Pay for Quality

KCE Reports 118 Pay for Quality 93
5.2.4.4 Implementing and communicating the programme
1. Base the first P4Q programme on new money. To keep budget equilibrium
couple already planned budget increases to the P4Q condition. (N)
2. Implement P4Q using a phased approach. Make initial use of demonstration
projects to avoid unpleasant surprises. Include both baseline and comparison
group measurements. (S)
3. Make initial use of a voluntary programme. Ensure by sufficient involvement
(democratic decision making) and a sufficient incentive size that the majority
of providers participates. (C)
4. Do everything possible to support communication and awareness of the
programme, especially in a direct and intensive way towards the participating
providers. (S)
5. Provide P4Q as a package together with other quality supporting tools. (S)
5.2.4.5 Evaluation of the programme
1. Incentivize a specific target for a sufficiently long time period (based on a
learning curve and clinical criteria concerning the effect interval). (S)
2. When a target performance plateau has been reached, focus on maintenance
of the level of quality of care. Include other priority targets to redirect quality
improvement resources. (N)
3. Sample regularly the performance on targets removed from the incentivized
set. (N)
4. Evaluate the P4Q programme as a whole on a regular basis, using scientifically
valid methods. (N)
5.2.4.6 Health care system and payer characteristics
1. Include only targets congruent with the health system and provider values.
Ensure consensus. Make sure that the system fits with internal motivation and
the non financial drive to provide healthcare. (N)
2. Provide one uniform P4Q system (in which local priorities may vary as
targets) from all payers to all participating providers to support transparency,
awareness and a sufficient incentive size. (S)
3. Integrate P4Q as one part of the healthcare payment system, with other
incentive types. directed at complimentary goals (income security, patient and
intervention volumes). (C)
5.2.4.7 Provider characteristics
1. Take into account the level of congruence with professional culture, but
realize that P4Q may also support a cultural shift. (N)
2. Both when implementing and evaluating P4Q include the level of leadership
support. The same is true for the history of engagement with quality
improvement activities. (N)
3. Target incentives at least at the individual provider level, when he or she
works in a larger organization. Combine individual incentives with team based
incentives when appropriate (hospital setting). (S)
4. Be aware and take into account that provider age, gender, ethnicity, and
training background will influence P4Q acceptance and performance. The
same is true for the organization’s purpose and structure (see medical groups
versus IPAs in the USA), the age of the organization, the ownership (degree
of resources available), the (non)teaching status, its geographical location and
the number of providers within a practice or organization. (W)