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

• Published in: Otolaryngology-head and neck surgery Vol. 160; no. 6; p. 1003
• Main Authors: Stanisce, Luke, Ahmad, Nadir, Deckard, Nathan, Solomon, Donald, Spalla, Thomas C, Gaughan, John P, Koshkareva, Yekaterina
• Format: Journal Article
• Language: English
• Published: England 01.06.2019
• Subjects: Ambulatory Surgical Procedures - adverse effects; Humans; Otorhinolaryngologic Surgical Procedures - adverse effects; Patient Safety; Postoperative Complications - epidemiology; Reimbursement, Incentive; Relative Value Scales; Retrospective Studies; RVU; incentive-based compensation; patient safety; relative value unit; payment reform; ambulatory surgery
• DOI: 10.1177/0194599819827881

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.