Pay for Quality
Pay for Quality
Pay for Quality
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KCE Reports 118 <strong>Pay</strong> <strong>for</strong> <strong>Quality</strong> 117<br />
The revaluation is given globally to all providers in the capitation<br />
fee system, without any consideration <strong>for</strong> their individual results.<br />
Results (if available) The costs are lower in the capitation fee system <strong>for</strong> specialist<br />
care in general, institutional care, medical imaging, clinical/medical<br />
biology and in vitro nuclear medicine.<br />
Sources (most relevant ones)<br />
248<br />
Total budget 10% of the global funding <strong>for</strong> the Belgian capitation system<br />
represents about €4 380 000 (2008).<br />
Table 12: EPA (European Practice Assessment)<br />
VI. EPA (European Practice Assessment) TOOL 2005<br />
Initiated by WONCA Europe / EQUIP <strong>Quality</strong> Assurance board/ TOPAS-<br />
Europe<br />
Overall objective To support the continuous use of quality of care enhancement, to<br />
assess and improve structure and processes in general practice<br />
Date of implementation in Belgium 2001: first testing, 2007: starting with KCE project<br />
Target audience General practices<br />
Content GPs that enter the EPA system appoint a quality manager (colleague<br />
or auxiliary personnel), and engage with all the members of the<br />
Team (physicians, administrative and supporting personnel) to start<br />
a quality evaluation and improvement process that takes 3 year.<br />
Three sources of in<strong>for</strong>mation are used (199 indicators):<br />
Staff questionnaires with quality related items, grouped in 5 areas<br />
(infrastructure, people, in<strong>for</strong>mation, financial accountancy, quality<br />
and safety).<br />
Patient Questionnaire, taken by 75 randomized patients<br />
Practice visits and coaching by a trained EPA coach.<br />
Benchmarking is used to compare results of a particular practice<br />
using a visual scale VISOTOOL to observe differences regionally or<br />
even internationally.<br />
A Plan Do Check Act (PDCA) cycle is started to discuss weak<br />
points, prepare actions and use opportunities, under guidance of the<br />
local quality manager and the EPA coach. At the end of the process,<br />
a new evaluation is done to see if targets are met.<br />
Primary focus (structure, process Measurable elements of quality issues on 5 areas or the patient<br />
outcome)<br />
questionnaire<br />
Type of indicators used (if any) 199 indicators of quality related issues<br />
Purpose of indicators used Results can trigger change within a practice. Benchmarking allows<br />
comparison between practices.<br />
Type of incentives Until now, there are no consequences or rewards <strong>for</strong> the<br />
obtainment of the EPA-quality label. In Germany, EPA is one of the<br />
suppliers of mandatory practice accreditation, is probably of best<br />
quality and has a market share of approximately 20 percent.<br />
Results (if available) Preparative field tests have run in different countries, including 32<br />
Flemish practices (Domus Medica) and some Walloon practices.<br />
Ten Flemish practices finished their 1 st year of EPA-process (9<br />
group-practices and 1 duo-practice, on the average with 4 GP’s and<br />
3 non medical collaborators), most of them as a teaching practice of<br />
the Leuven HASTA network.<br />
In a <strong>for</strong>mer KCE project the feasibility was studied in Flanders and<br />
the French speaking part of Belgium. This feasibility study shows that<br />
prior interest in EPA is low in the GP community. A number of<br />
logistic and organizational problems were encountered. It proved<br />
attractive to participants, but it can be augmented by coaching of<br />
participants in more than a one-off project to identify and achieve<br />
targets <strong>for</strong> quality improvement. 249 In the absence of commitment of<br />
the government, a network of universities and one scientific<br />
organization will offer EPA as a service to training practices in the<br />
near future.