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Home / News & IndustryManaged Care Insight and Analysis
Updated: April 28, 2009
P4P Program Reduces Emergency Room Congestion In British Columbia

Patients visiting the emergency departments of the busiest hospitals in British Columbia will benefit from shorter waits through $20 million in program funding aimed at providing financial incentives for delivering more timely care.

"Innovation can help unclog bottlenecks in our public health system and is critical to improving patient access and care," said Health Services Minister George Abbott. "In some hospitals in Vancouver, 25 percent of patients waited less as a result of the pay-for-performance pilot."

P4P funding to ease emergency department congestion was first piloted in 2007 by Vancouver Coastal Health (VCH). It rewarded hospitals that met predetermined targets for moving patients through the emergency department, either into a hospital bed or back to the community. In the first half of 2008, compared to the first half of 2007, VCH saw:

  • Twenty-two percent more patients with lower medical concerns being treated and discharged from emergency within the two-hour target;
  • Thirteen percent more patients with higher medical concerns getting care within the four-hour target; and
  • Twenty-four percent more patients who needed to be admitted getting a hospital bed within the 10-hour target.

"The results of our emergency decongestion pilot and the pay-for-performance funding model have been outstanding," said Dr. Eric Grafstein, an emergency physician and regional emergency services council chair for VCH. "Overall, 30,000 more patients were seen within the target time for discharge from the emergency department or admission to a ward. The success is due not just to the innovation and commitment of physicians and emergency department staff, but to everyone in the hospitals with a role in helping patients get care more quickly."

Following the successful emergency decongestion pilot in four hospitals in VCH, the program will continue as a Lower Mainland Innovation and Integration Fund (LMIIF) funded project at Vancouver General, St. Paul’s, Richmond and Lions Gate as well as expanding to Abbotsford Regional Hospital, Burnaby Hospital, Royal Columbian Hospital and Surrey Memorial Hospital in Fraser Health.

"Pay-for-performance is an innovative model to help ensure patients receive the care they need in a timely manner," said Dr. Nigel Murray, Fraser Health CEO. "Fraser Health welcomes the opportunity to reduce congestion by rewarding hospitals for their ability to meet patient-focused targets."

Fraser Health is focusing tailored resources for site-specific projects with the best chance of producing the desired results. This includes an emergency triage physician at Surrey Memorial Hospital, rapid assessment zones at Burnaby and Abbotsford and an emergency rehabilitation team at Royal Columbian.

"We physicians appreciate the funding that is targeted directly at reducing emergency department congestion," said Dr. Neil Barclay, an emergency physician at Royal Columbian Hospital. "We hope this will have a significant impact on wait times for patients who come to the emergency department."

Each emergency department has a current baseline of the time from arrival to treatment and discharge, or admission, for each category of patient. Reducing wait times from those baselines earns dollars to be reinvested by the facilities for further improvements.

With $20-million worth of resources available through the LMIIF, each hospital will now have the opportunity to fund unique projects anywhere in the healthcare system that may help it to meet targets for transit times for patients admitted and discharged through the emergency department.

For every low acuity patient treated and discharged in less than two hours, the hospital receives $100. For more serious patients treated and discharged in less than four hours, the payment will also be $100. For admitted patients who move to a bed in less than 10 hours, the hospital receives $600. The money will then be reinvested in improvements to hospital care.

Fraser Health and VCH have collaborated on a series of pilot programs as part of a two-year $75-million LMIIF to encourage new patient-focused funding models that will support patient access –a government initiative announced in the 2008 throne speech.

VCH received $14 million in its first year piloting this model. That money has been reinvested in the projects that delivered the results. Fraser Health has the opportunity to earn up to $12 million with $8 million available to VCH.

Address: British Columbia Ministry of Health Services, P.O. Box 9050, STN PROV GOVT, Victoria, BC V8W9E2 Canada; (950) 953-3547,

  This article was taken from:
Pay-For-Performance Reporter

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