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Impact of physician payment mechanism on emergency department operational performance
| Content Provider | Scilit |
|---|---|
| Author | Innes, Grant D. Scheuermeyer, Frank X. Marsden, Julian Sing, Chad Kim Kalla, Dan Stenstrom, Rob Law, Michael Grafstein, Eric |
| Copyright Year | 2018 |
| Description | Objective: Fee-for-service payment may motivate physicians to see more patients and achieve higher productivity. In 2015, emergency physicians at one Vancouver hospital switched to fee-for-service payment, while those at a sister hospital remained on contract, creating a natural experiment where the compensation method changed, but other factors remained constant. Our hypothesis was that fee-for-service payment would increase physician efficiency and reduce patient wait times.Methods: This interrupted time series with concurrent control analysed emergency department (ED) performance during a 42-week period, encompassing the intervention (fee for service). Data were aggregated by week and plotted in a time series fashion. We adjusted for autocorrelation and developed general linear regression models to assess level and trend changes. Our primary outcome was the wait time to physician.Results: Data from 142,361 ED visits were analysed. Baseline wait times rose at both sites during the pre-intervention phase. Immediately post-intervention, the median wait time increased by 2.4 minutes at the control site and fell by 7.2 minutes at the intervention site (difference=9.6 minutes; 95% confidence interval, 2.9-16.4;p=0.007). The wait time trend (slope) subsequently deteriorated by 0.5 minutes per week at the intervention site relative to the expected counterfactual (pfor the trend difference=0.07). By the end of the study, cross-site differences had not changed significantly from baseline.Conclusion: Fee-for-service payment was associated with a 9.6-minute (24%) reduction in wait time, compatible with an extrinsic motivational effect; however, this was not sustained, and the intervention had no impact on other operational parameters studied. Physician compensation is an important policy issue but may not be a primary determinant of ED operational efficiency. |
| Related Links | https://www.cambridge.org/core/services/aop-cambridge-core/content/view/FA109E49B766063C7B9B38B153ADEB2F/S1481803518000106a.pdf/div-class-title-impact-of-physician-payment-mechanism-on-emergency-department-operational-performance-div.pdf |
| Ending Page | 190 |
| Page Count | 8 |
| Starting Page | 183 |
| DOI | 10.1017/cem.2018.10 |
| Journal | Canadian Journal of Emergency Medicine |
| Issue Number | 2 |
| Volume Number | 20 |
| Language | English |
| Publisher | Cambridge University Press (CUP) |
| Publisher Date | 2018-03-01 |
| Access Restriction | Open |
| Subject Keyword | Canadian Journal of Emergency Medicine Education Research Emergency Department Wait Time Physician Compensation |
| Content Type | Text |
| Resource Type | Article |
