Original Investigation
October 11, 2023
Gender Differences in Medicare Practice and Payments to Neurosurgeons
Temitope O. Oshinowo, Michael S. Rallo, Clemens M. Schirmer, et al
JAMA Surg. Published online October 11, 2023. doi:10.1001/jamasurg.2023.4988
Question Is there variation in reimbursements to neurosurgeons based on gender?
Findings In this cross-sectional study of 6052 neurosurgeons providing care to Medicare fee-for-service patients between 2013 and 2020, women received significantly lower annual mean reimbursement even after controlling for metrics of practice volume. Women were also reimbursed less per service even after matching by Common Procedural Terminology code.
Meaning These findings suggest that differences in practice composition and billing and coding practices, such as the use of modifiers, may drive the gender disparities in payment.
Abstract
Importance Despite efforts to promote diversity within the neurosurgical workforce, individuals from underrepresented groups face significant challenges.
Objective To compare practice metrics and earning potential between female and male neurosurgeons and investigate factors associated with gender disparity in Medicare reimbursement.
Design, Setting, and Participants This retrospective cross-sectional study used publicly accessible Medicare data on reimbursements to female and male neurosurgeons for procedural and evaluation and management services delivered in both inpatient and outpatient settings between January 1, 2013, and December 31, 2020. Data were analyzed from December 9, 2021, to December 5, 2022.
Main Outcomes and Measures The primary outcome was the mean annual payments received and charges submitted by female and male neurosurgeons for services rendered between 2013 and 2020. Secondary outcomes included the total number and types of services rendered each year and the number of beneficiaries treated. Univariate and multivariable analyses quantified differences in payment, practice volume, and composition.
Results A total of 6052 neurosurgeons (5540 men [91.54%]; 512 women [8.46%]) served the Medicare fee-for-service patient population. Female neurosurgeons billed for lesser Medicare charges (mean [SE], $395 851.62 [$19 449.39] vs $766 006.80 [$11 751.66]; P < .001) and were reimbursed substantially less (mean [SE], $69 520.89 [$2701.30] vs $124 324.64 [$1467.93]; P < .001). Multivariable regression controlling for practice volume metrics revealed a persistent reimbursement gap (−$24 885.29 [95% CI, −$27 964.72 to −$21 805.85]; P < .001). Females were reimbursed $24.61 less per service than males even after matching services by code (P = .02).
Conclusions and Relevance This study found significant gender-based variation in practice patterns and reimbursement among neurosurgeons serving the Medicare fee-for-service population. Female surgeons were reimbursed less than male surgeons when both performed the same primary procedure. Lower mean reimbursement per service may represent divergence in billing and coding practices among females and males that could be the focus of future research or educational initiatives.
