Uptake of the Heart Failure Management Incentive Billing Code by Family Physicians in Ontario, Canada: A Retrospective Cohort Study

Benipal, Harsukh; Wang, Xuesong; Austin, Peter C.; Lee, Douglas S.; Demers, Catherine

doi:10.1016/j.cjca.2020.08.020

Cited by 6 publications

(7 citation statements)

References 5 publications

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“…Similarly, the Q050A code was claimed for 4.1% of all identified patients with HF in 2008 to 2009 living in Ontario, which increased to 5.9% of patients with HF in 2014 to 2015. 4 As such, there is a low uptake of this code within Ontario. Within the same period, there was an estimated 10 million Canadian dollars billed by PCPs, which further challenges the debated sustainability of the Canadian publicly funded health care system.…”

Section: Discussionmentioning

confidence: 99%

“… 3 In 2008, the Ontario Ministry of Health and Long‐Term Care introduced the Q050A billing code for primary care physicians (PCPs) to improve their prescription of both pharmacologic and nonpharmacologic therapies in managing patients with HF in the community. 4 This incentive has been in practice for >14 years with no evaluation of its impact on patient outcomes. Among PCPs, the uptake of Q050A was 10.4% in 2008 to 2009 and increased to 15.1% in 2014 to 2015.…”

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confidence: 99%

“…Among PCPs, the uptake of Q050A was 10.4% in 2008 to 2009 and increased to 15.1% in 2014 to 2015. 4 This translates into a payment of >10 million Canadian dollars to PCPs over the same period. 4 The effectiveness of these P4P models, however, has been a subject of significant debate, and to our knowledge, no literature evaluates the impact these models has on improving outcomes in solely community‐managed patients with HF.…”

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confidence: 99%

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Association of a Heart Failure Management Incentive in Primary Care With Clinical Outcomes: A Retrospective Cohort Study

Benipal,

Demers,

Cerasuolo

et al. 2024

JAHA

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Background We aim to examine the association between primary care physicians' billing of Q050A, a pay‐for‐performance heart failure (HF) management incentive fee code, and the composite outcome of mortality, hospitalization, and emergency department visits. Methods and Results This population‐based cohort study linked administrative health databases in Ontario, Canada, for patients with HF aged >66 years between January 1, 2008, and March 31, 2020. Cases were patients with HF who had a Q050A fee code billed. Cases and controls were matched 1:1 on age, sex, patient status on being rostered to a primary care physician, cardiologist, or internist visit in the 6 months before study enrollment, Johns Hopkins Adjusted Clinical Group resource use bands, days between HF diagnosis and study enrollment (±2 years), and the logit of the propensity score. A Cox proportional hazards model assessed the association of Q050A with the outcome. A total of 59 664 cases had a Q050A billed, whereas 244 883 patients did not. Before matching, patients who had a Q050A billed were more likely to be men (52% versus 49%), were rostered to a primary care physician (100% versus 96%), had a higher Charlson Comorbidity Index, and had higher health care costs. The mean follow‐up was 481 days for cases and 530 days for controls. The composite outcome (hazard ratio, 1.11 [95% CI, 1.09–1.12]) was significantly higher for cases than controls. Conclusions The Q050A incentive improved financial compensation for primary care physicians managing patients with HF but was not associated with improvements in the outcome. Research on promoting evidence‐based HF management is warranted.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Association of a Heart Failure Management Incentive in Primary Care With Clinical Outcomes: A Retrospective Cohort Study

Benipal,

Demers,

Cerasuolo

et al. 2024

JAHA

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“…Pay‐for‐performance incentives paid directly to cardiovascular and critical care providers, although promising in theory, have tended to yield unsustainable results if not aligned with institutional objectives and existing quality‐improvement initiatives. 24 , 44 , 45 , 46 , 47 , 48 , 49 Thus, financial investment in TAVI in Ontario may be most effective when paid to hospitals as incentives for restructured care delivery in alignment with the CCS TAVI Quality Project. 6…”

Section: Discussionmentioning

confidence: 99%

Financial Incentives for Transcatheter Aortic Valve Implantation in Ontario, Canada: A Cost‐Utility Analysis

