Patient Attribution Methodology
The NYQA methodology selects a provider as the patient’s attributed provider when that provider has the greatest number of evaluation and management (E&M) visits during the 12-month period preceding the end of the measurement period. The member must have at least one preventive care visit or two E&M visits with a physician in the most recent 12 months of the measurement period to be eligible for attribution using the Imputed PCP methodology.
The E&M Codes have been constrained to focus on E&M Visits rendered in an outpatient or Nursing Home Care setting to support the request to conduct attribution based upon outpatient visits only. The E&M code list now excludes inpatient hospital codes, but includes the following:
The following is the ranking hierarchy to be used in selecting the single attributed primary care provider for each patient:
1. Enrollment
Greatest number of E&M or Preventive visits. If more than one Enrollment PCP meets the criteria, then the most recent service date is used.
The E&M Codes have been constrained to focus on E&M Visits rendered in an outpatient or Nursing Home Care setting to support the request to conduct attribution based upon outpatient visits only. The E&M code list now excludes inpatient hospital codes, but includes the following:
1) Office Visits
2) Non-Inpatient Consultations
3) Home Visits
4) Nursing Home Care
2) Non-Inpatient Consultations
3) Home Visits
4) Nursing Home Care
The following is the ranking hierarchy to be used in selecting the single attributed primary care provider for each patient:
1. Enrollment
a. Enrollment PCP submitted by Health Plan as of the last day of the reporting period.
b. If the Enrollment PCP meets the criteria, then the following tiebreaker logic is used:
• The PCP on the eligibility span with the latest eligibility end date submitted by the plan
• Greatest number of E&M or Preventive visits
• Most recent E&M or Preventive visits visit date
2. Imputed• Most recent E&M or Preventive visits visit date
Greatest number of E&M or Preventive visits. If more than one Enrollment PCP meets the criteria, then the most recent service date is used.