Pay for Quality

KCE Reports 118 Pay for Quality 103
In the US, with all the different schemes, the degree of negotiation between insurance
companies or government and providers depends on the scheme. In the development of
the IHA programme in California the physician organisations were involved from the
very beginning. The inclusion of these physicians was very much part of the reason that
the initiative got off the ground.
The experts agree that it is important to include providers in the implementing phase of
a P4Q programme and to involve them in selecting the indicators. In fact, it is essential
that the indicators have clinical credibility, that they have to be developed in consent
with relevant clinicians and that they should be based on evidence based criteria.
6.2.4.2 Acceptance by professionals
In the UK, participation in the QOF scheme is quite high, probably because physicians
were largely involved in the negotiation process, because the targets are easily reached
by the majority of GP’s and because they can only gain additional income and can not
loose money. According to the UK experts, such a loss of income would never be
accepted by the professionals.
In US acceptance was mixed: some physicians were supportive and became interested in
making the most of P4Q by helping to develop good measures, while others were less
supportive, because US programmes involve frequently a withhold and physicians feel
that they are already underpaid.
In Australia there is an interplay of forces between 3 groups. The Australian medical
association is generally opposed to P4Q as it supports heavily FFS arrangements. The
royal Australian college of GP’s, which is a professional organization, is more supportive
to these quality payments. The Australian general practice network, which is another
GP organization network, is very supportive.
The pilot P4Q programme in the Netherlands included only physicians who were
supportive. It is difficult to predict the reaction of the majority of physicians when the
scheme becomes nationally implemented.
Experts agree that there remains substantial concern about P4Q schemes among groups
of professionals. There is still a very polarized view of physicians, some are very
opposed, and others are very supportive.
6.2.4.3 Mandatory or voluntary participation
As indicated above, participation in programmes can be mandatory or voluntary. The
UK and Australia make use of voluntary P4Q programmes. In the Netherlands,
participation in the pilot project is currently voluntary, but most probably participation
will be mandatory in the future, with new arrangements in the health care system. In the
US both mandatory as voluntary programmes can be identified.
Some experts believe that participation in P4Q programmes, which make use of
bonuses, should be voluntary. If you make these programmes mandatory, some
participants will not make the effort to score well. However some experts state that
data collection should be mandatory, to allow benchmarking within the group.
Key points on implementing and communicating the programme
• It is important to include providers in the implementing phase of a P4Q
programme because it leads to greater acceptance.
• Currently there is still a polarized view of physicians concerning P4Q.
• Most experts believe that participation in a P4Q programme should
voluntary, although according to some experts it can be important to make
data collection and hence participation mandatory to allow benchmarking
within the group.