Pay for Quality

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