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Exception Reporting Improves Pay-for-Performance Benefits

Inappropriate exclusion is rare

THURSDAY, July 17 (HealthDay News) -- Pay-for-performance programs benefit from use of exclusion reporting, whereby certain patients are excluded from quality calculations, and the practice of excluding patients to disguise missed targets, known as gaming, is rare, according to study findings published in the July 17 issue of the New England Journal of Medicine.

Tim Doran, M.D., of the University of Manchester in Manchester, U.K., and colleagues analyzed data from 8,105 family medical practices in England, accounting for 96 percent of the country's total, and calculated the rate of exception reporting for 65 clinical activities from April 2005 through March 2006.

A median 5.3 percent of patients were excluded from calculations, typically those related to achieving targets of providing treatment and reaching intermediate outcomes, the report indicates. Measurements of routine checks and offers of treatment were the least likely to be subject to exclusion reporting, the authors note. The estimated cost of exception reporting was 1.5 percent of the cost of the pay-for-performance program.

"The United Kingdom's experience with pay-for-performance programs provides some important lessons for other countries. As a system for safeguarding against inappropriate treatment, exception reporting has substantial benefits: it is precise, it increases acceptance of the program by physicians and it ameliorates perverse incentives to refuse care to 'difficult' patients," Doran and colleagues write. "The feared drawbacks of exception reporting -- that the provision would substantially increase the cost of the program and would be widely abused -- appear to be unfounded."

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