Effects of an alternate payment plan on pediatric surgical practice in an academic setting: the role of corporate indicators.

The objectives of this study were to describe the effects of an alternate payment plan (APP) on clinical surgical practice--at eight surgical divisions of Children's Hospital of Eastern Ontario--and to emphasize the important role of corporate indicators (CIs). To do this, we analyzed CIs comparing two years before the implementation of the APP with years one and two and years three and four post-implementation. The number of in-hospital consultations decreased in division two comparing pre-APP encounters with years one and two and years three and four post-APP. There was no difference between years one and two and three and four post-APP. Encounters in outpatient clinics increased in divisions four and seven. Division six had a decrease in encounters comparing pre-APP with years one and two and years three and four post-APP. There was no difference between years one and two and three and four post-APP. Encounters for same-day surgery increased in division six after the implantation of the APP; division two had a decrease comparing pre-APP with years one and two and years three and four post-APP. No difference was seen between years one and two and three and four post-APP. For in-patient surgery, only division eight had a significant decrease in encounters comparing pre-APP with years one and two and years three and four post-APP. There was no difference between years one and two and three and four post-APP. This study demonstrates that the APP has had little influence on patterns of clinical practice in our institution, which is the sole pediatric referral centre for the region. Since CIs are produced on a yearly basis by the institution and physicians have no influence on the data, CIs may play a role in replacing shadow billing as a way of measuring healthcare service delivery in an APP setting on academic institutions.