Pg. Duncan et M. Ballantyne, DOES THE METHOD OF PAYMENT AFFECT ANESTHETIC PRACTICE - AN EVALUATIONOF AN ALTERNATE PAYMENT PLAN, Canadian journal of anaesthesia, 44(5), 1997, pp. 503-510
Purpose: To test the null hypothesis that the method of physician paym
ent does not influence the practice of anaesthesia, Methods: Retrospec
tive cohort study of anaesthetists before (Jan-June, 1994) and after (
Jan-June, 1995) departure from fee-for-service practice into an altern
ate 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 parti
es, were compared before and after AFP implementation, Using index pro
cedures, details of individual patient decisions made by anaesthetists
were compared for the two study periods, and between subscribing and
non-subscribing physicians. Results: 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 clinic
al service (2% per physician) is inconsequential to the academic missi
on of the department. There was no change in cancellation rate and the
use of invasive monitors was unchanged. An increase in the use of reg
ional anaesthesia occurred but, since a similar increase occurred in t
he practice of those still on fee-for-service, it cannot be ascribed t
o the AFP. With respect to hip arthroplasty, the case was prolonged (P
= 0.001) if the surgeon was paid via the AFP. Conclusion: Payment of
physicians by non-free-for-service techniques did not have a construct
ive influence on measures of anaesthetic practice, The goal of alterna
te payment arrangements, to liberate time for academic pursuits, could
not be achieved in this experimental model.