*NCQA
PPC Version 2 is now available*
Click
here to learn more
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:
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
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. NCQA
has developed Physician Practice Connections (PPC) to assess
office practices' performance in the areas of clinical information
systems, patient education and support, and care management.
Physician Practice Connections is the performance assessment
program for the Bridges to Excellence rewards program, Physician
Office Link (POL).
To
pass NCQA's Physician Practice Connections program, practices
must submit data in any one of the performance areas measured
by NCQA: clinical information systems, patient education and
support, and care management. To qualify for Physician Office
Link rewards, the practice must submit data and obtain a three-year
recognition in each of the three performance areas above.
Does
obtaining recognition improve the quality of health care?
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
- Avoid medical
errors.
How
will the public know which practices have obtained recognition?
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.
Back
to Top
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.
Back
to Top
How
to Apply to NCQA
What
is the application process for NCQA's performance assessment
program?
- Go to www.ncqa.org/pol
or call NCQA Customer Support at 1-888-275-7585 to request
an application packet.
- 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).
- 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.
- Decide which
PCC modules to pursue when you complete the readiness evaluation.
- For information
about Physician Recognition Programs training schedule please
visit, http://www.ncqa.org/Physician_training.htm
- 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.
Back
to Top
