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Pay-for-performance approach proves beneficial in German clinic
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WARSAW, Poland — A pay-for-performance system recently introduced at Bellevue Eye Hospital, Kiel, Germany, could set a model for quality-based payment in ophthalmology.
“In German hospitals, we receive a fixed price for procedures. For cataract surgery, it is on average €450 to €500, independent of the quality of the service we provide,” Jörg Förster, CEO of Bellevue Eye Hospital, said at the winter meeting of the European Society of Cataract and Refractive Surgeons. “A goal of modern health care is to develop a payment system in which payment is geared not only to the expenses we have, but also to the quality of care we provide.”
Jörg Förster
A pay-for-performance program was initiated at the Bellevue clinic in collaboration with one of the major insurance companies in Germany. It started in October and has been so far applied to cataract procedures.
As a benchmark for quality, the Quality Index Bellevue (QIB), developed internally by processing a large amount of surgery outcome data obtained from German clinics, is used.
“We have a bonus-malus system. We get a bonus of €40 for QIB of at least 1.37, length of stay of maximum 4 hours for outpatient and discharge before 9:30 a.m. for inpatient. If we don’t reach these criteria, we have to pay a malus of €50,” Förster explained.
Results are currently based on 117 quality-based cataract cases, and long-term evaluation is needed, he said. However, significant improvements by introducing quality-based payments were seen in terms of reduced total time of hospital stay and increased overall patient satisfaction.
Disclosure: Förster has no relevant financial disclosures.