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

Objective: To determine the effects an incentive-based physician compensation model has on safety outcomes related to outpatient otolaryngology surgical procedures.

Study design: 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.

Setting: Single-center academic otolaryngology practice operating at a hospital-owned ambulatory surgery center.

Subjects and methods: 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.

Results: 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.

Conclusion: 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.