DOES THE METHOD OF PAYMENT AFFECT ANESTHETIC PRACTICE - AN EVALUATIONOF AN ALTERNATE PAYMENT PLAN

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.