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