Pay for Quality

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46 Pay for Quality KCE Reports 118 • An incentive per intervention as incentivized quality indicator, e.g. per vaccination 144, 177 , 178 , 179 , 180 , 181 , 182 , 196 . • An incentive per composite measure level. The composite measure is the 44 , aggregation of separate indicator measures into one overarching measure 174 , 175 , 176 , 193 , 206 , 211 , 222 , 223 . • An incentive amount according to the number of providers per clinic 201 . • An incentive based on the DRG based hospital payment amount 221 . 44 , 174 , 176 , 211 , • An incentive based on an all-or-none target performance 189 , 193 . The target level can be: • The individual provider level 69 , 177 , 180 , 182 , 187 , 193 . • The practice or organization level 172 , 183 , 184 , 188 , 196 , 201 , 210 , the physician organization or medical group level 74 , 197 , 203 44 , 174 , 176 , 211 , , the hospital level 221 . • The team level of per patient responsible individual providers combined 205 , 206 . • Some authors direct the incentive at the different levels of a network 191 . • The supervisors’ level 223 . In addition to additional bonus approaches, many USA systems competition and redistribution between providers or organizations based on their quality performance 44 , 174 , 175 , 176 , 187 , 188 , 191 , 211 . This implies in most cases the use of a bonus and withholds combination, imposing reward and punishment. In a few cases it concerns a bonus given to the best performing providers, without a withhold or punishment at the other end 183 , 205 , 206 . P4Q in the USA is sometimes directly combined with explicit incentives aimed at productivity, utilization management and/or cost containment 69 , 144, 171 , 188 , 212 . A minority of USA P4Q programmes provides an incentive based on the level of 181 , 183 , improvement through time instead of or combined with a fixed threshold level 184 . This longitudinal approach uses combinations of multiple thresholds for one indicator linked to the incentive amount 223 . For example, the bonus amount goes up gradually as a function of reaching a 20%, 40%…100% threshold. Exception reporting is used rarely in the evaluated USA P4Q programmes. One study uses it as a goal for reduction in the context of clinical pathway use 171 . The concept and approach differs from the UK QOF approach of exception reporting. The frequency of related quality measurements and the timing of the incentive provision vary. The most common frequencies include a yearly rate 170 , 188 , 195 , 210 , 222 , a semi-annual rate 183 , 184 , 193 , a four month interval rate 181 , 182 , a quarterly rate 74 , 195 177 , , a weekly rate 178 . Only a few authors describe the degree of time delays between healthcare provision, data collection, feedback (if present) and incentive payment. This can vary from no delay up to six months of delay 74 . Feedback and P4Q payment do not always occur within the same time frame. It is for example possible to provide monthly feedback and award an incentive each six months 193 . Most authors do not discuss the differential weighting of targets to be met, with some exceptions 197 . In most cases this implies the use of an equal weighting system, although this is not always clear. Although sometimes stated in early P4Q literature, only a few authors indicate that the proprietary nature of the P4Q schedule prohibits a detailed description 170 . 171 ,
KCE Reports 118 Pay for Quality 47 4.2.4.3 Australia, Germany, Italy, and Spain One P4Q programme studied in Australia is based on bonus payment varying according to case mix adjusted throughput, made to the hospital at the beginning of the financial year. The total bonus pool equals $7.2 million per year, and increased to $17 million for the last year. Bonus funds are absorbed within the general revenue of the hospital, with some funds directed to improving the emergency department and resources for bed management. Bonus reductions are applied if targets are not met in terms of percentages (1%, 5%, 20%, etc) 213 . The characteristics of the P4Q intervention are not specified in the other included Australian study 214 . The German study makes use of direct physician payments for every patient not smoking 12 months after recruitment. A physician receives $130 after study completion for each study participant they recruited who was proved smoke free. The time frame is not specified 216 . In Italy, one study tested the use of penalties according to the breastfeeding rate in a hospital setting. A deduction of 0,5% of the DRG annual revenues was applied, aimed at the intermediate regional health authority 217 . Finally, in Spanish Catalonia target payments were used with a maximum - per annum- of 5 200€ per physician and €6 200 per Primary Care Team manager. In addition, a professional development scheme was implemented and evaluated as part of Human Resource Management. Positive assessments implied an additional annual increase in individual salaries of €3 000 (physician) and €1 400 (nurses) 218 .
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Wettelijk depot : D/2008/10.273/50
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37. HTA Magnetische Resonantie Beel
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108. Tiotropium in de behandeling v
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Pay for Quality

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