Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona; Mayo Clinic Alix School of Medicine, Phoenix, Arizona.
Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona.
J Arthroplasty. 2024 Dec;39(12):3009-3015. doi: 10.1016/j.arth.2024.05.036. Epub 2024 May 17.
Prior studies have suggested there may be differences in reimbursement and practice patterns by gender. The purpose of this study was to comprehensively evaluate differences in reimbursement, procedural volume, and patient characteristics in total hip arthroplasty (THA) between men and women surgeons from 2013 to 2021.
The Medicare Physician and Other Practitioners database from 2013 to 2021 was queried. Inflation-adjusted reimbursement, procedural volume, surgeon information, and patient demographics were extracted for surgeons performing over 10 primary THAs each year. Wilcoxon, t-tests, and multivariate linear regressions were utilized to compare men and women surgeons.
Only 1.4% of THAs billed to Medicare between 2013 and 2021 were billed by women surgeons. Men surgeons earned significantly greater reimbursement nationally in 2021 compared to women surgeons per THA ($1,018.56 versus $954.17, P = .03), but no difference was found when assessing each region separately. Reimbursement declined at similar rates for both men and women surgeons (-18.3 versus -19.8%, P = .38). An increase in the proportion of women surgeons performing THA between 2013 and 2021 was seen in all regions except the South. In 2021, the proportion of all THAs performed by women surgeons was highest in the West (3.5%) and lowest in the South (1.0%). Women surgeons had comparable patient populations in terms of age, race, comorbidity status, and Medicaid eligibility to their men counterparts, but performed significantly fewer services per beneficiary (5.6 versus 8.1, P < .001) and fewer unique services (51.1 versus 69.6, P < .001).
Average reimbursement per THA has declined at a similar rate for men and women physicians between 2013 and 2021. Women's representation in THA surgery nationwide has nearly doubled between 2013 and 2021, with the greatest increase in the West. However, there are notable differences in billing practices between genders.
先前的研究表明，性别可能会导致报销和实践模式的差异。本研究的目的是全面评估 2013 年至 2021 年间男性和女性外科医生在全髋关节置换术（THA）中的报销、手术量和患者特征方面的差异。
从 2013 年至 2021 年，查询 Medicare 医师和其他从业者数据库。提取每年进行超过 10 例初次 THA 的外科医生的报销额、手术量、外科医生信息和患者人口统计学资料。利用 Wilcoxon 检验、t 检验和多元线性回归比较男性和女性外科医生。
2013 年至 2021 年，只有 1.4%的 Medicare 报销的 THA 是由女性外科医生开具的。与女性外科医生相比，2021 年男性外科医生在全国范围内每例 THA 的报销金额明显更高（1018.56 美元与 954.17 美元，P=0.03），但分别评估每个地区时没有差异。男女外科医生的报销额均以相似的速度下降（-18.3%与-19.8%，P=0.38）。除南部地区外，2013 年至 2021 年，所有地区行 THA 的女性外科医生比例均有所增加。2021 年，西部（3.5%）女性外科医生行 THA 的比例最高，而南部（1.0%）最低。女性外科医生在年龄、种族、合并症状况和医疗补助资格方面与男性外科医生的患者群体相似，但每位受益人的服务量（5.6 与 8.1，P<.001）和服务种类（51.1 与 69.6，P<.001）均显著减少。
2013 年至 2021 年间，男性和女性外科医生每例 THA 的平均报销额下降速度相似。2013 年至 2021 年间，全国范围内女性在 THA 手术中的代表性几乎翻了一番，西部的增幅最大。然而，性别之间的计费实践存在显著差异。
