A recent cross-sectional study found significant disparities in Medicare reimbursements between female and male surgeons across multiple subspecialties, including general surgery, surgical oncology, and colorectal surgery.
The study, led by Muhammad Musaab Munir, MD from The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, analyzed publicly available Medicare Fee-for-Service Provider Utilization and Payment data from January to December 31, 2021.
Published in JAMA Surgery, the study included 20,549 general surgeons (24.5% female), 1,065 surgical oncologists (42.3% female), and 1,601 colorectal surgeons (27% female). The primary outcomes were annual total submitted charges, payments, mean charge per service, mean payment per service, and the payment to charge ratio.
Key findings:
- Female surgeons billed fewer mean Medicare charges and received significantly lower mean reimbursements across all three subspecialties (all P < .001).
- Female general surgeons: 30.1% lower charges, 29.0% lower reimbursements
- Female surgical oncologists: 27.5% lower charges, 23.6% lower reimbursements
- Female colorectal surgeons: 21.7% lower charges, 24.5% lower reimbursements
- Female surgeons billed for fewer total services, had fewer beneficiaries, and used fewer unique service codes (all P < .001).
- A reimbursement gap remained after multivariable analysis across all subspecialties:
- General surgeons: –$14,963.46 (95% CI, –$18,822.27 to –$11,104.64; P < .001)
- Surgical oncologists: –$8,354.69 (95% CI, –$15,018.12 to –$1,691.25; P = .01)
- Colorectal surgeons: –$4,346.73 (95% CI, –$7,660.15 to –$1,033.32; P = .01)
The researchers found that female general and colorectal surgeons performed a greater proportion of evaluation and management services, while their male counterparts performed more procedural services (all P < .001). Among surgical oncologists, female surgeons conducted a greater percentage of procedural services (P < .001).
After matching procedure codes, female surgeons exhibited a minor decrease in overall and standardized payments per service. The authors suggested that differences in mean payment per service were associated with variations in billing and coding strategies among female and male surgeons.
"To improve gender-based equity in reimbursements, continued efforts are needed to optimize billing and coding practices that maximize accurate compensation and ensure a level playing field for women surgeons to build their clinical practice," the researchers wrote.
Limitations of the study include the lack of detailed information on work dynamics, such as employment status, practice setting, and nature of tasks, as well as the inability to assess the suitability and accuracy of billing practices. Additionally, Medicare payments represent only a fraction of physician revenue, and the study could not account for private payer clinical revenue.
The authors declared having no competing interests.