The impact of physician fee codes on laparoscopic hysterectomy practice in Canada: An interrupted time series analysis

Abstract

<h3>Objectives</h3> Laparoscopic hysterectomies lead to shorter recoveries and better patient outcomes compared to abdominal surgeries. Our objective was to determine whether the introduction of provincial remuneration incentives resulted in increased practice of laparoscopic hysterectomy. <h3>Methods</h3> This retrospective, population-based study used data from the Canadian Institute for Health Information. Inclusion criteria were all women aged ≥18 years undergoing hysterectomies for benign gynecologic indications in Canada from 2006/07–2016/17. Interrupted time series (ITS) analyses were performed using logistic regression for the rate of laparoscopic hysterectomy. <h3>Results</h3> After review of the fee code schedules the provinces with introduction of a financial incentive (additional 25%–50% remuneration) were British Columbia (2013), Saskatchewan (2012), and Prince Edward Island (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 (n=2,583) 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. <h3>Conclusions</h3> Introduction of a financial incentive appears to be associated with an increase in practice of laparoscopic hysterectomy in some provinces but not others. Given the differences in healthcare systems and contexts, future attempts to improve laparoscopic rates should consider multiple factors.