Peel

Miranda

Naimark

et al. 2022

JAHA

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Background Transcatheter aortic valve implantation (TAVI) is a minimally invasive therapy for patients with severe aortic stenosis, which has become standard of care. The objective of this study was to determine the maximum cost‐effective investment in TAVI care that should be made at a health system level to meet quality indicator goals. Methods and Results We performed a cost‐utility analysis using probabilistic patient‐level simulation of TAVI care from the Ontario, Canada, Ministry of Health perspective. Costs and health utilities were accrued over a 2‐year time horizon. We created 4 hypothetical strategies that represented TAVI care meeting ≥1 quality indicator targets, (1) reduced wait times, (2) reduced hospital length of stay, (3) reduced pacemaker use, and (4) combined strategy, and compared these with current TAVI care. Per‐person costs, quality‐adjusted life years, and clinical outcomes were estimated by the model. Using these, incremental net monetary benefits were calculated for each strategy at different cost‐effectiveness thresholds between $0 and $100 000 per quality‐adjusted life year. Clinical improvements over the current practice were estimated with all comparator strategies. In Ontario, achieving quality indicator benchmarks could avoid ≈26 wait‐list deaths and 200 wait‐list hospitalizations annually. Compared with current TAVI care, the incremental net monetary benefit for this strategy varied from $10 765 (±$8721) and $17 221 (±$8977). This would translate to an annual investment of between ≈$14 to ≈$22 million by the Ontario Ministry of Health to incentivize these performance measures being cost‐effective. Conclusions This study has quantified the modest annual investment required and substantial clinical benefit of meeting improvement goals in TAVI care.

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“…Open access chronic conditions-an increasingly important component of improving population-level health outcomes. 15 Thus, strong primary care is crucial in the management of chronic disease in Canada, [16][17][18][19] and other jurisdictions with similar ageing populations. In March 2020, the WHO declared COVID-19 a global pandemic.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Describing primary care patterns before and during the COVID-19 pandemic across Canada: a quasi-experimental pre–post design cohort study using national practice-based research network data

Hafid,

Freeman,

Aubrey-Bassler

et al. 2024

BMJ Open

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ObjectiveThe objective was to analyse how the pandemic affected primary care access and comprehensiveness in chronic disease management by comparing primary care patterns before and during the early COVID-19 pandemic.DesignWe conducted a quasi-experimental pre–post design cohort study and reported indicators for the 21 months before and after the onset of the COVID-19 pandemic.SettingWe used electronic medical record data from primary care clinics enrolled in the Canadian Primary Care Sentinel Surveillance Network from 1 January 2018 to 31 December 2021.PopulationThe study population included patients (n=919 928) aged 18 years or older with at least one primary care contact from 12 March 2018 to 12 March 2020, in Canada.Outcome measuresThe study indicators included three indicators measuring access to primary care (encounters, blood pressure measurements and lab tests) and three for comprehensiveness (diagnoses, non-COVID-19 vaccines administered and referrals).Results67.3% of the cohort was aged ≥40 years, 56.4% were female and 53.5% were from Ontario, Canada. Fewer patients received an encounter during the pandemic (91.5% to 81.5%), while the median (IQR) number of encounters remained the same (5 (2–1)) for those with access. Fewer patients received a blood pressure measurement (47.9% to 31.8%), and patients received fewer measurements during the pandemic (2 (1–4) to 1 (0–2)).ConclusionsEncounters with primary care remained consistent during the pandemic, but in-person care, such as lab tests and blood pressure measurements, decreased. In-person care indicators followed temporally to national COVID-19 case counts during the pandemic.

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Uptake of the Heart Failure Management Incentive Billing Code by Family Physicians in Ontario, Canada: A Retrospective Cohort Study

Cited by 6 publications

References 5 publications

Association of a Heart Failure Management Incentive in Primary Care With Clinical Outcomes: A Retrospective Cohort Study

Association of a Heart Failure Management Incentive in Primary Care With Clinical Outcomes: A Retrospective Cohort Study

Financial Incentives for Transcatheter Aortic Valve Implantation in Ontario, Canada: A Cost‐Utility Analysis

Describing primary care patterns before and during the COVID-19 pandemic across Canada: a quasi-experimental pre–post design cohort study using national practice-based research network data

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