7754 The Impact of Physician Remuneration Incentive on Laparoscopic Hysterectomy Practice in Canada: An Interrupted Time Series Analysis

Abstract

<h3>Study Objective</h3> To determine whether the introduction of a physician remuneration incentive within certain Canadian provinces resulted in increased practice of laparoscopic hysterectomy over time. <h3>Design</h3> Retrospective population-based study with interrupted time series analysis of federal health administrative data from the Canadian Institute for Health Information <h3>Setting</h3> Hospitals in all the provinces of Canada, excluding territories <h3>Patients or Participants</h3> 81,507 patients aged ≥18 years undergoing hysterectomy for benign gynecologic indication in Canada from 2006/07 to 2016/17 <h3>Interventions</h3> Hysterectomy <h3>Measurements and Main Results</h3> Reviewof physician remuneration fee schedules for each province in Canada identified three provinces where a physician incentive (additional 25-50% remuneration) was introduced: British Columbia (BC) (2013), Saskatchewan (SK) (2012), and Prince Edward Island (PEI) (2011). During the 10-year period, the rates of laparoscopic hysterectomy increased rapidly in BC (6.0%-54.7%), SK (13.5%-66.7%), and PEI (<1.0%-36.9%) (<i>p</i><0.05 for all trends). In SK (n=7,857 hysterectomies), there was a significant additional increase in the rate of laparoscopic hysterectomy from 40.6% to 49.4% in the quarter following the incentive (<i>p</i><0.0001). In BC (n=16,332), there was no significant additional increase in the rate of laparoscopic surgeries after the introduction of a financial incentive. Though PEI appeared to demonstrate an increase in the rate of laparoscopic hysterectomy following the incentive, ITS analyses were not performed due to the small sample size (n=2,583). <h3>Conclusion</h3> The introduction of physician remuneration incentive appears to be associated with an increase in practice of laparoscopic hysterectomy in some provinces but not others. While physician incentive may help encourage minimally invasive surgical practice, the effects are likely modified by other important factors, such as operating room resources and training opportunities.