Influence of the revision of surgical fee schedule on surgeons’ productivity in Japan: A cohort analysis of 7602 surgical procedures in 2013–2016

Abstract

The goal of this study is to evaluate the pure impact of the revision of surgical fee schedule on surgeons' productivity. We collected data from the surgical procedures performed by the surgeons working in Teikyo University Hospital from 1 April through 30 September in 2013-2016. We employed non-radial and non-oriented Malmquist model. We defined the decision-making unit as a surgeon with the highest academic rank in surgery. Inputs were defined as (1) the number of doctors who assisted surgery and (2) the time of surgical operation. The output was defined as the surgical fee for each surgery. We focused on the revisions in 2014 and 2016. We first calculated each surgeon's natural logarithms of the changes in productivity, technique and efficiency in 2013-2014, in 2014-2015 and in 2015-2016. Then, we subtracted the changes in 2014-2015 from the changes in 2013-2014 and in 2015-2016. We analyzed 62 surgeons who performed 7602 surgical procedures. The productivity changes were not significantly different from 0. Their efficiency change was significantly greater than 0, while their technical change was smaller than 0 in revision 2014. Their efficiency change was significantly smaller than 0, while their technical change was greater than 0 in revision 2016 (p < 0.05). This finding suggests that we could increase overall productivity through revision if we could increase both efficiency and technique.

Internet-based survey of the perceptions of surgical scars of Japanese patients

“…Scars located on visible parts of the body and size of scar had the greatest impact on the patient's interest and experience of scar care. Additional research is required in the following areas: (1) approved by the ethics committee of the Kitasato University Kitasato Institute Hospital (approval number: 18042). All aspects of this research were in accordance with the principles set out in the Declaration of Helsinki.…”

“…The number of patients undergoing surgery has progressively increased over time due in part to the rapid advances in medical and surgical technology. [1][2][3][4] Development of a completely scar-less world is ideal; however, this objective is difficult to achieve with the current scientific technology. 5 Development of scar at the site of surgical incision is inevitable.…”

Efficient perioperative time-management methods for operating theatres: a systematic review showing how to reduce overall patient waiting times for elective surgery

“…Among the 20 included studies, nine (45%) introduced perioperative management methods in common for all elective surgeries (27)(28)(29)(30)(31)(32)(33)(34)(35). There were four studies each on preoperative methods for general surgery (36-39) and for neurosurgery (40)(41)(42)(43), two articles for eye surgery (44,45) and one article for head and neck surgery (46).…”

“…Nakata (49) conducted a cohort study to evaluate the impact of the revision of surgical fee schedule on surgeons' productivity in Japan. They analysed 62 surgeons who performed 7602 surgical procedures in 2015 to 2016.…”

“…Measured outcome variables were heterogeneous across the included studies. Eight studies reported overall OT e ciency (6, 28, 32,33,36,43,44,50) and eight studies reported overall OT utilisation (27,29,31,39,40,(44)(45)(46). Some studies focused on single process improvement approach in perioperative processes (29-31, 35, 41, 42, 44, 45, 50) but other studies targeted on preoperative time management with multiple approaches (27, 28, 32-34, 36, 37, 39, 40, 43, 46).…”