Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts.
Ophthalmology. 2022 Sep;129(9):1056-1063. doi: 10.1016/j.ophtha.2022.05.006. Epub 2022 May 17.
To evaluate differences in Medicare reimbursements between male and female ophthalmologists between 2013 and 2019.
Retrospective cohort study.
Ophthalmologists receiving Medicare reimbursements between 2013 and 2019.
The Centers for Medicare and Medicaid Services Physician and Other Supplier Public Use File was used to determine total reimbursements and number of services submitted by ophthalmologists between 2013 and 2019. Reimbursements were standardized to account for geographic differences in Medicare reimbursement per service. Data from the American Community Survey (ACS) were used to determine socioeconomic characteristics (unemployment, poverty, income, and education) by zip code for the location of each physician's practice. A multivariate linear regression model was used to evaluate differences in annual reimbursements by sex, accounting for calendar year, years of experience, total number of services, ACS zip code data, and proportion of procedural services.
Annual Medicare reimbursement and use of billing codes (e.g., outpatient office visits and eye examinations, diagnostic testing, laser treatment, and surgery).
Among 20 281 ophthalmologists who received Medicare reimbursements between 2013 and 2019, 15 451 (76%) were men. The most common billing codes submitted were for outpatient visits and eye examinations (13.8 million charges/year), diagnostic imaging of the retina (5.6 million charges/year), intravitreal injections (2.9 million charges/year), and removal of cataract with insertion of lens (2.4 million charges/year). Compared with men, female ophthalmologists received less in median annual reimbursements (median, $94 734.21 [interquartile range (IQR), $30 944.52-$195 701.70] for women vs. $194 176.90 [IQR, $76 380.76-$355 790.80] for men; P < 0.001) and billed for fewer annual median services (median, 1228 [IQR, 454-2433] vs. 2259 [IQR, 996-4075, respectively]; P < 0.001). After adjustment for covariates, female ophthalmologists billed for 1015 fewer services (95% confidence interval [CI], 1001-1029; P < 0.001) and received $20 209.12 less in reimbursements than men (95% CI, -$21 717.57 to -$18 700.66; P < 0.001).
Female ophthalmologists billed for fewer services and received less in reimbursement from Medicare than men over time and across all categories of billing codes. Disparities persisted after controlling for physician and practice characteristics.
评估 2013 年至 2019 年间男性和女性眼科医生在医疗保险报销方面的差异。
回顾性队列研究。
2013 年至 2019 年间接受医疗保险报销的眼科医生。
使用医疗保险和医疗补助服务中心医生和其他供应商公共使用文件确定 2013 年至 2019 年间眼科医生提交的总报销和服务数量。报销金额经标准化处理，以考虑每服务 Medicare 报销的地理位置差异。使用美国社区调查 (ACS) 的数据确定每位医生执业地点邮政编码的社会经济特征（失业、贫困、收入和教育）。使用多元线性回归模型评估按性别、日历年度、经验年限、总服务数量、ACS 邮政编码数据和程序服务比例计算的年度报销差异。
医疗保险年度报销和计费代码的使用（例如，门诊就诊和眼部检查、诊断测试、激光治疗和手术）。
在 2013 年至 2019 年间接受医疗保险报销的 20281 名眼科医生中，15451 名（76%）为男性。提交的最常见计费代码是门诊就诊和眼部检查（每年 1380 万次就诊）、视网膜的诊断成像（每年 560 万次就诊）、玻璃体内注射（每年 290 万次就诊）和白内障切除联合人工晶状体植入（每年 240 万次就诊）。与男性相比，女性眼科医生的年 median 报销金额较低（中位数，$94734.21[四分位距（IQR），$30944.52-$195701.70]与男性相比，$194176.90[IQR，$76380.76-$355790.80]；P < 0.001），每年 billed 的 median 服务数量也较少（中位数，1228[IQR，454-2433]与 2259[IQR，996-4075]；P < 0.001）。调整协变量后，女性眼科医生 billed 的服务数量少 1015 次（95%置信区间[CI]，1001-1029；P < 0.001），收到的医疗保险报销金额少 20209.12 美元（95%CI，-$21717.57 至 -$18700.66；P < 0.001）。
随着时间的推移和所有计费代码类别，女性眼科医生 billed 的服务数量和收到的医疗保险报销金额均少于男性。在控制医生和实践特征后，这种差异仍然存在。
