Table 1 DOMAINS OF PERFORMANCE AND POTENTIAL INDICATORS

QUALITY

• Clinical indicators e.g. % adherence to specific treatment for specific disease

• Incremental payment where evidence of specific indicator

• Adherence to (any) endorsed care path

• Increment for adherence to care path

• Provision of data to allow clinical benchmarking

• Payment for provision of data

• Achievement of hospital accreditation

• Bonus for accreditation

• Complications which arise during course of treatment (such as adverse events)

• Remove complications (which occur after the patient was admitted, contrasting with comorbidities which were present on admission) from the definition of DRG and hence determination of casemix payment

• Score on consumer satisfaction questionnaire

• Incremental payment

• Appropriateness of care such as measured by agreed instrument

• Discount payment for cases which do not meet appropriateness of admission criteria as they are of less 'value' to purchaser

• Propensity to admit conditions that exhibit high geographic variation such as carpal tunnel operations.

• Reduce "profitability" of these cases by discounted payment for admission of high variability conditions

ACCESS

• Elective surgery waiting times

• Discount/penalties for high percent or number of patients waiting in excess of threshold time

• Premium paid for patients treated within acceptable timeframe (or penalty for revenue).

• Additional payments (or access to other types of additional funding arrangements) if negotiated target reduction in long wait patients achieved.

• Hospital emergency service times to treatment (by triage category)

• Penalties for failure to achieve threshold treatment time goals

• Long stays in hospital emergency service

• Penalties for number of patients denied timely admission to ward.

PREVENTION

• Avoidable hospital admissions

• Discounted payment for avoidable admissions

• Avoidable mortality

• Penalty in population funding formula for excess avoidable mortality

CODING QUALITY AND TIMELINESS

• Timeliness

• Zero payment for submission of data outside specific timeframes

• Incidence of "error" DRGs

• Discounted payment for 'error' DRG codes.

• Coding error as measured by audit

• Penalty for upcoding (eg. double deduction where overcoding found).