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

Poster Details

First Author: T.Herbst GERMANY

Co Author(s):    J. Foerster   D. Holland           

Abstract Details


On the basis of a self-developed quality measurement system for medical outcome, a pay-for-performance approach was implemented for cataract surgery in the Eye Hospital Bellevue. Together with a German health insurance, the reimbursement system was implemented in October 2012. Experiences gained within two and a half years will be presented and possible effects of quality-based payments on medical outcome will be described and explained.


The Eye Hospital Bellevue founded the “Quality Network Bellevue“ (QNB) and developed the “Quality Index Bellevue” (QIB) as a quality measurement system for medical outcome. Both will be characterized during presentation. 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 different findings before and after the introduction of the P4P system. For comparison of single QiB findings, Mann-Whitney-Test and Kruskal-Wallis tests will be used. For examination on aggregate level, ANOVA test as well as ordinary t-test will be used.


We identified significant improvements after introducing of the quality-based payments in the following aspects: total time of hospital stay (p=0.014) and increased overall patient satisfaction (p=0.001). Since medical care seems to be independent of health insurance, we did not find any differences in peri- and postoperative medical findings. Average quality-based payment (per patient) was -12.57 €.


In the Eye Hospital Bellevue, payments per patient receiving cataract treatment depend on reached quality level of medical outcome, which is captured by quality index Bellevue system. The individual QIBs of every single cataract case are compared to a predefined value, which represents the overall mean QiB of the past year as a benchmark. This comparison decides about a financial bonus (in case of higher quality level) or malus (lower quality level). Our results support our hypotheses of a significant reduced hospital stay as well as an increase in patient satisfaction due to the implementation of a P4P system.

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