We wanted to make sure to report on the success of the pay-for-performance program in Britain and give it adequate space in Dark Daily and it’s full due. However, we also wanted to note, in this separate piece, that the success of the program in Britain may be slightly exaggerated.

In the study Pay for-Performance Programs in Family Practices in the United Kingdom, targets were met for 83% of eligible patients and practices earned nearly 97% of possible points available. The National Health Service (NHS) anticipated that practitioners would earn only 75%. Why did so many practitioners perform so well? There are a couple of plausible explanations.

First, the targets for high performance may have been too easy for practitioners to achieve. Trial and error is the only effective way for the NHS to find out how ambitious the targets should be. To address the possible problem of targets being set too low, the NHS has altered the 2006-2007 scheme so that all minimum and some maximum payment thresholds have been raised, 30 indicators have been dropped or modified, and 18 new indicators have been introduced.

The second reason that so many practitioners did an exceptional job of meeting targets is that there may have been some misreporting by practitioners. Certain patients may have been omitted from documentation to make it easier to meet targets. To ensure that misreporting is more difficult to get away with, the NHS has established Primary Care Trusts. These Trusts are statutory bodies responsible for the delivery of health care in local areas. They will inspect local practices and perform audits and inspections both randomly and at practices suspected of incorrect or fraudulent returns.

It is highly likely that the pay-for-performance program in the US will have similar results with practitioners performing better than expected in its first year. Doctors, hospitals, and laboratories who pay attention to developing targets from The Centers for Medicare and Medicaid and who make incremental improvements in their practices and facilities before the US adopts a pay-for-performance program in 2007 will put themselves in an excellent position early success. These health care practitioners and facilities will ensure not only that they meet appropriate standards and provide patients with the best possible care, but also that they will reap the maximum benefits and incentives from the government for their meeting targets.