Evaluating Trends in Medicare Reimbursements Between Male and Female Otolaryngologists From 2013 to 2018.

Abstract

Objective: Gender-based pay disparities exist in otolaryngology. Determining whether such patterns have been consistently present could help expose whether, and to what extent, gender-based inequalities exist within our field.

Study design: Retrospective, cross-sectional analysis of publicly available Centers for Medicare and Medicaid Services (CMS) data for otolaryngologists from 2013 to 2018.

Setting: A database study.

Methods: CMS databases were used to evaluate whether gender differences exist within clinical productivity and reimbursement patterns among otolaryngologists over time, and if so, what those trends have been. Outcomes included the number of unique billing codes and charges submitted per physician (clinical productivity) and physician reimbursements. Results were controlled for geography, levels of clinical productivity, and gender.

Results: Male otolaryngologists consistently submitted more charges for reimbursement (median [interquartile range, IQR], 291,539 [154,380-503,932] vs 196,029 [94,849-337,224]) and a greater number of unique billing codes (median [IQR], 52.0 [34.0-72.0] vs 41.0 [27.0-59.0]) than female otolaryngologists. Male otolaryngologists received greater reimbursements than female otolaryngologists (median [IQR], $114,390 [$61,732-$184,209] vs $72,679 [$34,855-$122,473]). Contrast ratios of estimated marginal means for reimbursements between male and female otolaryngologists demonstrated that 75% to 81% (P < .0001) of the estimated payment for physician services were received by male otolaryngologists.

Conclusion: There appears to be a consistent, general trend that the female gender is associated with decreased clinical productivity and lower CMS payments among otolaryngologists. These disparities persist even among highly productive female otolaryngologists. To better address gender pay disparities within otolaryngology, billing patterns among female otolaryngologists should be more closely assessed to help optimize reimbursement patterns for equivalent services provided by male otolaryngologists.

Level of evidence: Level IV.