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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
PubMed

Insights

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.
Abstract

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