Medicare Reimbursements Are Higher for Male Ophthalmologists
By Lynda Seminara
Selected by Russell N. Van Gelder, MD, PhD
Journal Highlights
Ophthalmology, September 2022
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Medicare reimbursement by sex has not been studied widely for ophthalmologists. The few studies that exist have not fully addressed the differences in reimbursement or billing patterns by service category or procedure type, and none has accounted for procedural services or socioeconomic factors by practice location. To fill these gaps, Halawa et al. analyzed billing patterns for a longer period than in previous studies, while accounting for potential confounding variables. They found that female ophthalmologists billed for fewer services and received less reimbursement than their male counterparts, even when controlling for confounders.
In this review, the authors looked at Medicare reimbursements to ophthalmologists from 2013 to 2019. They used “physician and other supplier” data from CMS to determine total reimbursements and the number of services submitted by ophthalmologists. The payouts were standardized to account for geographic differences in Medicare reimbursement by service. Data from the American Community Survey (ACS) were used to determine socioeconomic characteristics by the zip code of each physician’s practice. These included employment status and levels of poverty, income, and education. Multivariate linear regression was applied to assess differences in annual reimbursement by sex, accounting for calendar year, years of experience, number of services, ACS zip code data, and proportions of procedural services. The main outcome measures were total annual reimbursements and specific reimbursements by billing code.
During the study period, 20,281 ophthalmologists were reimbursed by Medicare, 76% of whom were men. The most common billing codes assigned were for outpatient visits and eye exams (13.8 million charges/year), retinal diagnostic imaging (5.6 million charges/year), intravitreal injections (2.9 million charges/year), and cataract removal plus IOL insertion (2.4 million charges/year). In the primary analysis, the median annual Medicare reimbursement was approximately $94,734 for females, versus $194,177 for males (p < .001). The median annual number of billed services also was lower for females (1,228 vs. 2,259 for males; p < .001). After adjustment for covariates, annual Medicare reimbursement was $20,209 higher for male ophthalmologists, and men billed for 1,015 more services per year (both p < .001).
Medicare does not discriminate by sex when reimbursing for services, so other sources of the disparities should be explored, said the authors. They hope that further research in larger datasets will lead to policies that reduce the reimbursement gender gap.
The original article can be found here.