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

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 2004 - 2009 – 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 228012 Thoracale of thoraco-abdominale oesofagectomie of gastro-oesofagectomie in één operatietijd met herstellen van de continuïteit 228023 Thoracale of thoraco-abdominale oesofagectomie of gastro-oesofagectomie in één operatietijd met herstellen van de continuïteit 228174 Subtotale oesofagectomie tot op het niveau van de arcus aortae, met herstellen van de continuïteit 228185 Subtotale oesofagectomie tot op het niveau van de arcus aortae, met herstellen van de continuïteit 228233 Thoracale of thoraco-abdominale oesofagectomie of gastro-oesofagectomie in één operatietijd met herstellen van de continuïteit en uitgebreid klierevidement 228244 Thoracale of thoraco-abdominale oesofagectomie of gastro-oesofagectomie in één operatietijd met herstellen van de continuïteit en uitgebreid klierevidement 228255 Subtotale oesofagectomie tot op het niveau van de arcus aortae met herstellen van de continuïteit en uitgebreid klierevidement 228266 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 NAAMGEMEENTE20062007200820092010201120122013 OesofagectomieVLAANDERENANTWERPEN710009Z.N.A. ANTWERPENANTWERPEN121197914199 710300UNIVERSITAIR ZIEKENHUIS ANTWERPEN-U.Z.EDEGEM1188 78 8 710099GASTHUISZUSTERS ANTWERPENWILRIJK876428137 710097H. HARTZIEKENHUISLIER75632234 710682FUSIEZIEKENHUIS MONICADEURNE53655112 710710KLINABRASSCHAAT14242453 710689V.Z.W. IMELDABONHEIDEN34322163 710063A.Z. TURNHOUTTURNHOUT4244431 710709A.Z. ST. DIMPNAGEEL 2213 11 710314ALGEMEEN ZIEKENHUIS H. FAMILIEREET 4 2 1 710104ST. JOZEFKLINIEKBORNEM 31 11 LIMBURG710371ZIEKENHUIS OOST-LIMBURGGENK64796755 710243JESSAZIEKENHUISHASSELT25323584 710715REGIONAAL ZIEKENHUIS ST TRUDOSINT TRUIDEN 1 12 710719MARIA ZIEKENHUIS NOORD-LIMBURGOVERPELT 1 2 710716A.Z. VESALIUSTONGEREN 1 OOST VLAANDEREN710670U.Z. GENTGENT3644282943564852 710126ONZE LIEVE VROUWZIEKENHUISAALST7227915105 710017A.Z. MARIA MIDDELARES - ST JOZEFGENT777247118 710012A.Z. ST.-BLASIUSDENDERMONDE23497545 710290AZ ST-LUCASGENT63386336 710176ALGEMEEN STEDELIJK ZIEKENHUISAALST34151676 710170AZ OUDENAARDEOUDENAARDE21323212 710550AZ GLORIEUXRONSE 13 5121 710217A.Z. ST. ELISABETHZOTTEGEM114 2 1 710713A.Z. JAN PALFIJNGENT123 1 710032A.Z. ALMAEEKLO21 111 710595A.Z. NIKOLAASSINT NIKLAAS111 710134SINT VINCENTIUSZIEKENHUISDEINZE1 1 VLAAMS BRABANT710322ACADEMISCHE ZIEKENHUIZEN K.U.L.LEUVEN119117999710696110131 710204A.Z. VILVOORDEVILVOORDE411132 WEST VLAANDEREN710049FUSIEZIEKENHUIS A.Z. ST. JANBRUGGE71091114132118 710396A.Z.GROENINGEKORTRIJK98787674 710525ALGEMEEN ZIEKENHUIS DAMIAANOOSTENDE41499643 710117H. HARTZIEKENHUIS ROESELARE - MENENROESELARE24763244 710395ST ANDRIESZIEKENHUISTIELT32341 13 710057REGIONAAL ZIEKENHUIS JAN YPERMANIEPER 311 114 710378ST. REMBERTZIEKENHUISTORHOUT 312 710002STEDELIJK ZIEKENHUISROESELARE1 2 2 710310KLINIEK ST. AUGUSTINUSVEURNE 1 1 710397O.L.V. VAN LOURDES ZIEKENHUIS WAREGEMWAREGEM 1

15 Esophagectomy – Result public disclosure Result: More patiënts (also per hospital) in less hospitals (minus 12) 200620072008200920102011201220132014 Aantal BE 447438429405438458499470500 N Hosp200620072008200920102011201220132014 Vlaanderen 303534312930312724 Wallonië 28 26182427262721 Brussel 12911 109 9 België 70727160636667 6355

16 Lung cancer surgery www.ima-aim.be atlas.ima-aim.be 16 N Hosp200620072008200920102011201220132014 Vlaanderen 4649484547 48 46 -- Wallonië 34 33353735 3433 -- Brussel 12 1112101112 -- België 929592 949395 9491 -- 200620072008200920102011201220132014 Aantal BE 2132212222132307231123912579 26072787

17 transparency and public disclosure PubMed Commons Cochrane Database Syst Rev. 2011 Nov 9;(11):CD004538. doi: 10.1002/14651858.CD004538.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?