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Pay-for-performance in cataract surgery: the first quality-based payment system in Europe

Session Details

Session Title: Cataract I

Session Date/Time: Friday 14/02/2014 | 10:30-12:30

Paper Time: 12:20

Venue: Kosovel Hall (Level -2)

First Author: : TimHerbst GERMANY

Co Author(s): :    Joerg Foerster   Detlef Holland   Detlef Uthoff        

Abstract Details


Based upon the first results, which have been presented on ESCRS in Warsaw and Amsterdam, 1.5 year results of the first pay-for-performance approach for cataract surgery in Germany will be presented. Together with a German health insurance, the reimbursement system has been introduced in October 2012. Furthermore, possible effects of quality-based payments on medical outcome quality will be presented.


“Quality Network Bellevue“ (QNB) and “Quality Index Bellevue” (QiB) as the foundation for quality measurement will be characterized. A description of the developed quality-based payment system will be made and first results will be presented.


The presentation of the pay-for-performance approach will occur in a descriptive way. Statistical methods will be used for identifying significant effects, which may be explained by quality-based payments. Therefore, we will compare first findings after introducing quality-based payments with corresponding findings before introduction. For comparisons of single QiB findings, we will use Mann-Whitney-Test and Kruskal-Wallis tests. For examinations on aggregate levels, ANOVA test as well as ordinary t-test will be used.


We identified significant improvements by introducing quality-based payments in the following aspects: reduced total time of hospital stay (p=0.014) and increased overall patient satisfaction (p=0.001). Since medical care seem to be independent of health insurance, we did not find any differences in peri- and postoperative medical findings.


The long-run goal of every healthcare system is to develop a payment system, in which the amount of payments are geared not only to incurred costs but also to rendered quality of care. The Eye Hospital Bellevue has made the first step towards the realization of this vision together with a German health insurance. Payments per patient receiving cataract treatment depend on reached quality level of medical outcome, which is captured by Quality Index Bellevue system (QiB system). The individual QiB of every single cataract case is compared to a predefined value, which represents the overall mean QiB of the past year. This comparison decides about a financial bonus (in case of higher quality level) or malus (lower quality level). Our results support our hypotheses of significant reduced time of hospital stay as well as increased patient satisfaction. Structural model supports causality between introduced payment system and explanatory variables (total time of hospital stay, patient satisfaction). FINANCIAL INTEREST: NONE