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The impact of public disclosure of reimbursement data on quality of care Michael Callens, MD Director R&D Christian Sickness funds Belgium EUMASS Congress,

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Presentatie over: "The impact of public disclosure of reimbursement data on quality of care Michael Callens, MD Director R&D Christian Sickness funds Belgium EUMASS Congress,"— Transcript van de presentatie:

1 The impact of public disclosure of reimbursement data on quality of care Michael Callens, MD Director R&D Christian Sickness funds Belgium EUMASS Congress, Ljubljana, 9-12/6/ 2016

2 Faculty Disclosure nothing to disclose

3 Reimbursement data contains a substantial amount of information about medical practice in Belgium. In addition to information on possible fraud, it also provides information on quality of health care.

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5 Caseload rare/complexe cancers high volume > medium > low > very low Better processes of care Lower PO mortality Higher 5 year survival KCE reports 5

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7 Urgent need for a centralization of care Only when hospitals perform sufficient interventions (20), quality can be proven with statistical significance. KCE: recommandation surgery upper GI cancers

8 – 2012…. idem > 80% less than 20 interventions 50% Hosp. 4 interventions or less/y 8 Source: RIZIV-INAMI > 80% of all hospitals

9 transparency and quality Does transparency and benchmarking/feedback to the providers automatically leads to improvement of quality? No: is necessary but not sufficient: KCE study on quality: often limited effect if only feed back to the health providers Eg,: feedback on antibiotics prescription in Belgium Eg,: benchmarking on volume/outcome of complex and rare cancers

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11 oesophageal cancer Research by the Belgian KCE survival rate at five years: up to four times higher if treated in hospital with at least 20 surgical procedures/year.

12 oesophageal cancer Since feedback and self-regulation yield little results: The Christian mutual health insurance funds in 2013 and IMA in 2014 published the numbers for oesophageal cancer surgery per hospital for the first time to the public based on reimbursement data

13 Esophagectomy: public disclosure: june 2012 CM - june 2013 IMA Gebruikte nomenclatuurOmschrijving Thoracale of thoraco-abdominale oesofagectomie of gastro-oesofagectomie in één operatietijd met herstellen van de continuïteit Thoracale of thoraco-abdominale oesofagectomie of gastro-oesofagectomie in één operatietijd met herstellen van de continuïteit Subtotale oesofagectomie tot op het niveau van de arcus aortae, met herstellen van de continuïteit Subtotale oesofagectomie tot op het niveau van de arcus aortae, met herstellen van de continuïteit Thoracale of thoraco-abdominale oesofagectomie of gastro-oesofagectomie in één operatietijd met herstellen van de continuïteit en uitgebreid klierevidement Thoracale of thoraco-abdominale oesofagectomie of gastro-oesofagectomie in één operatietijd met herstellen van de continuïteit en uitgebreid klierevidement Subtotale oesofagectomie tot op het niveau van de arcus aortae met herstellen van de continuïteit en uitgebreid klierevidement Subtotale oesofagectomie tot op het niveau van de arcus aortae met herstellen van de continuïteit en uitgebreid klierevidement

14 Esophagectomy– IMA- data Flanders INGREEPREGIOPROVINCIEINSTELLING NUMMERINSTELLING NAAMGEMEENTE OesofagectomieVLAANDERENANTWERPEN710009Z.N.A. ANTWERPENANTWERPEN UNIVERSITAIR ZIEKENHUIS ANTWERPEN-U.Z.EDEGEM GASTHUISZUSTERS ANTWERPENWILRIJK H. HARTZIEKENHUISLIER FUSIEZIEKENHUIS MONICADEURNE KLINABRASSCHAAT V.Z.W. IMELDABONHEIDEN A.Z. TURNHOUTTURNHOUT A.Z. ST. DIMPNAGEEL ALGEMEEN ZIEKENHUIS H. FAMILIEREET ST. JOZEFKLINIEKBORNEM LIMBURG710371ZIEKENHUIS OOST-LIMBURGGENK JESSAZIEKENHUISHASSELT REGIONAAL ZIEKENHUIS ST TRUDOSINT TRUIDEN MARIA ZIEKENHUIS NOORD-LIMBURGOVERPELT A.Z. VESALIUSTONGEREN 1 OOST VLAANDEREN710670U.Z. GENTGENT ONZE LIEVE VROUWZIEKENHUISAALST A.Z. MARIA MIDDELARES - ST JOZEFGENT A.Z. ST.-BLASIUSDENDERMONDE AZ ST-LUCASGENT ALGEMEEN STEDELIJK ZIEKENHUISAALST AZ OUDENAARDEOUDENAARDE AZ GLORIEUXRONSE A.Z. ST. ELISABETHZOTTEGEM A.Z. JAN PALFIJNGENT A.Z. ALMAEEKLO A.Z. NIKOLAASSINT NIKLAAS SINT VINCENTIUSZIEKENHUISDEINZE1 1 VLAAMS BRABANT710322ACADEMISCHE ZIEKENHUIZEN K.U.L.LEUVEN A.Z. VILVOORDEVILVOORDE WEST VLAANDEREN710049FUSIEZIEKENHUIS A.Z. ST. JANBRUGGE A.Z.GROENINGEKORTRIJK ALGEMEEN ZIEKENHUIS DAMIAANOOSTENDE H. HARTZIEKENHUIS ROESELARE - MENENROESELARE ST ANDRIESZIEKENHUISTIELT REGIONAAL ZIEKENHUIS JAN YPERMANIEPER ST. REMBERTZIEKENHUISTORHOUT STEDELIJK ZIEKENHUISROESELARE KLINIEK ST. AUGUSTINUSVEURNE O.L.V. VAN LOURDES ZIEKENHUIS WAREGEMWAREGEM 1

15 Esophagectomy – Result public disclosure Result: More patiënts (also per hospital) in less hospitals (minus 12) Aantal BE N Hosp Vlaanderen Wallonië Brussel België

16 Lung cancer surgery atlas.ima-aim.be 16 N Hosp Vlaanderen Wallonië Brussel België Aantal BE

17 transparency and public disclosure PubMed Commons Cochrane Database Syst Rev Nov 9;(11):CD doi: / CD pub2.Cochrane Database Syst Rev. Public release of performance data in changing the behaviour of healthcare consumers, professionals or organisations. Ketelaar NA Ketelaar NA 1, Faber MJ, Flottorp S, Rygh LH, Deane KH, Eccles MP.Faber MJFlottorp SRygh LHDeane KHEccles MP Conclusion: …More quality improvement activities were initiated in response to the publicly-released report cards…

18 transparency and quality Transparency: at what level? Network – hospital – individual provider? UK – US: shift to individual provider CM study on hip prosthesis: people ask for numbers per provider – quid ‘privacy?’ Transparency and statistics: how many cases annually to prove quality? KCE = 20 (10?) Obligation to publish? ‘moral’, legal, financial,…

19 Quality indicator QI: the mirror of the health care system “ Quantity is the ennemy of Quality” fe: volume can be a good proxy, not ’20’ indicators “the more transparant, the less you see” Structure, proces indicators: only for evaluating efficiency

20 Supporting informed decision-making If sickness funds publish health outcomes standards, patients could use valid data to find the best-fitting physicians for them ‘Persoonsvolgende financiering’: patient can make choices: transparency needed to tackle information asymmetry Public = ‘payer’: wants accountability and spend their money on quality care: you can only prove quality through transparency of data/outcome

21 Questions? Experiences?


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