Does the method of payment affect anaesthetic practice? An evaluation of an alternate payment plan

To test the null hypothesis that the method of physician payment does not influence the practice of anaesthesia.

Retrospective cohort study of anaesthetists before (Jan-June, 1994) and after (Jan-June, 1995) departure from fee-for-service practice into an alternate funding arrangement (AFP). Another group of physicians was studied as a concurrent control. Case numbers, induction times, cancellation rates, and operating hours for the department, recorded by third parties, were compared before and after AFP implementation. Using index procedures, details of individual patient decisions made by anaesthetists were compared for the two study periods, and between subscribing and non-subscribing physicians.

Implementation of AFP resulted in a modest reduction in case numbers (7.2%) offset by an increase (5.7%) in the average case duration. Net change in time dedicated to clinical service (2% per physician) is inconsequential to the academic mission of the department. There was no change in cancellation rate and the use of invasive monitors was unchanged. An increase in the use of regional anaesthesia occurred but, since a similar increase occurred in the practice of those still on fee-for-service, it cannot be ascribed to the AFP. With respect to hip arthroplasty, the case was prolonged (P = 0.001) if the surgeon was paid via the AFP.

Payment of physicians by non-fee-for-service techniques did not have a constructive influence on measures of anaesthetic practice. The goal of alternate payment arrangements, to liberate time for academic pursuits, could not be achieved in this experimental model.