Quality

In a Health Affairs Web exclusive, Martin Roland, director of the National Primary Care and Research and Development Centre at the University of Manchester, England, discussed initial results of the United Kingdom's Quality Outcomes Framework, the "world's most ambitious" pay-for-performance program.

Performance by U.K. general practitioners exceeded expectations, with a mean of 91% compliance with clinical guidelines. However, the response by physicians resulted in $700 million in additional physician payments above the $1.8 billion in new payments included in the QOF budget.

Bob Galvin -- director of Global Health Care at General Electric, who conducted the interview -- in asking Roland for recommendations for pay-for-performance programs in the U.S., noted that U.S. programs do not rely on additional funds.

Randolph said that given that constraint, the British government might have implemented its pay-for-performance program differently.

In addition, Galvin noted that "[p]rivate sector U.S. payers have moved aggressively to develop pay-for-performance programs but that there has not been a coordinated evaluation strategy. As a result, data about pay-for-performance's effectiveness is lacking."

Roland also discussed future plans for the U.K.'s pay-for-performance system (Galvin, Health Affairs, 9/6).

Health care officials' perceptions vary greatly on how pay-for-performance programs affect care provided at their facilities, with views largely depending on the particular circumstances at health care facilities, according to a study in the Joint Commission Journal on Quality and Patient Safety.

For the study, the authors from July 2003 through January 2004 interviewed administrators and medical directors at 22 medical groups and nine hospitals affiliated with 10 large, integrated health systems.

The study found that because hospitals have different sizes and scopes of operation, the effects of pay-for-performance programs are based on a number of different measures including institutional culture, organizational strategy and structure, and the sustainability of interventions, among others.

Researchers suggested that grants to fund infrastructure changes might be needed to establish new quality initiatives, particularly at facilities with limited resources, but that financial incentives are not necessary to develop successful pay-for-performance programs. The authors noted that regardless of whether financial incentives are used, P4P programs need:

Data systems to support quality improvement efforts;
Transparent and relevant quality measures; and
Accurate and timely data.

The authors suggest that incentives might need to be coordinated across the health care sector for P4P programs to succeed. Such coordination might require federal action to remove antitrust laws, according to researchers. In addition, the relationship between financial rewards and provider motivation should be considered, the study found (Conrad et al., Joint Commission Journal on Quality and Patient Safety, August 2006). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.