Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus.
Deputy Editor, JAMA Surgery.
JAMA Surg. 2024 Sep 1;159(9):1060-1070. doi: 10.1001/jamasurg.2024.2298.
Gender inequities and limited representation are an obstacle to surgical workforce diversification. There has been limited examination of gender-based disparities in billing practices among surgeons.
To evaluate variations in practice metrics and billing practices among female and male surgeons and identify factors associated with gender disparities in Medicare reimbursements.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study used publicly available Medicare Fee-for-Service Provider Utilization and Payment data from January to December 31, 2021, to identify demographics, annual services provided, and financial payments and charges for general surgeons, surgical oncologists, and colorectal surgeons. Data were analyzed from November 2023 to February 2024.
The primary exposure of interest was surgeon gender (ie, female or male).
The annual total submitted charges and payments submitted in 2021 by female and male surgeons were assessed. Additionally, the total number and types of services provided each year and the number of beneficiaries treated were examined. Multivariable linear regression models were used to evaluate the association of surgeon gender with payments, number of services, and beneficiaries.
A total of 20 549 general surgeons (5036 [24.5%] female; 15 513 [75.5%] male), 1065 surgical oncologists (450 [42.3%] female; 615 [57.7%] male), and 1601 colorectal surgeons (432 [27.0%] female; 1169 [73.0%] male) were included. Across all surgical subspecialties, female surgeons billed fewer mean (SE) Medicare charges (general surgeons: 30.1% difference; $224 934.80 [$3846.97] vs $321 868.50 [$3933.57]; surgical oncologists: 27.5% difference; $277 901.70 [$22 857.37] vs $382 882.90 [$19 566.06]; colorectal surgeons: 21.7% difference; $274 091.70 [$10 468.48] vs $350 146.10 [$8741.66]; all P < .001) and received significantly lower mean (SE) reimbursements (general surgeons: 29.0% difference; $51 787.61 [$917.91] vs $72 903.12 [$890.35]; surgical oncologists: 23.6% difference; $57 945.18 [$3853.28] vs $75 778.22 [$2622.75]; colorectal surgeons: 24.5% difference; $63 117.01 [$2248.10] vs $83 598.53 [$1934.77]; all P < .001). On multivariable analysis, a reimbursement gap remained across all 3 surgical subspecialties (general surgeons: -$14 963.46 [95% CI, -$18 822.27 to -$11 104.64] [P < .001]; surgical oncologists: -$8354.69 [95% CI, -$15 018.12 to -$1691.25] [P = .01]; colorectal surgeons: -$4346.73 [95% CI, -$7660.15 to -$1033.32] [P = .01]).
In this cross-sectional study, there was considerable gender-based variation in practice patterns and reimbursement among different surgical subspecialties serving the Medicare population. Differences in mean payment per service were associated with variations in billing and coding strategies among female and male surgeons.
重要性：性别不平等和代表性有限是外科劳动力多元化的障碍。外科医生计费做法方面的性别差异研究有限。
目的：评估女性和男性外科医生之间的实践指标和计费做法的差异，并确定与医疗保险报销中性别差距相关的因素。
设计、设置和参与者：本回顾性横断面研究使用 2021 年 1 月至 12 月 31 日公开的医疗保险按服务付费者使用和支付数据，确定普通外科医生、外科肿瘤学家和结直肠外科医生的人口统计学数据、每年提供的服务数量以及财务支付和收费。数据分析于 2024 年 2 月进行。
暴露：主要暴露因素是外科医生的性别（即女性或男性）。
主要结果和措施：评估了女性和男性外科医生 2021 年提交的年度总收费和支付情况。此外，还检查了每年提供的服务总数和类型以及治疗的受益人数。使用多变量线性回归模型评估外科医生性别与支付、服务数量和受益人数的关联。
结果：共有 20549 名普通外科医生（5036 [24.5%] 名女性；15513 [75.5%] 名男性）、1065 名外科肿瘤学家（450 [42.3%] 名女性；615 [57.7%] 名男性）和 1601 名结直肠外科医生（432 [27.0%] 名女性；1169 [73.0%] 名男性）纳入研究。在所有外科亚专业中，女性外科医生开具的医疗保险计费较少（普通外科医生：30.1%差异；$224934.80[3846.97] 与$321868.50[3933.57]；外科肿瘤学家：27.5%差异；$277901.70[22857.37] 与$382882.90[19566.06]；结直肠外科医生：21.7%差异；$274091.70[10468.48] 与$350146.10[8741.66]；所有 P<0.001），且收到的报销金额明显较低（普通外科医生：29.0%差异；$51787.61[917.91] 与$72903.12[890.35]；外科肿瘤学家：23.6%差异；$57945.18[3853.28] 与$75778.22[2622.75]；结直肠外科医生：24.5%差异；$63117.01[2248.10] 与$83598.53[1934.77]；所有 P<0.001）。在多变量分析中，所有 3 个外科亚专业仍存在报销差距（普通外科医生：-$14963.46[95%CI，-$18822.27 至-$11104.64] [P<0.001]；外科肿瘤学家：-$8354.69[95%CI，-$15018.12 至-$1691.25] [P=0.01]；结直肠外科医生：-$4346.73[95%CI，-$7660.15 至-$1033.32] [P=0.01]）。
结论和相关性：在这项横断面研究中，为医疗保险人群服务的不同外科亚专业之间的实践模式和报销存在相当大的性别差异。服务平均支付金额的差异与女性和男性外科医生计费和编码策略的差异有关。
