Does Productivity-Based Physician Compensation Affect Surgical Rates for Elective Arthroplasty Surgery?

Area of Science:

• Orthopedic Surgery
• Health Economics
• Healthcare Policy

Background:

• Surgeon compensation models can influence the utilization of elective orthopedic procedures.
• The study investigates the impact of transitioning from salaried to relative value unit (RVU) based compensation on surgical rates and patient selection for total hip and knee arthroplasty (THA and TKA).

Purpose of the Study:

• To assess the effect of a change in surgeon compensation from a salaried model to an RVU-based productivity model on the rate of elective THA and TKA procedures.
• To determine if this compensation model change influenced patient selection for these arthroplasty procedures.

Main Methods:

• Retrospective analysis of primary THA and TKA patients before (salaried) and after (RVU) July 2016.
• Surgical rate defined as THA/TKA procedures per outpatient arthroplasty/osteoarthritis clinic encounters.
• Beta regression used to analyze the impact of reimbursement structure on surgical rates.

Main Results:

• The surgical rate for THA and TKA significantly increased in the RVU period (15.8% and 16.7%) compared to the salaried period (11.1% and 11.7%).
• The odds of undergoing THA or TKA increased by approximately 48-50% under the RVU model compared to the salaried model.
• No significant differences were observed in patient demographics (age, gender, race, BMI) or comorbidity index between the two compensation periods.

Conclusions:

• Productivity-based physician compensation, such as the RVU model, may lead to an increased rate of elective arthroplasty procedures.
• The study suggests that RVU-based compensation can drive higher surgical volumes without a corresponding change in the selection of patients for THA and TKA.