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Quality Assurance Group Announces Standards Update

By Reed Cooley, CQ Staff

July 11, 2008 -- The National Committee for Quality Assurance (NCQA) has announced it will update its standards for evaluating the way health plans measure and report on the cost and quality of health care providers.

NCQA first implemented the Physician and Hospital Quality (PHQ) program in 2006, but has decided to issue updates to the program due to "demand from employers, consumers, regulators, and physicians . . . and changes in the market," said an NCQA press release.

"Any effort to compare physicians and hospitals is only as good as its methods and its data . . . The updates to this program raise the bar," said NCQA President Margaret E. O'Kane.

Among other things, the updates, released late last month, would introduce a requirement that some physician quality measures be approved by third-party evaluators.

Insurance industry representatives said it was too early to tell what impact the updates would have on insurers but commended NCQA and other accreditation programs for holding providers accountable on measures of cost and quality.

"Our members certainly endorse the concept of having transparency in physician performance measurements," said Robert Zirkelbach, a spokesperson for America's Health Insurance Plans (AHIP).

He added that AHIP companies wishing to comply with the certification updates most likely would have to allocate new resources to make the required changes.

However, Greg Bury of Medica, an AHIP insurance company in Minnesota that is PHQ certified, said his company would have to change little to adjust to the updates.

"The changes are not going to have any impact for us and we're fine with the revisions," he said.

Consumer advocates, although supportive of NCQA and other quality reporting systems, warned that such programs will be limited if they continue to be voluntary.

"In general when we're looking at performance information there's a number of very good voluntary efforts underway . . . The overall impact of those efforts has been pretty modest," said John Santa, director of the Health Ratings Center at Consumer Reports, in an interview.

Santa said that only a requirement from a purchaser with "significant market clout" or a mandate from the federal government that all providers hold to particular set of standards could improve quality on a wider scale.

The updates would also open up the possibility for certification to independent Web sites and other information venues that assess the competency of insurers' quality reporting programs.

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