Frequently Asked Questions

About the Quality Measures in My Quality Counts!

1. Q. What is the New York Quality Alliance Collaborative?

A. The New York Quality Alliance Collaborative (NYQA) was formed as the governance organization for the New York State Department of Health (NYSDOH) Pay for Performance Demonstration grant. A steering committee, comprised of key stakeholders of the initiative, worked together to provide overall project planning, decision-making and fiduciary responsibilities. Project workgroups were convened – Clinical, Data Governance, Evaluation, Governance, Communications and a Physician Alliance – to foster subject-matter expertise.

2. Q. What measures are included in the NYQA report and who determined them?

A. The first report contains 10 ambulatory quality measures addressing diabetes, heart disease, treatment of URIs in children, and preventive services.

Each of the measures is based on generally-accepted national guidelines for quality care endorsed by the National Quality Forum, the Institute of Medicine and/or HEDIS®.

The NYQA report provides summary data based on 10 ambulatory metrics, including the following:

Breast Cancer Screening

Cervical Cancer Screening

Chlamydia Screening

Persistence of Beta-Blocker Treatment After a Heart Attack

Comprehensive Diabetes Care - A1C Testing

Comprehensive Diabetes Care - LDL Testing

Comprehensive Diabetes Care - DRE(Eye)

Comprehensive Diabetes Care - Urine Protein(Neph)

Appropriate Treatment for Children with URI

Appropriate Testing for Children with Pharyngitis

As this initiative is updated over time, other ambulatory measures may be added.

3. Q. What is the benchmark or desired rate for each measure?

A. As a reference point, we have provided a regional benchmark based on the reporting of all NYQA members.

4. Q. Why does the report emphasize primary care and not specialists?

A. The focus areas of the report -- which mainly address preventative services and care for people with diabetes, heart disease, and other chronic conditions – reflect the categories of care that make up a significant portion of ambulatory care services provided in the community. Primary care clinicians typically provide the care that is known to be most effective in keeping people with chronic conditions as healthy as possible; however, the data collected and reflected in this initiative includes care provided by primary care providers and by specialists.

About the Data in My Quality Counts!

5. Q. What data is included in the My Quality Counts! reports?

The NYQA report is based on data that reflects care provided to more than five million people in the state. The data was provided by the following organizations:
The NYQA report uses insurance claims data to measure certain aspects of care. The data being provided through your password-protected web portal is “includes information that identifies individual patients, such as name and address, if they met the measure criteria or missed a service or screening that they should have received.

6. Q. Why are the My Quality Counts! reports based on claims data?

A. For accurate measurement and comparison across the state, large data sets are essential. Claims data is the only type of high volume data that we are aware of that is readily available in electronic format for the vast majority of health care providers. Over time, the NYQA initiative will be expanded to reflect data from other sources, such as electronic medical records, labs, and patient experience surveys. Currently, much of that information is inaccessible because either it is trapped in paper (in the case of medical records) or the data is not currently being streamed into any centralized location (i.e., lab results).

7. Q. How can quality of care be measured using claims data?

A. Claims data reflects information submitted by providers to payers as a part of the billing process. While not all medical care shows up in billing data, it does include quite a bit of information about diagnoses and services provided. Using claims data, for example, one can measure “care processes” such as “What percentage of patients with diabetes were given or ordered an HbA1c test at least once during the measurement period?” The current reporting structure does not consider the cost or payment for that care in outcomes.

8. Q. Are there limitations when using claims data for performance reporting?

A. Yes. While claims submissions are the only high volume data source that we are currently aware of that is readily available in electronic format for all health care providers, we realize that using claims data is not perfect.

9. Q. How old is the claims data used in this report?

A. The data used in this report reflects care provided during calendar year 2008, with comparative data from the 2005-2007 timeframe.

10. Q. What is the minimal sample size?

A. The minimum sample size for any single measure in the NYQA report is 30 patients. If your practice does not sustain enough patients for the measure.

11. Q. Why is the data being provided at physician level and not at practice/clinic level?

A. Granularity of data is optimal in this situation. Patient attribution at physician level provides for a more accurate process to verify data. It also promotes responsibility and accountability at the physician level. NYQA is working to develop a methodology to roll up physicians to sites, groups and networks.

12. Q. Does the data put into place a hybrid adjustment factor to resolve the differences between administrative claims data and actual clinical activity?

A. Yes.

13. Q. Who has access to the aggregated reports posted onto the web?

A. In addition to the project report host, Clinical Support Services, who is providing back-end services to post the data, and ViPS, the data aggregator, each participating health plan will receive the aggregated collaborative data scores.

15. Q. What if patients don’t comply with a physician’s recommended treatment?

A. We acknowledge that certain patients are less likely to follow through with recommended care. NYQA is intended to inform everyone about aspects of care that are vitally important to getting and staying as healthy as possible. In addition to producing this report, efforts are underway across the state to engage people to do their part to improve personal health and comply with their doctors’ advice.

17. Q. What about the inclusion of data from fee-for-service Medicaid plans?

A. Efforts are currently underway with State Medicaid fee-for-service to become a member of this collaborative in future reports to physicians.

18. Q. How will interpretation of the data be used to change the way I practice?

A. Based on the aggregate report that you are provided, you will decide if and how your practice will need to change.

19. Q. Will it be possible for the physicians to validate the information in the aggregated report?

A. No. The initial funding was not adequate to develop a verification portal or process for physician data correction. However, a sustainability plan is being developed that will include processes for data verification and correction, and it is the intent of the three collaborating health plans to develop an actionable portal in the future.

20. Q. Can reports be run for groups as a whole?

A. NYQA is working to develop a methodology to be able to "roll up" individual physicians into site, group and network practice reports. Currently, NYQA is only able to publish reports at the physician level.

21. Q. Can I opt out of this program?

A. There is really no opt in or opt out. Information will come from the plans based on their administrative data and sent to the data aggregator for the development of a physician specific report using data from all the plans. Whether you, as a provider, wish to access it is voluntary.

22. Q. Will my data be publicized?

A. No, there is no public reporting requirement during the two years of the NYSDOH demonstration grant (2007-2009).

23. Q. What are some tips on succeeding with performance measures?

A. Knowledge of the measures and coding will assist with success. The measures are based on national standards and best practices and employing treatment standards will result in greater compliance. While this pilot set of 10 measures addresses only a handful of conditions, by working on these measures your practice can gain experience in using measures to gauge how closely you are able to consistently follow evidence-based guidelines.