1 Cooper Medical School at Rowan University, Camden, New Jersey, USA.
2 Department of Otolaryngology-Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, USA.
Otolaryngol Head Neck Surg. 2019 Jun;160(6):1003-1008. doi: 10.1177/0194599819827881. Epub 2019 Feb 5.
To determine the effects an incentive-based physician compensation model has on safety outcomes related to outpatient otolaryngology surgical procedures.
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.
Single-center academic otolaryngology practice operating at a hospital-owned ambulatory surgery center.
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.
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.
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.
确定基于激励的医师薪酬模式对门诊耳鼻喉外科手术相关安全结果的影响。
这是一项回顾性分析，对前瞻性维护的数据库进行评估，以比较实施相对价值单位（RVU）为基础的薪酬结构前后门诊手术量和术后不良结果的差异。
在一家医院所有的门诊手术中心运营的单中心学术耳鼻喉科。
从手术中心进行的门诊耳鼻喉外科手术中前瞻性收集数据，并对 2013 年 4 月至 2018 年 4 月的数据进行回顾性分析。根据支付结构的时间顺序变化，为 4 名外科医生计算了相等的预 RVU 和后 RVU 研究期（范围为 46-56 个月）。比较了预 RVU 和后 RVU 研究期在外科医生和小组水平上的病例量和不良结果（包括术后感染、急诊就诊、非计划住院和返回手术室）的发生率。
在小组水平上，后 RVU 期与手术病例量较高相关（P =.001）。不良结果的总发生率（P =.21）或术后住院率（P =.39）、感染率（P =.45）、非计划返回手术室率（P = 1.00）或急诊就诊率（P =.39）均无显著差异。在个别外科医生水平上也观察到了类似的结果。
在增加门诊耳鼻喉科手术的情况下，实施基于激励的薪资制与不良安全结果的发生率变化无关。
