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Does Productivity-Based Physician Compensation Affect Surgical Rates for Elective Arthroplasty Surgery?
- Source :
- The Journal of Arthroplasty. 35:3445-3451.e1
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- Surgeon compensation models could potentially influence the utilization of elective procedures. We assessed whether transitioning from salaried to a relative value unit (RVU) productivity-based physician compensation model changed the surgical rate and patient selection in elective total hip and knee arthroplasty (THA and TKA) procedures.Our institution transitioned from salaried to RVU productivity-based reimbursement in July 2016. We performed a retrospective analysis on patients undergoing primary THA and TKA from July 2014 to July 2018 before and after the transition (salary period n = 820; RVU period n = 1188). Beta regression was used to determine the reimbursement structure as a predictor of surgery. The surgical rate was defined as the number of primary THA and TKA procedures per reimbursement period divided by all arthroplasty and osteoarthritis outpatient clinic encounters.There was a surgical rate of 15.8% (95% confidence interval [CI] 13.8%-17.8%) THA and 16.7% (95% CI 15.1%-18.1%) TKA procedures during RVU reimbursement compared to 11.1% (95% CI 9.8%-12.8%) THA and 11.7% (95% CI 10.5%-12.8%) TKA procedures during the salaried period (P.001). The adjusted odds of undergoing a THA or TKA procedure increased in the RVU compared to the salaried model (THA odds ratio 1.48, 95% CI 1.43-1.53; TKA odds ratio 1.50, 95% CI 1.46-1.55; P.001). There were no significant differences in patient age, gender, race, body mass index, or Charlson Comorbidity Index in salaried vs RVU productivity periods (P.05 for all covariates).Productivity-based physician compensation may encourage higher rates of elective arthroplasty procedures without broadening patient selection.
- Subjects :
- musculoskeletal diseases
medicine.medical_specialty
Knee Joint
Arthroplasty, Replacement, Hip
medicine.medical_treatment
03 medical and health sciences
0302 clinical medicine
medicine
Retrospective analysis
Humans
Outpatient clinic
Orthopedics and Sports Medicine
Arthroplasty, Replacement, Knee
Productivity
Reimbursement
Retrospective Studies
030222 orthopedics
business.industry
musculoskeletal system
Arthroplasty
Confidence interval
Surgery
surgical procedures, operative
Elective Surgical Procedures
Beta regression
business
Relative value unit
Subjects
Details
- ISSN :
- 08835403
- Volume :
- 35
- Database :
- OpenAIRE
- Journal :
- The Journal of Arthroplasty
- Accession number :
- edsair.doi.dedup.....2ad65aea5c0c00e75814f926920ae912