Pay for Quality
Pay for Quality
Pay for Quality
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60 <strong>Pay</strong> <strong>for</strong> <strong>Quality</strong> KCE Reports 118<br />
Table 1 : Cost-effectiveness evaluation of 12 QOF indicators by Mason et al.<br />
(2008)<br />
<strong>Quality</strong> indicator Incremental<br />
QALYs per patient<br />
AF3: treatment with anticoagulant<br />
drug therapy or an antiplatelet<br />
drug therapy<br />
BP5: hypertension, BP 150/90 in<br />
past 5 months<br />
Incremental costs per Net monetary<br />
patient treated (2006) benefit per patient<br />
treated (2006)<br />
treated (2006)*<br />
1.465 to 2.2 -£1 162 to -£16 922 £45 162 to £46 222<br />
0.7 £751 £13 249<br />
CHD9: aspirin 0.0066 -£30 £162<br />
CHD 10: beta blocker 1.89 £234 £37 566<br />
CHD 11: ACE inhibitor/<br />
Angiotensin Receptor Blocker<br />
0.08 £488 £1 112<br />
ChKD4: ACE inhibitor/<br />
Angiotensin Receptor Blocker<br />
0.8076 to 1.5308 -£31 811 to -£32 906 £49 058 to £62 427<br />
CS1: Cervical screening 0.137 £68 £2 672<br />
DM15: proteinuria /<br />
microalbuminuria on ACE<br />
0.7210 -£9 662 £24 081<br />
DM21: diabetic retinal screening 0.4865 £9 750 -£21<br />
LVD/HF3: ACE inhibitor/<br />
Angiotensin Receptor Blocker<br />
0.21 £25 £4175<br />
Smoking 2: Smoking<br />
advice/referral<br />
0.0157 to 0.0451 £11 to £90 £303 to £812<br />
Stroke9/stroke12:<br />
antiplatelet/anticoagulant<br />
0.17 £371 £3 029<br />
* The net monetary benefit is calculated by assigning a value of £20,000 <strong>for</strong> each QALY gained.<br />
Curtin et al. (2006) 225 focus on the cost-effectiveness of a pay <strong>for</strong> quality programme in<br />
primary care in the USA, directed at physician organizations, and focusing specifically on<br />
diabetic care. Between 2000 and 2004 a partnership was established between a Health<br />
Plan and a physician organization. The physician organization withholds 10 percent of<br />
claims payments to practitioners of which typically 70 percent to 100 percent is<br />
available <strong>for</strong> distribution at the end of the year. Additional dollars derived from gainsharing<br />
programmes were added to the pool. <strong>Pay</strong>ment in the <strong>Pay</strong> <strong>for</strong> <strong>Quality</strong><br />
programme varied from 50 to 150 percent, as a result from which an average full-time<br />
primary care physician could earn between $6 000 and $18 000 extra in a given year,<br />
based on per<strong>for</strong>mance. The return on investment calculation, included in this study<br />
makes use of a cost trend, to project costs and compare the projected cost with the<br />
actual cost. As a result the actual costs seem to be lower than the projected cost. As<br />
shown in Table 2, this resulted in a plan saving of $1 894 470 in year 1 (2003) and<br />
$2 923 760 in year 2 (2004). The annual system development costs were estimated at<br />
$1 150 000. As a result the return on investment estimate would be 1.6 to 2.5.<br />
Table 2 : Return on investment evaluation of a diabetes quality<br />
improvement programme by Curtin et al. (2006)<br />
Plan savings diabetes Total cost per year of Return on<br />
care against two-year<br />
rolling trend<br />
the programme investment<br />
Year 1 $1 894 470 $1 150 000 1.6:1<br />
Year 2 $2 923 760 $1 150 000 2.5:1<br />
Nahra et al. (2006) 107 evaluated the cost-effectiveness of hospital <strong>Pay</strong> <strong>for</strong> <strong>Quality</strong><br />
incentives in the USA, focusing on heart care related hospital inpatient care. The pay <strong>for</strong><br />
quality programme has been implemented in 85 hospitals and provides incentives to<br />
increase adherence to heart-care related clinical guidelines. Three process measures <strong>for</strong><br />
heart care discharge have been considered, namely the percentage of eligible AMI<br />
patients receiving aspirin orders at discharge, the percentage of eligible AMI patients