Plastic Surgery Compensation Models and Patient Outcomes
Year: 2023
Type: article
Abstract: Compensation models for plastic surgeons vary between, and within, institutions. A fee-for-service approach is the most common model of healthcare compensation in the United States and compensates surgeons with certain dollar values for each service provided.1 A salary-based approach guarantees a fixed salary regardless of clinical volume or activity. Recently, institutions have increasingly adopted a hybrid approach to compensation, using a model with a base salary plus productivity-related bonuses. Work relative value units (wRVUs),1 linked to reimbursements, are applied in this approach. RVUs quantify effort and provide a measure of the technical skill required to deliver a specific service.1 They are then converted into monetary values to be paid to providers. No compensation model is ideal, and each has attendant advantages and disadvantages (Table 1). Table 1. - Characteristics of Common Physician Compensation Models in the United States Fee-for-service Productivity-based Care Salary Only Value-based Care Payment model Fees for each service rendered by a physician Base salary plus RVUs as a measure of productivity Fixed salary regardless of clinical volume or activity Payment tied to patient outcomes and costs Pros Encourage extensive workups and procedures Balances productivity and costs Discourages overutilization of resources Reduced healthcare spending, higher patient satisfaction Cons Increases systemic and patient healthcare costs RVUs do not perfectly capture surgical effort or patient outcomes De-emphasize productivity Requires reliable measures of patient outcomes and satisfaction Data on patient outcomes tied to compensation models are extremely limited. Two studies have reported outcomes after a switch from a salary-based compensation model to one based on wRVUs. Conducted by the vascular2 surgery and otolaryngology3 departments at Cooper University, no significant differences in readmissions, return to the operating room, mortality, or safety outcomes after the transition were reported.2,3 There was a significant increase in number of cases for otolaryngology procedures.3 Generalizations from these studies are limited due to short follow-up times2 and restriction of analysis to only outpatient procedures.3 There is a dearth of similar investigations in plastic surgery. One potential reason is lack of wRVUs for some aesthetic and reconstructive procedures, complicating productivity quantification and necessitating use of tools such as net charges.1 Value-based care (VBC) compensation models have become popular to address limitations of older models (Fig. 1). VBC closely ties compensation with patient outcomes, creating a self-reinforcing feedback loop.4 Care quality is assessed through surgical experience and technical skill (already elements of wRVUS), as well as medical outcomes4 in combination with patient outcomes such as satisfaction and functional and psychological relief.4 It is challenging to quantify these factors in a field as diverse as plastic surgery, thus hampering the transition to VBC. One proposed accounting tool to help with this is Time-drive activity-based costing (Td-ABC). Td-ABC analyzes care as a production line, identifying inefficiencies to minimize unit cost per time.5 Td-ABC has been successfully applied to the workup of appendicitis.5 However, the caveat to the implementation of Td-ABC is that it functions best for repetitive services with predictable outcomes, which is not always true for plastic surgery cases.Fig. 1.: Components of VBC.VBC is nascent in plastic surgery likely because of the difficulties of value quantification, wide variety (and subsequent costs) of procedures, and the relatively recent emergence of VBC as a whole. Thus, there are little data on patient outcomes after implementation of VBC compensation models, limiting the scope of this viewpoint. To that end, well-designed studies investigating VBC compensation models in plastic surgery, following a similar model to the aforementioned studies in vascular surgery and otolaryngology before and after implementation of a VBC compensation model, are crucial to improving our understanding of the impact of compensation models on our patients. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.
Institutions: Northwestern University, Northwestern Medicine
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $2,195
OpenAlex ID: W4386774009