrate high levels of performance in these areas are eligible for incentive bonuses paid by participating purchasers.

Why is the Physician Office Link program targeting office systems?

Systematic processes contribute to improvements in health care. Physicians who use systematic processes are better able to:

• Monitor their patients' medical histories
  
• Work with patients over time not just during office visits
  
• Follow up with patients and with other providers
  
• Manage populations, not just individuals, using evidence-based care
• Encourage better health habits and self-management of medical conditions.
  
  

What standards are in Physician Office Link?

Meeting POL standards means that practices have links--to information, to patients, to other practitioners, to evidence. The links in POL take several forms, and NCQA evaluates three overlapping categories of standards:

• Clinical Information Systems/Evidence-Based Medicine
  How does the practice use information to keep track of patients' treatments, follow up on tests, check medications and use researched standards of care?
  
• Patient Education and Support
  How does the practice use resources and referrals to help patients manage their own health? How does the practice measure and improve quality?
  
• Care Management
  How does the practice actively help patients with chronic conditions and patients with very complex problems maximize their health and prevent hospitalization?

Read a summary of the standards within the POL categories.

Eligibility

Which physician practices are eligible to apply for Physician Office Link rewards?

An NCQA evaluation of a practice's performance against POL standards, requires the practice to:

• Be located in areas where Bridges to Excellence operates.
  
• Serve patients who get their health care coverage through purchasers affiliated with Bridges to Excellence.
  
• Meet NCQA's definition of a physician practice. For this program NCQA defines a physician practice as one or more physicians at a single geographic location who practice together. The practice may include primary care physicians, any specialty physicians or a combination. Practicing together means that for all the physicians in a practice:
  • A single site is the location of practice for at least the majority of their clinical time
    
  • The non-physician staff follow the same procedures and protocols
    
  • Medical records, whether paper or electronic, of all patients treated at the practice site are available to and shared by all physicians as appropriate
    
  • The same systems-electronic (computers) and paper-based-and procedures support both clinical and administrative functions: scheduling time, treating patients, ordering services, prescribing, keeping medical records and follow-up.

How do I know how many of my practice's patients are covered under this program?

Physicians and patient counts are determined by the participating purchasers' health plans, based on ambulatory claim and encounter data for a 12-18 month period. Practices will identify those physicians who are part of their practice based on a physician list supplied by NCQA. The practice's total count of eligible patients is then calculated as the sum of the patient counts attributed to the individual physicians at that practice.

In Year 1 of the program, there will not be an appeal process regarding eligible patient counts. Questions regarding patient counts can be directed to Medstat at 1-800-224-7161.

How are patients attributed to physicians?

1. Participating purchasers' health plans identified all covered members enrolled with those plans in the target market.
   
2. Health plans then identified those physicians who saw covered members as patients for office visits, based on review of all ambulatory fee-for-service claims and capitated encounters during 2002 or the first half of 2003.
   
3. For those covered members who are enrolled with a managed care plan and who did not have any office visits during the measurement period, the health plans identified the primary care physician of record.

Which patients are included in the Physician Office Link rewards?

The patients included in POL rewards are:

• Subscriber employees of BTE purchasers
  
• Subscriber spouses and dependents of BTE purchasers
  
• Pre-65 retirees of BTE purchasers.

If an eligible patient sees more than one physician in the same practice, can the practice site count that patient more than once for purpose of the Physician Office Link rewards?

Yes, claims data is used to identify who sees the patient. The patient count is credited one time for each physician who provides care to the patient.

Are there any instances when a patient can be counted more than once for the purpose of Physician Office Link rewards?

Yes, a patient who receives care at more than one practice site can be counted more than once. For example, a patient who receives primary care from a physician at one practice site and receives specialist care at another practice site can be counted twice-once by the primary care practice and once by the specialty practice.

The Physician Office Link Rewards

How are the Physician Office Link rewards determined?

After a practice achieves a passing score on any one or all of the POL modules, it is eligible to receive a reward for each Bridges to Excellence employee or family member who receives care at the practice. The amounts of the rewards vary depending on the modules passed.

