*NCQA PPC Version 2 is now available*
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Physician Office Link (POL)

*Please note that some of the information below could be specific to a region, for example reward amounts and/or fee reimbursement. For market specifics, please contact your local BTE administrator.

The POL program is designed to promote and reward office practices for the use of systematic information to enhance the quality of patient care.

Systematic processes have been shown to contribute to improvements in health care, including physicians' ability to monitor their patients' medical histories and their ability to follow up with their patients and with other providers.

  • Office practice sites which implement specific processes to reduce errors and increase quality can earn up to $50 per year for each patient covered by a participating employer.
  • A report card for each physician office describing its performance on the program measures is made available to the public.

Systematic processes have been shown to contribute to improvements in health care, including physicians' ability to monitor their patients' medical histories and their ability to follow up with their patients and with other providers. View the full report from the California HealthCare Foundation.

NCQA Physician Practice Connections Version 2 Standards

On January 31, 2006, NCQA released Physician Practice Connections Version 2 (PPC v2) to the public.

PPC v2 will not impact the current BTE pilot markets of Boston, MA and Capital Region NY; the current physician recognition and application process will stay the same until the end of the BTE pilot on 7/24/06.

Bridges to Excellence is supporting the use of the new PPC v2 standards in all future markets and will work to transition from v1 to v2 in current markets upon completion of the pilot phase.

There are 9 modules in PPC v2:

PPC 1 - Access and Communication
PPC 2 - Patient Tracking and Registry Functions
PPC 3 - Care Management
PPC 4 - Self Management Support
PPC 5 - Electronic Prescribing
PPC 6 - Test Tracking
PPC 7 - Referral Tracking
PPC 8 - Performance Reporting and Improvement
PPC 9 - Interoperability

Each of these modules has 3 possible levels of element completion:

  • Basic elements assess the use of evidence-based standards of care, maintenance of patient registries for the purpose of identifying and following up with at-risk patients and provision of educational resources to patients.
  • Intermediate elements ask whether practices use electronic systems to maintain patient records, provide decision support, enter orders for prescriptions and lab tests and provide patient reminders.
  • Advanced elements ask whether a practice’s electronic systems interconnect and whether they are “interoperable” with other systems, whether it uses nationally accepted medical code sets and whether it can automatically send, receive and integrate data such as lab results and medical histories from other organizations’ systems.
  • Individual markets will determine the reward schedule that corresponds to the number of passed modules and the level at which the elements in each module are passed.

    For POL rewards, BTE recommends the following reward schedule:

    Basic recognition in PPC constitutes eligibility for $15 in rewards per patient per year.

    For Intermediate recognition it is $30 and for Advanced it is $50.

    For a comparision of PPCv1 requirements to PPCv2 requirements, download this chart (57kb MS Word Document).

    For more information about PPC v2, please visit NCQA's website at www.ncqa.org/ppc.

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NCQA Physician Practice Connections Assessment Program

To obtain the rewards available through the Bridges to Excellence Physician Office Link (POL) reward program, eligible physicians must demonstrate that they have implemented systematic office processes passing NCQA's Physician Practice Connections assessment program.

Office practices are assessed in three critical system areas: clinical information systems, patient education and support, and care management.

NCQA Program Overview

  • 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
  • Avoid medical errors.

All BTE rewards-eligible practices and physicians who obtain recognition with NCQA's Physician Practice Connections (PPC) program will be promoted as recognized practices and physicians through NCQA's web site. To identify the physicians in your area who demonstrate a high level of performance in providing care, click on the PPC directory on NCQA's Recognized Physician page. Practices that submit an application but do not achieve recognition are not publicly identified.

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NCQA Measures

What measures will be used to determine eligibility for recognition?

Meeting PPC standards means that practices have links--to information, to patients, to other practitioners, to evidence. The links in PPC take several forms, and NCQA evaluates three overlapping categories of standards in measuring physician office practice's performance:

  • 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?

For more information, refer to the summary of the standards for each of the Physician Practice Connections program category modules.

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How to Apply to NCQA

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

  1. Go to www.ncqa.org/pol or call NCQA Customer Support at 1-888-275-7585 to request an application packet.
  2. Complete and submit NCQA's Practice Background Information Worksheet. Based on the list of physicians provided with the worksheet, identify your practice's physicians (who must spend at least 51% of their time at that practice location).
  3. Purchase a user license for the PCC through NCQA's Interactive Survey System (ISS). The ISS allows your practice to review the standards and conduct a self-scoring readiness evaluation.
  4. Decide which PCC modules to pursue when you complete the readiness evaluation.
  5. For information about Physician Recognition Programs training schedule please visit, http://www.ncqa.org/Physician_training.htm
  6. Submit to NCQA the following:
  • A completed PPC application
  • An application fee (the fee table is included in the application agreement)
  • A signed PCC agreement
  • A signed Business Associate addendum
  • A completed Survey Tool with attached supporting documentation that validate responses.

How do I receive application materials from NCQA?

Visit the POL web site (www.ncqa.org/pol) or call NCQA's Customer Support at 1-888-275-7585 to request an application packet.

What does it cost to apply for recognition?

Application fees for the Physician Practice Connections program may be found by visiting the program Web site at www.ncqa.org/pol.

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 PPC program. Physicians who pass NCQA's performance criteria will be reimbursed by Bridges to Excellence for 1 average applicant fee per 50 POL patients.

For example, a practice with 6 physicians and 160 qualifying POL patients applies to NCQA for the PPC program, paying $2,400 in application fees. The practice passes NCQA's performance criteria and is eligible for rewards through Bridges to Excellence. With 6 physicians, the practice paid an average NCQA fee of $400 per applicant ($2,400/6 = $400). With 160 qualifying POL patients, the practice qualifies for 3 applicant fee reimbursements (160/50 = 3). The practice will be reimbursed by Bridges to Excellence a total of $1,200 ($400 x 3 = $1,200) for applicant fees paid to NCQA.

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.

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 the practice passes NCQA's performance criteria, Bridges to Excellence will pay the annual reward that the practice has earned during the quarter after it passes NCQA's office practice performance assessment program.

In NY & MA BTE pilot market, physicians &/or practices must submit their completed NCQA applications to NCQA by July 24, 2006 and achieve NCQA recognition by September 24, 2006 to receive their BTE rewards.

In non-pilot markets, please contact your BTE administrator for further information on deadlines.

How long will it take 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 NCQA to process an application?

NCQA will make a decision on an application and notify the practice 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 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. If your practice is selected for an audit, processing will take an additional 30 days, a total of 60 days.

Is the data submitted confidential?

All information submitted in the application materials and the Interactive Survey System tool is confidential for both physicians and their patients. All BTE rewards-eligible practices and physicians achieving recognition will be promoted through the Bridges to Excellence web site. In addition, recognized physicians will be promoted through the NCQA web site. Practices that do not achieve recognition will not be identified. To further protect practices, practices and NCQA will execute a business associate addendum to ensure compliance with the Health Insurance Portability and Accountability Act of 1996 ("HIPAA").

How long can a practice maintain recognition with NCQA?

PPC recognition and associated rewards through the Bridges to Excellence POL program are valid for three years. At the end of the three-year period, the practice submits a new application. When a practice wishes to qualify for PPC modules other than those passed in the first survey, it should contact NCQA to apply for an Add-On Survey. If the practice does not meet the required number of modules for full BTE rewards in any year, rewards may be reduced from the full available amount.

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