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Accounting for multimorbidity in pay for performance: a modelling study using UK Quality and Outcomes Framework data.
Summary
The UK Quality and Outcomes Framework (QOF) incentivizes healthcare but overpays for multimorbidity. A fairer payment system is needed to accurately reflect workload and ensure equitable rewards for general practices.
Area of Science:
- Health Services Research
- Primary Care Medicine
- Health Economics
Background:
- The UK Quality and Outcomes Framework (QOF) uses financial incentives for disease-specific care.
- Current QOF structure does not account for patients with multiple chronic conditions (multimorbidity).
Purpose of the Study:
- To analyze payment variations within the QOF for indicators applied across multiple disease domains.
- To assess the impact of multimorbidity on QOF payments for blood pressure control and influenza immunisation.
Main Methods:
- A modelling study utilized cross-sectional data from 314 Scottish general practices.
- Calculated maximum potential QOF payments for blood pressure control and influenza immunisation based on the number of coexisting conditions.
- Re-modeled payments assuming a single payment per incentivised action.
Main Results:
- Significant payment variation observed for single indicators (£4.71-£11.08 for BP control, £2.09-£5.78 for immunisation).
- Practices received substantially higher payments for the same actions in patients with increasing multimorbidity (up to £29.72 for BP control).
- Deprived practices served more patients with multiple incentivised conditions, receiving higher overall payments under the existing system.
Conclusions:
- Existing QOF payment structures exhibit over twofold variation for identical processes in single-condition patients.
- Multiple payments for the same intervention in multimorbid patients are prevalent.
- A revised payment model is essential for equitable reward distribution and accurate workload funding in general practice.
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