Awad Nadia, Caputo Francis J, Carpenter Jeffrey P, Alexander James B, Trani José L, Lombardi Joseph V
Division of Vascular Surgery, Department of Surgery, Cooper University Hospital, Camden, NJ.
Division of Vascular Surgery, Department of Surgery, Cooper University Hospital, Camden, NJ.
J Vasc Surg. 2017 Feb;65(2):579-582. doi: 10.1016/j.jvs.2016.08.104. Epub 2016 Nov 19.
Given the increased pressure from governmental programs to restructure reimbursements to reflect quality metrics achieved by physicians, review of current reimbursement schemes is necessary to ensure sustainability of the physician's performance while maintaining and ultimately improving patient outcomes. This study reviewed the impact of reimbursement incentives on evidence-based care outcomes within a vascular surgical program at an academic tertiary care center.
Data for patients with a confirmed 30-day follow-up for the vascular surgery subset of our institution's National Surgical Quality Improvement Program submission for the years 2013 and 2014 were reviewed. The outcomes reviewed included 30-day mortality, readmission, unplanned returns to the operating room, and all major morbidities. A comparison of both total charges and work relative value units (RVUs) generated was performed before and after changes were made from a salary-based to a productivity-based compensation model. P value analysis was used to determine if there were any statistically significant differences in patient outcomes between the two study years.
No statistically significant difference in outcomes of the core measures studied was identified between the two periods. There was a trend toward a lower incidence of respiratory complications, largely driven by a lower incidence in pneumonia between 2013 and 2014. The vascular division had a net increase of 8.2% in total charges and 5.7% in work RVUs after the RVU-based incentivization program was instituted.
Revenue-improving measures can improve sustainability of a vascular program without negatively affecting patient care as evidenced by the lack of difference in evidence-based core outcome measures in our study period. Further studies are needed to elucidate the long-term effects of incentivization programs on both patient care and program viability.
鉴于政府项目要求调整报销方式以反映医生所取得的质量指标的压力不断增加，有必要对当前的报销方案进行审查，以确保医生绩效的可持续性，同时维持并最终改善患者的治疗效果。本研究回顾了报销激励措施对一所学术性三级医疗中心血管外科项目中循证医疗结果的影响。
回顾了我们机构2013年和2014年提交给国家外科质量改进项目的血管外科部分患者的30天随访确认数据。审查的结果包括30天死亡率、再入院率、非计划重返手术室率以及所有主要并发症。在从基于薪水的薪酬模式转变为基于生产率的薪酬模式前后，对产生的总费用和工作相对价值单位（RVU）进行了比较。采用P值分析来确定两个研究年份之间患者结果是否存在任何统计学上的显著差异。
在两个时期之间，所研究的核心指标结果未发现统计学上的显著差异。呼吸并发症的发生率有下降趋势，这主要是由2013年至2014年肺炎发病率较低所推动。在实施基于RVU的激励计划后，血管外科部门的总费用净增加了8.2%，工作RVU净增加了5.7%。
如我们研究期间循证核心结果指标无差异所证明的那样，提高收入的措施可以提高血管外科项目的可持续性，而不会对患者护理产生负面影响。需要进一步的研究来阐明激励计划对患者护理和项目可行性的长期影响。
