Female radiation oncologists are receiving less reimbursement from Medicare, compared with their male counterparts, according to a new study.
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An examination of Medicare claims submitted by 4,393 radiation oncologists in 2016 (1,133 women) revealed that female physicians in the non–facility-based setting submitted a mean of 1,051 fewer charges, collected a mean of $143,610 less in revenue, and used a mean of 1.32 fewer billing codes. In the facility-based setting, female radiation oncologists submitted a mean of 423 fewer charges, collected a mean of $26,735 less in revenue, and submitted a mean of 1.28 fewer billing codes.
Additionally, the study noted that women accounted for 46 of the 397 most highly productive radiation oncologists in the facility-based setting and collected a mean of $33,206 less than men who were similarly productive. In the non–facility-based setting, women represented 54 of the 326 most highly productive radiation oncologists and collected $345,944 less than similarly productive men.
“Our study illustrates a gap between the sexes in Medicare charges and collection for radiation oncologists, the latter of which is possibly attributable to female physicians consistently submitting fewer charges and charging for services that are less well reimbursed,” Luca Valle, MD, of the University of California, Los Angeles, and colleagues wrote in JAMA Network Open.
The authors identified a number of factors that could be contributing to the discrepancy, the first of which could be traditional gender roles, particularly related to domestic responsibilities.
“A flexible work schedule and opportunities for part-time employment have been shown to be attractive options for female radiation oncologists; thus less clinical activity may be a natural consequence of the value-based labor choices that female practitioners make, particularly within a sex-structured society within which women continue to be expected to shoulder a greater share of domestic responsibilities,” Dr. Valle and colleagues wrote.
The authors also suggested that women “prioritize time spent with a given patient versus number of patients seen, and that extra time spent counseling patients is not reflected in HCPCS [Healthcare Common Procedure Coding System] code volume.”
Another possibility is the ongoing issues of gender discrimination, leaving female physicians to receive less referrals and fewer opportunities to care for patients, despite the authors noting that there is “no evidence to suggest that women are less competent and have more limited aspirations for their medical careers than men.”
Also contributing to the discrepancy is that women may have a greater portion of less well-reimbursed technologies (that is, three-dimensional conformal therapies used for treating breast cancer) rather than more favorably reimbursed technologies, such as intensity modulation radiation therapy, which is typically used for treating genitourinary malignant neoplasms.
“The sex-based distinctions in subspecialization may develop because men are more attuned to the possibility of differences in revenue generation, or because radiation oncology subspecialties that women choose [or are encouraged to choose] involve less revenue-generating ‘communal’ attributes rather than more favorably reimbursed ‘agentic’ attributes,” Dr. Valle and colleagues wrote.
The authors also suggest that it is possible that, when presented with multiple treatment options, female radiation oncologists are more likely to choose the more cost-effective option, “as women in other specialties have shown to adhere more closely to clinical guidelines, practice value-based care, forgo costly interventions, and engage in shared decision making with patients more frequently.”
The authors noted that the study was limited by using only Medicare payment data and it is not clear whether the same pattern occurs in different payer environments, such as Medicare Advantage or commercial insurance. It is also limited by the snapshot of a single year.
One coauthor reported receiving stock options from Equity Quotient; personal fees from Amgen and Vizient; and grants from the National Institutes of Health, the Doris Duke Foundation, the Greenwall Foundation, the Komen Foundation, and Blue Cross Blue Shield of Michigan; another reported receiving personal fees from ViewRay.
SOURCE: Valle L et al. JAMA Netw Open. 2019 Mar 22. doi: 10.1001/jamanetworkopen.2019.0932.