Relation of improved postoperative nausea/vomiting quality metric to physician incentive pay

As part of a compensation overhaul for physicians, a small percentage of remuneration (1.75% for the highest tier) was linked to quality incentives. For the anesthesiologists, this entailed adherence to previously published postoperative nausea and vomiting (PONV) metrics for adults and children. This observational study examined the hypothesis that incentivizing this metric would result in proper PONV prophylaxis for high-risk patients while reducing the need for rescue therapy in the postanesthesia care unit (PACU). Over the course of more than 2 years, available reports from the electronic medical record for eight separate institutions were obtained to examine the rate of prophylaxis administration for the 50,408 patients who received general anesthesia and were scored as being at high risk for PONV. Rescue therapy in the postanesthesia care unit for all patients receiving general anesthesia (87,893 patients) was also examined. There was a statistically significant increase in PONV prophylaxis administration to the high-risk group, from 92.8% to 98.3% (P < 0.001). Additionally, there was a statistically significant decrease in PACU rescue therapy, from 17.6% to 14.4% (P < 0.001). Results suggested that the visibility of the risk score on the preoperative evaluation combined with heightened awareness of prophylaxis due to the incentivized quality metric led to an effect for the entire population of surgical patients.