Pay-for-Performance Plan Shows High Achievement

U.K. plan for primary care docs includes few who may underreport to skew rank, pay

WEDNESDAY, July 26 (HealthDay News) -- Results from a British primary care pay-for-performance program show that most practices attain high levels of achievement, according to a report in the July 27 issue of the New England Journal of Medicine. However, a few practices may be skewing their performance by underreporting.

The program is part of a national initiative in which primary care physicians can increase their pay up to 25 percent based on performance in the care of 10 chronic diseases measured by 146 quality indicators. Tim Doran, M.P.H., from the University of Manchester in the U.K., and colleagues measured the performance of 8,105 practices.

Overall achievement was found to be 83.4 percent and was determined, for example, by how many asthma patients had a review within the past 15 months or how many hypertensive patients' last blood pressure measurement was 150/90 mm Hg or less. Practices could exclude some patients from their reporting, such as those allergic to a monitored drug, which usually correlated with increased achievement. Most kept exclusion reporting low, although the few that excluded more than 15 percent of patients potentially increased their performance and, ultimately, their pay.

"Perhaps the most important lesson we can take from the experience in the United Kingdom would be to consider carefully the myriad potential consequences of pay for performance and to monitor the implementation of such a program carefully," states Arnold M. Epstein, M.D., of Harvard Medical School in Boston, in an accompanying editorial.

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