Doctor Behaviour Under a Pay for Performance Contract: Further Evidence from the Quality and Outcomes Framework

Since 2003, 25% of UK general practitioners’ income has been determined by the quality of their care. The 65 clinical quality indicators in this scheme (the Quality and Outcomes Framework) are in the form of ratios, with financial reward increasing linearly with the ratio between a lower and upper threshold. The numerator is the number of patients for whom an indicator is achieved and the denominator is the number of patients the practices declare are suitable for the indicator. The number declared suitable is the number of patients with the relevant condition less the number exception reported by the practice for a specified range of reasons. Exception reporting is designed to avoid harmful treatment resulting from the application of quality targets to patients for whom they were not intended. However, exception reporting also gives GPs the opportunity to exclude patients who should in fact be treated in order to achieve higher financial rewards. This is inappropriate use of exception reporting or ‘gaming’. Practices can also increase income if they are below the upper threshold by reducing the number of patients declared with a condition (prevalence), or by increasing reported prevalence if they were above the upper threshold. This study examines the factors affecting delivered quality (the proportion of prevalent patients for indicators were achieved) and tests for gaming of exceptions and for prevalence reporting being responsive to financial incentives.Quality. Incentives. Gaming. Pay for performance.

Doctor Behaviour Under a Pay for Performance Contract: Evidence from the Quality and Outcomes Framework

Since 2003, 25% of UK general practitioners’ income has been determined by the quality of their care. The 65 clinical quality indicators in this scheme (the Quality and Outcomes Framework) are in the form of ratios, with financial reward increasing linearly with the ratio between a lower and upper threshold. The numerator is the number of patients for whom an indicator is achieved and the denominator is the number of patients the practices declares are suitable for the indicator. The number declared suitable is the number of patients with the relevant condition less the number exception reported by the practice for a specified range of reasons. Exception reporting is designed to avoid harmful treatment resulting from the application of quality targets to patients for whom they were not intended. However, exception reporting also gives GPs the opportunity to exclude patients who should in fact be treated in order to achieve higher financial rewards. This is inappropriate use of exception reporting or ‘gaming’. Practices can also increase income if they are below the upper threshold by reducing the number of patients declared with a condition (prevalence), or by increasing reported prevalence if they were above the upper threshold. This study examines the factors affecting delivered quality (the proportion of prevalent patients for indicators were achieved) and tests for gaming of exceptions and for prevalence reporting being responsive to financial incentives.Quality. Incentives. Gaming. Pay for performance.

Computer-aided boundary delineation of agricultural lands

The National Agricultural Statistics Service of the United States Department of Agriculture (USDA) presently uses labor-intensive aerial photographic interpretation techniques to divide large geographical areas into manageable-sized units for estimating domestic crop and livestock production. Prototype software, the computer-aided stratification (CAS) system, was developed to automate the procedure, and currently runs on a Sun-based image processing system. With a background display of LANDSAT Thematic Mapper and United States Geological Survey Digital Line Graph data, the operator uses a cursor to delineate agricultural areas, called sampling units, which are assigned to strata of land-use and land-cover types. The resultant stratified sampling units are used as input into subsequent USDA sampling procedures. As a test, three counties in Missouri were chosen for application of the CAS procedures. Subsequent analysis indicates that CAS was five times faster in creating sampling units than the manual techniques were

Abell 1201: a Minor merger at second core passage

We present an analysis of the structures and dynamics of the merging cluster Abell~1201, which has two sloshing cold fronts around a cooling core, and an offset gas core approximately 500kpc northwest of the center. New Chandra and XMM-Newton data reveal a region of enhanced brightness east of the offset core, with breaks in surface brightness along its boundary to the north and east. This is interpreted as a tail of gas stripped from the offset core. Gas in the offset core and the tail is distinguished from other gas at the same distance from the cluster center chiefly by having higher density, hence lower entropy. In addition, the offset core shows marginally lower temperature and metallicity than the surrounding area. The metallicity in the cool core is high and there is an abrupt drop in metallicity across the southern cold front. We interpret the observed properties of the system, including the placement of the cold fronts, the offset core and its tail in terms of a simple merger scenario. The offset core is the remnant of a merging subcluster, which first passed pericenter southeast of the center of the primary cluster and is now close to its second pericenter passage, moving at ~1000 km/s. Sloshing excited by the merger gave rise to the two cold fronts and the disposition of the cold fronts reveals that we view the merger from close to the plane of the orbit of the offset core.Comment: accepted by Ap