See the table below for the specific rewards practices may receive for each employer patient.

How much can a practice earn under Physician Office Link?

Qualifying practices will be entitled to up to $55-per-patient yearly bonuses, and unlike the Diabetes and Cardiac Care Link programs, bonuses are not tied to treating patients with a particular disease. For example, a physician caring for 150 participating patients could earn a year-end bonus up to $8,250, with a maximum possible award of $20,000 per physician annually.

For physicians who are eligible for both the Physician Office Link (POL) and Diabetes Care Link (DCL) programs, physicians are eligible for the full $100 reward per diabetes patient under the DCL program. However, the eligible reward amount under POL will be reduced by 25% for the identified diabetes patients, since physicians may be rewarded for these specific diabetes patients under both the DCL and POL programs.

If a practice concurrently participates in Diabetes Care Link and Cardiac Care Link, the eligible reward amount under Physician Office link will be reduced by 25% for the identified diabetes patients, since physicians may be rewarded for these specific diabetes patients under both the DCL and POL programs.

Does a practice need to bring forward all of its physicians for the Physician Office Link reward payments?

No, a practice may bring forward some or all of it physicians for the Physician Office Link rewards.

How long can a physician practice receive annual rewards for Physician Office Link?

For each Module the practice passes, the associated rewards are valid for three years. At the end of the annual three-year period, the practice submits a new application. When a practice wishes to qualify for Modules other than those passed in the first survey, it contacts NCQA to apply for an Add-On Survey. If the practice does not meet the required number of modules in any year, rewards may be reduced.

What are the reward amounts a physician practice can receive during the three-year period?

The practice receives the rewards associated with Year 1 in the first year, the rewards associated with Year 2 in the second year and the rewards associated with Year 3 in the third year. The more modules the practice passes each year, the higher the reward amounts.

The following two examples use information from the table above to clarify the rewards structure:

EXAMPLE 1

• A practice that passes one module in each category in Year 1 but does not apply for and pass any additional modules in Year 2 or 3 will receive:
  • $55 per employer patient in Year 1
    
  • $20 per employer patient in Year 2
    
  • $10 per employer patient in Year 3.

EXAMPLE 2

• A practice that passes one module in each category in Year 1 and applies for and passes three additional modules in Year 2 but does not apply for or pass any additional modules in Year 3 will receive:
  • $55 per employer patient in Year 1
    
  • $55 per employer patient in Year 2
    
  • $25 per employer patient in Year 3.

What is the schedule for the rewards payments?

A practice will receive its annual reward payment for Year 1 in the quarter after it achieves a passing score and annually thereafter for Year 2 and Year 3. The annual rewards are based on the most current census data for the practice. Bridges to Excellence will reassess the number of employer patients in the practice semi-annually and the physicians attributed to the practice annually.

Will a practice receive rewards for a physician who was attributed to the practice at the time of the application but left the practice before the rewards payment due to retirement or relocation to another state or another practice?

Yes, the practice will reap the rewards for that physician's patients in Year 1. However, the reward amount may change in Year 2 and Year 3 due to the semi-annual assessment of the number employer patients and the annual assessment of physicians attributed to the practice.

What is the time period for Year 1 Physician Office Link rewards?

Year 1 for the Physician Office Link rewards is 2003 and 2004.

If a practice applies for Physician Office Link rewards and achieves passing scores in 2003, will Bridges to Excellence pay rewards associated with Year 1 in 2003 and 2004?

No, Bridges to Excellence will pay the rewards associated with Year 1 to practices only once. Although, Physician Office Link starts in mid-2003, Bridges to Excellence has extended the Year 1 rewards into 2004 to provide practices more time to qualify for the rewards associated with Year 1.

If additional purchasers join during the first year, will a physician get the rewards for the new purchaser's employees who are the their patients?

Yes. As new purchasers join during the first year, Medstat or BTE will calculate the additional patient counts for each qualifying physician practice and send a check at the end of the quarter after they joined. This will happen automatically for all qualifying practices.

If an eligible patient sees a nurse practitioner, will the physician receive credit for this?

