The Effect of an Incentive Billing Code on Heart Failure Management in Primary Care: A Population-Based Study

Background: To support family physicians (FPs) in managing patients with heart failure (HF), the Ministry of Health in Ontario, Canada implemented the Q050A billing code in 2008, a pay-for-performance incentive for guideline-based HF care. We studied whether the incentive was associated with any change in the prescription of HF medications. Methods: We identified all patients with HF in Ontario aged ≥ 66 years who were managed by FPs claiming the Q050A incentive between 2008 and 2021. We determined the proportion of patients who were prescribed renin-angiotensin system inhibitors (RASis), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), and diuretics 3 months before and after the Q050A billing code was used in claims for these patients. As applicable, we classified the agents by whether they are guideline-directed as recommended by the Canadian Cardiovascular Society. Results: We included 39,425 HF patients in the study. The median age was 80 years (interquartile range, 73-85); 49% were female. Compared to the pre-Q050A period, prescriptions increased after the incentive was implemented, from 45.2% to 45.8% for RASis, 51.9% to 54.4% for BBs, 9.2% to 11.7% for MRAs, and 63.2% to 65.7% for diuretics (P < 0.05). The proportion of those who were not on any HF medications decreased from 27.5% to 24.9% (P < 0.001). Those with newly diagnosed HF and prompt follow-up with FPs experienced the largest-but a clinically modest-increase in HF medications. Conclusions: The Q050A incentive led to a minimal increase in the prescription of HF medications; disease-modifying agents are underutilized.