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RVU-Based Compensation Incentivization in an Academic Vascular Practice Improves Productivity with No Early Adverse Impact on Quality
Nadia Awad, MD, Joseph Lombardi, MD, Jeffrey Carpenter, MD, James Alexander, MD, Jose Trani, MD, Francis Caputo, MD.
Cooper University Hospital, Camden, NJ, USA.
Objectives:
Relative value unit (RVU)-incentive programs have shown improvements in productivity without decreasing patient satisfaction. Evidence has shown pay-for-performance reimbursement schemes help maximize profitability without negatively impacting the quality of patient care. We sought to review the impact of reimbursement incentives on evidence-based care outcomes within a vascular surgical program at an academic tertiary care healthcare system.
Methods:
We reviewed the data for confirmed 30-day follow-up for the vascular surgery subset of our institution’s National Surgical Quality Initiative Program (NSQIP) submission for the years 2013 and 2014. The outcomes reviewed included 30-day mortality, readmission, unplanned return to the operating room, and all major morbidities. RVU comparison was performed before and after changes were made to the compensation model.
Results:
No statistically significant difference in 30-day mortality, readmission, or unplanned return to the operating room was identified between the two periods. However, there was a trend towards a lower incidence of overall respiratory occurrences between 2013 and 2014. (Table 1) This trend was largely attributed to a trend towards lower incidence in pneumonia between the two study years. The vascular division had a 7% overall increase in productivity after the RVU-incentivization program was instituted.
Conclusions:
Revenue-improving measures can improve sustainability of a vascular program without negatively impacting 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.
Table 1: 30-day post-operative occurrence summary | | | | | 2013 | 2014 | P-value | | Number of Cases | 235 | 257 | | | Mortality | 7 (3.0%) | 7 (2.7%) | .87 | | Readmission | 29 (12.3%) | 32 (12.5%) | .97 | | Unplanned return to OR | 17 (7.2%) | 22 (8.6%) | .59 | | All wound occurrences | 15 (6.4%) | 19 (7.4%) | .66 | | All respiratory occurrences | 30 (12.8%) | 20 (7.8%) | .07 | | All renal occurrences | 10 (4.3%) | 8 (3.1%) | .50 | | All CNS occurrences | 0 (0%) | 3 (1.2%) | .25 | | All cardiac occurrences | 6 (2.6%) | 9 (3.5%) | .51 |
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