The Impact of RVU-Based Compensation on Patient Safety Outcomes in Outpatient Otolaryngology Procedures.

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The Impact of RVU-Based Compensation on Patient Safety Outcomes in Outpatient Otolaryngology Procedures.

Otolaryngol Head Neck Surg. 2019 Feb 05;:194599819827881

Authors: Stanisce L, Ahmad N, Deckard N, Solomon D, Spalla TC, Gaughan JP, Koshkareva Y

Abstract
OBJECTIVE: To determine the effects an incentive-based physician compensation model has on safety outcomes related to outpatient otolaryngology surgical procedures.
STUDY DESIGN: A retrospective analysis of a prospectively maintained database assessing the difference in outpatient surgical volume and postoperative adverse outcomes before and after the implementation of a relative value unit (RVU)-based payment structure.
SETTING: Single-center academic otolaryngology practice operating at a hospital-owned ambulatory surgery center.
SUBJECTS AND METHODS: Data prospectively collected from outpatient otolaryngology surgical cases performed at the surgery center from April 2013 to April 2018 were retrospectively reviewed. Equal pre-RVU and post-RVU study periods were calculated for 4 surgeons based on their chronological transition in payment structure (range, 46-56 months). Case volume and incidence rates of adverse outcomes, including postoperative infections, emergency department visits, unplanned hospital admissions, and returns to the operating room, were compared between the pre-RVU and post-RVU study periods at both the surgeon and group levels.
RESULTS: At the group level, the post-RVU period was associated with a higher volume of surgical cases ( P = .001). No significant differences were observed in the overall incidence of adverse outcomes ( P = .21) or among the specific rates of postoperative hospitalizations ( P = .39), infections ( P = .45), unplanned returns to the operating room ( P = 1.00), or emergency department visits ( P = .39). Comparable results were observed at the individual surgeon level.
CONCLUSION: The implementation of an incentive-based salary was not associated with a change in the incidence of adverse safety outcomes in the setting of increased outpatient otolaryngology procedures.

PMID: 30717639 [PubMed - as supplied by publisher]

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