Pay for Quality

KCE Reports 118 Pay for Quality 49
The effect of these developments was that it became increasingly possible both to
define high-quality care and to provide methods that could be used to measure some
aspects of the quality of care. The change in the culture of the profession that occurred
during this decade in the UK was enormous 55 . The last piece missing was the political
will to implement the proposed changes. To tie a substantial proportion of physicians’
income to the quality of the care would produce winners and losers. However, the
British Medical Association was unwilling to accept a change in remuneration that would
result in the loss of income for large numbers of its members. In 2000 the government
of the United Kingdom decided to provide a substantial increase in health care funding.
This change came as a result of recognition of the serious underfunding of health care in
the United Kingdom as compared with that of similar countries, and the publication of
data suggesting poor outcomes for health care in the country.
Negotiations took place between the British Medical Association and the NHS, with the
assistance of a small group of academic advisers. The academic advisers drew on
published national guidelines for sources of evidence, such as those from specialist
societies. The details of the new contract were voted on by general practitioners in
June 2003. There was a 70 percent turnout, and 79 percent voted in favour.
Although this description of the implementation and communication process is relevant
to the interpretation of the included UK studies, most authors do not specify the
context of implementation and communication.
4.2.5.2 United States of America
Similar to all other characteristics and the P4Q intervention design, the process of
implementation and communication is also very heterogeneous in the USA. Like in the
UK, many USA studies do not report on this subject. The history of implementation,
especially the level of involvement and support by healthcare providers, is rarely
described. The studies that do report on this can be grouped into low and high
implementation and communication support for P4Q programmes. Support is provided
in one or more of the following ways:
• Involvement of healthcare providers/peers throughout the P4Q programme
design process by regular meetings 189 , 197 , 205 , 206 .
• Involvement of healthcare providers/peers to review and approve evidence
based guidelines as a basis for the P4Q programme 184 , use of a
multidisciplinary task force to identify evidence based practice and usable
indicators 171 , 189 , 193 .
• Involvement of healthcare providers/peers in the continuous updating process
of the programme 205 , 206 .
• Involvement of patients, office staff, educators, etc. 190 .
• Clear leadership support 175 , 197 , coordination by central leadership 190 ,
directors and administrators invited to a project launch meeting 196 .
• Support of similar involvement in the care improvement activities 190 .
• Use of a small core work group and later refinement by the larger
development team 190 .
• The contact strategy:
o Feedback by mail or in person by a medical director 188 , the use of
multiple individual mailings 183 , the use of letters and a brochure 184 ,
notification in monthly bulletin 197 , 201 , 206 , 220 .
o The use of formal presentations at standing meetings 197 .
o Face to face feedback 210 , personal communication 201 , visit by a project
representative offered to each intervention site 196 .
o Annual manual provided with an executive summary, full description of
the programme, answers to commonly asked questions 197 , 206 .
o Provision of technical specifications for each measure 197 , transparency
of the methods used to determine performance rates and translation
into a financial incentive amount via a public website 206 .