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The Effect of an Incentive Billing Code on Heart Failure Management in Primary Care: A Population-Based Study.
Shijie Zhou1, Douglas S Lee1,2, Francis Nguyen3
1Division of Cardiology, University of Toronto, Toronto, Ontario, Canada.
CJC Open
|September 2, 2025
Summary
Ontario's Q050A incentive for heart failure (HF) care saw a small increase in HF medication prescriptions among eligible patients managed by family physicians. Despite this, disease-modifying HF drugs remain underutilized.
Area of Science:
- Cardiology
- Health Services Research
- Public Health Policy
Background:
- Ontario's Ministry of Health introduced the Q050A billing code in 2008.
- This pay-for-performance incentive aimed to improve guideline-based heart failure (HF) care by family physicians (FPs).
- The study investigates the impact of this incentive on HF medication prescribing patterns.
Purpose of the Study:
- To evaluate the association between the Q050A incentive and changes in HF medication prescriptions.
- To assess the utilization of guideline-directed HF therapies following the incentive's implementation.
Main Methods:
- Retrospective study of 39,425 HF patients aged 66+ in Ontario managed by FPs claiming Q050A (2008-2021).
- Analysis of prescription proportions for renin-angiotensin system inhibitors (RASis), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), and diuretics.
- Comparison of prescribing data 3 months before and after the Q050A billing code was claimed.
Main Results:
- Prescription rates increased post-incentive: RASis (45.2% to 45.8%), BBs (51.9% to 54.4%), MRAs (9.2% to 11.7%), and diuretics (63.2% to 65.7%).
- The proportion of patients not on any HF medications decreased significantly (27.5% to 24.9%, P < 0.001).
- Newly diagnosed HF patients with prompt FP follow-up showed the largest, though clinically modest, increase in medication use.
Conclusions:
- The Q050A incentive resulted in a minimal increase in heart failure medication prescriptions.
- Disease-modifying heart failure agents continue to be underutilized despite the incentive.
- Further strategies may be needed to enhance the uptake of guideline-directed therapies.
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