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At 1 year, length of hospital stay affected results of pay-for-performance plan at German clinic
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Ljubljana, SLOVENIA — Inpatient hospital length of stay negatively affected the outcome of the bonus-malus pay-for-performance remuneration plan adopted by the Bellevue Eye Clinic in Kiel, Germany.
“The [pay-for-performance plan] is the first quality-based remuneration system introduced in Europe in 2012 through an agreement between our clinic and an insurance company. A bonus payment of +€40 or a malus subtraction of –€50 is applied to each cataract procedure depending on the quality level of medical outcome,” Tim Herbst, project manager at Bellevue, said at the winter meeting of the European Society of Cataract and Refractive Surgeons.
Tim Herbst
The main parameter for quality assessment is the Quality Index Bellevue, introduced in the clinic in 2007. In the overall evaluation at 1 year, medical performance was mostly above the index threshold for bonus payment. However, the second parameter, which was the time limit of hospital stay — 9.30 a.m. for inpatient procedures — was not met in a high number of cases, leading to a mean malus payment of –€12.57 per case.
Increased length of hospitalization was not a disservice to patients but mostly a consequence of performing accurate follow-up visits or prolonging observation in some cases the day after surgery, Herbst explained.
“We are setting up a questionnaire to evaluate patients’ attitudes in this respect. Based on results, we might be able to renegotiate with the insurance a relatively smaller weight for the hospital length of stay component in relation to quality,” he said.
Disclosure: Herbst has no relevant financial disclosures.