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Table 1 DOMAINS OF PERFORMANCE AND POTENTIAL INDICATORS

From: Design of price incentives for adjunct policy goals in formula funding for hospitals and health services

DOMAIN INDICATOR POSSIBLE INCENTIVE DESIGN
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).