No, the rewards are based on physician visits only.

If a physician sees some patients several times during the course of a year, will they receive a reward for each visit?

No, the patient will only be counted once for the purpose of the rewards incentives.

Benefits of Physician Office Link recognition

Will the public know which physicians and practices have received Physician Office Link rewards?

Yes, when a practice achieves a passing score for any Physician Office Link module, the practice and the participating physicians in the practice will be listed on the NCQA and Bridges to Excellence Web sites. Practices that apply but do not pass will not be identified on either Web site. All information provided by applicants to NCQA will be held strictly confidential.

Application process

What is the application process for Physician Office Link?

1. Request from NCQA the Practice Background Information worksheet. Use this worksheet to identify the physicians who at least for the majority of their time, practice at that location.
   
2. Determine, from information provided by Bridges to Excellence, the number of BTE patients your practice has and therefore the amount of financial reward and fee reimbursement for which you are eligible.
   
3. Purchase an Interactive Survey System (ISS) license and single application. The Physician Office Link ISS allows your practice to review the standards and conduct a self-scoring readiness evaluation.
   
4. Request from NCQA the application packet.
   
5. Decide which Physician Office Link Evaluation Options (Modules) to pursue when you complete the readiness evaluation.
   
6. Submit to NCQA the following:

• A completed application
  
• An application fee (the fee table is included in the application packet)
  
• A signed applicant agreement
  
• A signed Business Associate addendum
  
• Completed Survey Tool with attached supporting documentation that validate responses
  
• A completed Practice Background Information worksheet

How can practices receive Physician Office Link application materials?

Practices may contact NCQA Customer Support for application materials and information about the program.

• Contact NCQA to purchase a Physician Office Link publication via the NCQA Web site or call Customer Support for materials or information at 888-275-7585.

What does it cost to apply for Physician Office Link?

The application fees for a full survey are as follows. The full survey price is the fee for practices undergoing the process for the first time and applying for 1 - 9 modules.

Will Bridges to Excellence reimburse fees for the program?

Yes, there are some instances when Bridges to Excellence will reimburse the NCQA application fee to physician practices. To qualify for reimbursement of the application fee in addition to rewards, the practice must have an average of 50 patients per physician from BTE purchasers.

Is there a deadline for submitting an application for Physician Office Link rewards?

A practice may submit an application at any time. Rewards will be paid based on the modules the practice passes and the calendar year in which the practice applies.

How long will it take a physician practice to prepare an application?

Preparation time may vary based on the following factors:

• The number of Modules for which the practice applies
  
• The number of elements in the Modules the practice selects
  
• The number of supporting documents the practice has to validate its responses
  
• The size of the practice and dedicated resources for the application.

How long will it take for an application to be processed?

NCQA will make a decision on an application and notify the practice within 30 days of receipt of a completed application packet and submission of responses and supporting documents in the Interactive Survey System. Application packet documents include the Application, Agreement, Business Associate Addendum and Practice Background Information worksheet.

How will NCQA know if accurate data has been submitted?

Random audits of applications will occur to ensure the validity of the responses and supporting documentation submitted.

How does Bridges To Excellent relate to the MHQP Rewarding Results Initiative?

There is another RWJ project in Massachusetts focusing on rewarding physicians for quality improvement. This project is known as Massachusetts Health Quality Partners (MHQP) Reward Results. In Boston, MHQP Rewarding Results goals are:

• Build the infrastructure to support sustainable and reliable aggregate reporting of clinical performance results at the physician group level
  
• Provide these results to physicians, physician organizations, and health plans to help them focus their quality improvement efforts
  
• Publicly release the results at the physician organization in 2004 and the group level in 2005
  
• Evaluate how health plans' new financial and non-financial incentives impact the quality of care as measured by HEDISâ clinical measures for chronic care management and preventive care.

BTE and MHQP staff and evaluators are working closely together to ensure that both programs operate smoothly and that the impact of each can be measured accurately. Numerous opportunities for collaboration between the two programs are expected to develop as each gets off the ground.

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