Patel Nisarg A, Ji Yisi D, Donoff R Bruce
Resident, Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA; and Research Affiliate, Department of Biomedical Informatics, Harvard Medical School, Boston, MA.
Resident, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA.
J Oral Maxillofac Surg. 2020 May;78(5):688-694. doi: 10.1016/j.joms.2019.12.024. Epub 2020 Jan 7.
To characterize and compare clinical productivity and payments between female and male oral and maxillofacial surgeons (OMSs) serving Medicare beneficiaries in 2017.
This cross-sectional study was composed of Medicare Provider Utilization and Payment Data from 2017. Providers were included if they were labeled as maxillofacial surgeons. The primary outcome variable was Medicare payment. Secondary outcome variables included clinical productivity (number of charges), unique billing codes, mean payment per charge, and beneficiary hierarchical condition category. Descriptive statistics and pair-wise comparisons were computed at an α level of .05.
The analysis cohort was composed of 737 distinct OMSs, of whom 58 were women. Although female surgeons recorded higher mean clinical productivity, total Medicare payments, and number of unique Healthcare Common Procedure Coding System billing codes relative to male surgeons in both the facility and office settings, the differences were not statistically different. Payment per charge did not differ significantly between genders in the office setting. In the facility setting, women were reimbursed $63.74 per charge whereas men were reimbursed $109.69 per charge (P < .02). Female OMSs treated more medically complex patients relative to male OMSs (P < .02).
Clinical productivity and total Medicare payments were similar between genders in both the facility and office settings, disputing prior surveys that illustrated bias about the productivity and ability of female OMSs. Female OMSs earned, on average, less per submitted charge in facility settings, which may be due to differences in documentation. The reason for this difference warrants further study.
对2017年为医疗保险受益人提供服务的女性和男性口腔颌面外科医生(OMS)的临床工作效率和薪酬进行特征描述和比较。
这项横断面研究由2017年医疗保险提供者利用和支付数据组成。如果提供者被标记为颌面外科医生,则纳入研究。主要结果变量是医疗保险支付。次要结果变量包括临床工作效率(收费数量)、独特计费代码、每次收费的平均支付以及受益人分层条件类别。在α水平为0.05时计算描述性统计和成对比较。
分析队列由737名不同的OMS组成,其中58名是女性。尽管在机构和办公室环境中,女性外科医生相对于男性外科医生记录了更高的平均临床工作效率、医疗保险总支付以及独特医疗保健通用程序编码系统计费代码数量,但差异无统计学意义。在办公室环境中,每次收费的支付在性别之间没有显著差异。在机构环境中,女性每次收费报销63.74美元,而男性每次收费报销109.69美元(P < 0.02)。相对于男性OMS,女性OMS治疗的患者病情更复杂(P < 0.02)。
在机构和办公室环境中,临床工作效率和医疗保险总支付在性别之间相似,这与之前表明对女性OMS的工作效率和能力存在偏见的调查结果相矛盾。在机构环境中,女性OMS每次提交的收费平均收入较低,这可能是由于记录方式的差异。这种差异的原因值得进一步研究。