Compressor Performance Comparison of R454A and R454C for Refrigeration

The intent of this paper is to compare compressor performance of two low GWP refrigerants that are mildly flammable. Since there are limited test capabilities for compressors with flammable refrigerants, the compressor tests in this paper are based on a non-flammable refrigerant, in this case R513A. The tested compressor is an open type screw compressor that is driven by an external motor and is vapor injected. A physical compressor model is created from test data. This compressor model is not based on maps for efficiencies, capacity, or power consumption, but rather a basis of physical bulk elements, such as pressure drop from orifices (at suction, discharge and vapor injection), leakage orifices, volume ratio between the suction port and the vapor injection port as well as volume ratio between the suction port and the discharge port. The compressor displacement and speeds are the most fundamental inputs for both the model and the tests. For mechanical losses a friction coefficient and friction exponent, relative to the speed, are obtained from the developed compressor model. This model can predict the actual compressor operation with different refrigerants. This compressor model developed based on R513A testing is applied to predict the performance of R454A and R454C refrigerants that are potential candidates for low GWP transport refrigeration. R454A always gives higher capacity than R454C. For COP, R454A outperforms R454C in some conditions while R454C outperforms R454A in others

Determinants of General Practitioners' Wages in England

We analyse the determinants of annual net income and wages (annual net income/hours) of general practitioners (GPs) using a unique, anonymised, non-disclosive dataset derived from tax returns for 21,657 GPs in England for the financial year 2002/3. The average GP had a gross income of £189,300, incurred expenses of £115,600, and earned an annual net income of £73,700. The mean wage was £35 per hour. Net income and wages depended on gender, experience, list size, partnership size, whether or not the GP worked in a dispensing practice, whether or not they worked in a Primary Medical Service (PMS) practice, and the characteristics of the local population (limiting long term illness rate, proportion from ethnic minorities, population density, Index of Multiple Deprivation 2000). The findings have implications for discrimination by GP gender and country of qualification, economies of scale by practice size, incentives for competition for patients, compensating differentials for local population characteristics, and the attractiveness of PMS versus General Medical Services contracts.Physician, family. General practitioner. Income. Wages. Contract.

The ICO Approach to Quantifying and Restoring Forest Spatial Pattern: Implementation Guide

This document is intended as a “How To” guide for managers and stakeholders wishing to implement the Individual, Clumps, and Openings (ICO) method for silvicultural prescriptions and/or monitoring. This guide is organized into stand-alone chapters. Managers should read and use chapters as they find useful to their own needs.https://scholarworks.umt.edu/ico/1002/thumbnail.jp

Observation of Weyl nodes in TaAs

In 1929, H. Weyl proposed that the massless solution of Dirac equation represents a pair of new type particles, the so-called Weyl fermions [1]. However the existence of them in particle physics remains elusive for more than eight decades. Recently, significant advances in both topological insulators and topological semimetals have provided an alternative way to realize Weyl fermions in condensed matter as an emergent phenomenon: when two non-degenerate bands in the three-dimensional momentum space cross in the vicinity of Fermi energy (called as Weyl nodes), the low energy excitation behaves exactly the same as Weyl fermions. Here, by performing soft x-ray angle-resolved photoemission spectroscopy measurements which mainly probe bulk band structure, we directly observe the long-sought-after Weyl nodes for the first time in TaAs, whose projected locations on the (001) surface match well to the Fermi arcs, providing undisputable experimental evidence of existence of Weyl fermion quasiparticles in TaAs.Comment: 10 pages, 4 figures, see also related papers on TaAs arXiv:1501.00060, arXiv:1502.0468