Pay for Quality

106 Pay for Quality KCE Reports 118
Quality measurement
1. Establish an audit system;
2. No one has ever suggested that clinical guidelines should relate to all patients,
so allow for an exception reporting mechanism like in the UK;
3. If possible, make use of available data collection systems to measure quality.
An unnecessary increase in administration workload should be avoided.
P4Q incentives
1. The ideal incentive size should range between 5% and 25%, although it seems
that some P4Q programmes with a small incentive can also induce a striking
effect;
2. Find a balance between rewarding high achievement and rewarding
improvement (There is an argument that payment should be related to
improvement, that would give more incentives to low scoring practices);
Implementing and communicating the programme
1. It is important that government and clinical leadership recognize that quality
is variable and improvement is important;
2. Include government/ insurers as well as the health care providers and
academics from the start in the negotiation process to implement a P4Q
programme;
3. Invest in IT development and make data collection automatically. This makes
participation less time consuming and it makes gaming more difficult. P4Q can
be seen as an opportunity to promote the use of IT and electronic health
records;
4. Make use of a phased approach. For example start in a certain region, start
with a limited set of indicators or implement an adaption year in which
participation is being remunerated;
5. Allocate a well defined amount of money to the development and
implementation of a P4Q programme;
6. Make sure that health care providers who will be subject of P4Q have
adequate information about their own performance and adequate support for
quality improvement;
Evaluation of the programme
1. Examine unintended consequences and think about how schemes could be
developed to maintain/improve equity;
2. Measure your baseline first (in the UK, the first targets were easily reached
because baseline wasn’t measured properly. This caused the government
financial embarrassment).
Health care system and payer characteristics
1. Try to create a uniform P4Q system which is applicable for all physicians
(not like in the US with its diversity of schemes and the payer fragmentation
problem, where physicians often don’t know what targets should be achieved
in which programme);
2. It is important to recognize that P4Q is not a magic bullet. P4Q programmes
could have some value it they are organised in the right way, however, these
programmes should be seen as part of a range of quality improvement
initiatives.
Provider characteristics
1. Incentives should be targeted at the provider unit or the practice group.
Incentives that are given on a higher level could create a moral hazard
problem.
Patient characteristics
1. Monitor the effect on unintended consequences concerning patient
characteristics.