Male cardiologists received significantly higher reimbursements from the U.S. Centers for Medicare & Medicaid Services (CMS) in 2016 than their female counterparts, according to a new analysis.
Inbar Raber, MD, of Beth Israel Deaconess Medical Center, Boston, and colleagues reported these findings in a manuscript published online Wednesday in JAMA Cardiology.
The authors sought to determine whether gender differences existed in reimbursements, charges, and reimbursement per charge from CMS by performing a cross-sectional analysis of CMS reimbursement data from 2016. The study analyzed the amount of reimbursements cardiologists received, the charges submitted and unique billing codes, as well as gender differences in reimbursement data in both the inpatient and outpatient settings.
In 2016, 17,524 cardiologists, of whom 2,312 were women (13%) and 15,212 were men (87%), received CMS payments in an inpatient setting, and 16,929 cardiologists, of whom 2,151 were women (13%) and 14,778 were men (87%), received CMS payments in an outpatient setting. According to the study authors, men received higher payments in both the inpatient (men: median $62,897 [interquartile range (IQR) $30 904-$104 267] vs. women: median $45,288 [IQR $21,371-$73,191]; p<0.001) and outpatient (men: median $91,053 [IQR $34,820-$196,165] vs. women: median $51,975 [IQR $15,622-$120,175]; p<0.001) settings. Men also submitted more charges in both the inpatient (men: median 1,190 [IQR 569-2,093] charges vs. women: median 959 [569-2,093] charges; p<0.001) and outpatient (men: median 1,685 [IQR 644-3,328] charges vs. women: median 870 [273-1,988] charges; p<0.001) settings.
After the authors performed a multivariable-adjusted linear regression analysis, adjusting for number of charges, number of unique billing codes, the complexity of patient panel, years since graduation, and physician subspeciality, they found that women still received fewer CMS payments compared to men (log-scale β = –0.06; 95% confidence interval , –0.11 to –0.02).
However, the authors stated that they do not believe there is “a CMS reimbursement gender bias,” but, rather, differences in coding patterns or clinical practices between men and women.
While “women practicing cardiology may receive less CMS payments and submit fewer CMS charges than men in inpatient and outpatient settings,” the authors wrote, “other important mitigating circumstances likely affect total CMS payment by gender.”
The authors noted that male and female cardiologists may have different practice styles, differences in patient volume and patient populations, experience different organizational barriers, or different schedules (part-time vs. full-time work).
The limitations of the analysis, according to the authors, are largely missing data points from the CMS database. These include work description (full time vs. part time, clinical vs. administrative assignments), time spent per patient encounter, and additional sources of income physicians have besides Medicare payments.
Raber and colleagues, noting these limitations, called for further research to identify and understand potential gender-associated differences in reimbursement.
Raber I, Al Raifi M, McCarthy CP et al. Gender Differences in Medicare Payments Among Cardiologists. JAMA Cardiology. 2021 Sep 8. doi:10.1001/jamacardio.2021.3385 [Article in press]
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