title: Relative value unit-based compensation incentivization in an academic vascular practice improves productivity with no early adverse impact on quality.
abstract: Given the increased pressure from governmental programs to restructure reimbursements to reflect quality metrics achieved by physicians, review of current reimbursement schemes is necessary to ensure sustainability of the physician's performance while maintaining and ultimately improving patient outcomes. This study reviewed the impact of reimbursement incentives on evidence-based care outcomes within a vascular surgical program at an academic tertiary care center.
  
  
  
  Data for patients with a confirmed 30-day follow-up for the vascular surgery subset of our institution's National Surgical Quality Improvement Program submission for the years 2013 and 2014 were reviewed. The outcomes reviewed included 30-day mortality, readmission, unplanned returns to the operating room, and all major morbidities. A comparison of both total charges and work relative value units (RVUs) generated was performed before and after changes were made from a salary-based to a productivity-based compensation model. P value analysis was used to determine if there were any statistically significant differences in patient outcomes between the two study years.
  
  
  
  No statistically significant difference in outcomes of the core measures studied was identified between the two periods. There was a trend toward a lower incidence of respiratory complications, largely driven by a lower incidence in pneumonia between 2013 and 2014. The vascular division had a net increase of 8.2% in total charges and 5.7% in work RVUs after the RVU-based incentivization program was instituted.
  
  
  
  Revenue-improving measures can improve sustainability of a vascular program without negatively affecting 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.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Cooper University Hospital, Camden, NJ.
authors.forename: Nadia
authors.initials: N
authors.lastname: Awad
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Cooper University Hospital, Camden, NJ.
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Caputo
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Cooper University Hospital, Camden, NJ.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Carpenter
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Cooper University Hospital, Camden, NJ.
authors.forename: James B
authors.initials: JB
authors.lastname: Alexander
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Cooper University Hospital, Camden, NJ.
authors.forename: José L
authors.initials: JL
authors.lastname: Trani
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Cooper University Hospital, Camden, NJ. Electronic address: lombardi-joseph@cooperhealth.edu.
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Lombardi
mesh_terms: D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D003695:Delivery of Health Care / Q000191:economics*; D004526:Efficiency; D006801:Humans; D009515:New Jersey; D011216:Practice Management, Medical / Q000191:economics*; D017064:Process Assessment, Health Care / Q000191:economics*; D015397:Program Evaluation; D019984:Quality Indicators, Health Care / Q000191:economics*; D012052:Reimbursement, Incentive / Q000191:economics*; D015895:Relative Value Scales; D062606:Tertiary Care Centers / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D057188:Workflow