GP heart disease targets, to which payments are related, should be based less on the measurement of risk factors and more on disease treatment and prevention, according to an article in the British Medical Journal (BMJ), this week’s issue.
The UK GP QOF (Quality and Outcomes Framework) is the largest pay-for-performance program in the world, say the authors.
GPs in the UK have the largest healthcare pay-for-performance program in the world, say the authors. The more points a GP practice earns the more money it attracts for the practice.
In this article, Professor Bruce Guthrie and team discuss how effective the system is regarding cardiovascular disease management. They illustrate how practices can accumulate loads of extra points and extra income without always lowering its risk.
If a practice receives nine points, each of which earns approximately £125 ($250), for generating a list of patients with hypertension, it could clock up another 30 points if at least 90% of those patients have a record of risk factors, such as blood pressure and smoking history in their medical notes. It would receive a further 56 points if at least 70% of those patients’ records showed that their blood pressure was brought down to below specific target values.
About £200 million is paid out to the UK’s approx. 11,000 general practices as a result of measuring cardiovascular risk factors, such as blood pressure and cholesterol, and documenting whether they are below specified values.
The authors say it is about time treatment information be incorporated into quality indicators. As treatment of risk factors reduces risk, rather than their measurements, it makes sense, they say.
Good management is not secured just by meeting current cardiovascular disease targets, they argue. Opportunities for intervention and better patient care could be clearly identified if treatment information were incorporated.
In an accompanying Editorial, David Walk, Consultant Cardiologist, agrees. In his view the treatment and prevention of cardiovascular disease is becoming a succession of isolated tasks linked to financial rather than clinical values. QOF measurements relating to cardiovascular disease does not achieve much, he adds.
The QOF, explains Walk, has been useful in highlighting the importance of cardiovascular disease treatment and prevention. What it has not done, however, is to focus minds on how best treat and prevent it. Payments should be directly linked to treatment and prevention, not the process, while at the same time protecting the independent professional status of UK doctors, he writes.
“Tackling therapeutic inertia: role of treatment data in quality indicators”
Bruce Guthrie, Melanie Inkster, and Tom Fahey
BMJ Volume 335, pp 542-4
Editorial: Problems with performance related pay in primary care
David Walk
BMJ Volume 335, pp 523-4
Written by: Christian Nordqvist