Pay for Quality
Pay for Quality
Pay for Quality
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
KCE Reports 118 <strong>Pay</strong> <strong>for</strong> <strong>Quality</strong> 29<br />
3.3 IMPLEMENTING AND COMMUNICATING THE PROGRAM<br />
In this paragraph, we discuss, largely based on the above knowledge, which steps are to<br />
be involved when initiating a P4Q programme, and which elements require special<br />
attention in that process. Importantly, these steps should be considered in the context<br />
of a quality circle, whereby the measurement phase leads to adjusting the goals, design<br />
and implementation.<br />
Understand the concepts and the context<br />
A logic requirement when planning the introduction of a P4Q programme is to<br />
understand all the above after carefully considering all relevant mediators and reaching<br />
consensus in terms of the choices and options which have to be assessed and decided<br />
upon. Specifically <strong>for</strong> a semi-decentralized system like Belgium this means that the<br />
political context within which a possible programme is implemented must be clarified<br />
(responsibilities of the federal and the regional health authorities)<br />
Making money available<br />
Obviously, introducing a P4Q programme implies that money is made available.<br />
Potential sources of funds <strong>for</strong> a P4Q initiative include (see Dudley and Rosenthal 2006<br />
78<br />
, and see above -incentives):<br />
• New money<br />
• Redirection of existing money<br />
• Reallocation of payment among providers, e.g., through a combined bonuspenalty<br />
payment scheme.<br />
• Cost savings resulting from improved quality.<br />
• The latter seems to be sometimes wrongly conceived as a necessary<br />
consequence of P4Q programmes (see <strong>for</strong> instance Young et al, 2005 54 ). Yet,<br />
improving quality is not necessarily associated with net savings.<br />
Stepwise introduction<br />
<strong>Pay</strong>ers introducing a P4Q programme may consider a stepwise introduction, also called<br />
phasing 78 . Advantages <strong>for</strong> phasing in P4Q are that it permits testing of measures be<strong>for</strong>e<br />
full scale implementation, giving providers time to gear up <strong>for</strong> a P4Q initiative; and<br />
enables purchasers to evaluate the small scale impact be<strong>for</strong>e applying it to the larger<br />
group of providers.<br />
Options <strong>for</strong> phasing in P4Q include the following:<br />
• Pilot test a payment scheme in a limited geographic area.<br />
• Focus on specific provider types or clinical areas.<br />
• Begin with pre-existing, national target sets and add targets over time.<br />
• Rely on existing data (most likely billing data) and incorporate additional data<br />
as needed over time.<br />
• Begin with a voluntary system.<br />
• Begin with (private) quality reports and introduce incentives over time.<br />
• Begin with a modest benchmark <strong>for</strong> per<strong>for</strong>mance and raise the standard over<br />
time.<br />
• Begin with requiring or rewarding data collection and reporting and<br />
introduce per<strong>for</strong>mance incentives over time.