Should doctors be able to exclude patients from pay-for-performance schemes?

In 2004, the UK introduced what was at the time the world's most ambitious pay-for-performance scheme, the Quality and Outcomes Framework or ‘QOF’. Twenty five per cent of general practitioners’ (GPs’) pay was tied to a complex set of 136 quality indicators, the majority of which were extracted electronically from GPs’ medical records.1 Typical indicators related to blood pressure control in hypertension or blood sugar control in patients with diabetes. However, GPs were given the opportunity to exclude patients from these quality calculations, and this was called exception reporting. If a GP ‘exception reported’ a patient (or an individual indicator), that patient (or indicator) was removed from the quality calculation with no financial penalty to the GP. The rationale for exception reporting was that even the best evidence-based guidelines were never intended to apply to all patients who visit their doctor. For example, it would be inappropriate...
Source: BMJ Quality and Safety - Category: Journals (General) Authors: Tags: BMJQS Noteworthy articles Editorials Source Type: research