Gender Differences in Physician Service Provision Using Medicare Claims Data

Mahr, Michael A.; Hayes, Sharonne N.; Shanafelt, Tait D.; Sloan, Jeff A.; Erie, Jay C.

doi:10.1016/j.mayocp.2017.02.017

Cited by 32 publications

(39 citation statements)

References 25 publications

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“…In addition to differences in institutional support, female physicians have also been shown to be unfairly compensated for clinical care. Despite demonstrating their clinical value and high level of patient care as shown in studies such Tsugawa et al , female physicians received fewer dollars via Medicare reimbursement compared with male physicians 15 19. Mahr et al even specifically present data showing that, grossly, female interventional pain physicians earned only 67% of the Medicare-allowed physician charges that were given to male counterparts.…”

Section: Discussionmentioning

confidence: 97%

Exploration of Gender-Specific Authorship Disparities in the Pain Medicine Literature

Karri

Navarro

Duong

et al. 2019

Reg Anesth Pain Med

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BackgroundGiven the readily increasing membership of the pain physician community, efforts toward correcting notable gender disparities are instrumental. The under-representation of women is particularly prevalent within leadership roles in academic medicine, thought to be driven largely by diminished research efforts. Consequently, we aimed to characterize gender differences among the highest impact pain literature.MethodsThe 20 highest cited articles per year from 2014 to 2018 were extracted from each of seven impactful journals affiliated to the largest pain medicine societies. Collected data from each article included genders of the first and last authors, the number of citations accumulated and the journal impact factor at the time of publication.ResultsAcross all considered literature, female authors were surprisingly not under-represented when considering the national prevalence of female pain physicians. However, more in-depth analysis found trends toward significance to suggest that female authorship was relatively diminished within more impactful and higher cited literature. When exploring gender–gender collaboration patterns, we found that male authors were favored over female counterparts with statistical significance; it must be noted that this likelihood analysis and preference toward male authors may be statistically obfuscated by the high prevalence of male authors. Nonetheless, these findings help to quantify overt, demonstrated disparity patterns. Of note, this inequity may also be fully secondary to the lower number of female pain physicians and/or those involved in research endeavors and decreased number of submissions from female physicians. Establishing gender discrimination patterns as causal factors in such disparities can be extremely challenging to determine.ConclusionIn our analysis of authorship between genders within the context of pain medicine literature, we found trends, although non-significant, toward women being lesser represented in the more impactful literature. We suggest that these inequities are possibly resultant of a markedly small and outnumbered female pain physician membership that has yet to achieve a critical mass and possible implicit gender biases that may restrict female authorship. However, further exploration and analysis of this issue are necessary to more clearly illuminate which systemic deficits exist and how they may, in turn, be corrected with cultural and macroscopic organizational-driven change.

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Section: Discussionmentioning

confidence: 97%

Exploration of Gender-Specific Authorship Disparities in the Pain Medicine Literature

Karri

Navarro

Duong

et al. 2019

Reg Anesth Pain Med

View full text Add to dashboard Cite

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“…These statistically significant findings may invite speculation about variations in male and female risk aversion and norm adherence [ 20 ]. It may also, if proven consistent in future studies, come to partially explain variations in male and female provider compensation [ 21 – 26 ]. However, considering the scope and primary aims of the present study, such suggestions should be taken with caution.…”

Section: Discussionmentioning

confidence: 92%

Billing by residents and attending physicians in family medicine: the effects of the provider, patient, and visit factors

et al. 2018

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BackgroundMedical billing and coding are critical components of residency programs since they determine the revenues and vitality of residencies. It has been suggested that residents are less likely to bill higher evaluation and management (E/M) codes compared with attending physicians. The purpose of this study is to assess the variation in billing patterns between residents and attending physicians, considering provider, patient, and visit characteristics.MethodA retrospective cohort study of all established outpatient visits at a family medicine residency clinic over a 5-year period was performed. We employed the logistic regression methodology to identify residents’ and attending physicians’ variations in coding E/M service levels. We also employed Poisson regression to test the sensitivity of our result.ResultsBetween January 5, 2009 and September 25, 2015, 98,601 visits to 116 residents and 18 attending physicians were reviewed. After adjusting for provider, patient, and visit characteristics, residents billed higher E/M codes less often compared with attending physicians for comparable visits. In comparison with attending physicians, the odds ratios for billing higher E/M codes were 0.58 (p = 0.01), 0.56 (p = 0.01), and 0.63 (p = 0.01) for the third, second, and first years of postgraduate training, respectively. In addition to the main factors of patient age, medical conditions, and number of addressed problems, the gender of the provider was also implicated in the billing variations.ConclusionResidents are less likely to bill higher E/M codes than attending physicians are for similar visits. While these variations are known to contribute to lost revenues, further studies are required to explore their effect on patient care in relation to attendings’ direct involvement in higher E/M-coded versus their indirect involvement in lower E/M-coded visits.

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“…Our observational data are also limited to a single snapshot in 2016, and examining these same trends at multiple time points and across multiple generations would be useful to add more context to our findings, particularly because other studies have shown that the gap in clinical activity and payment widens with time. 33 The role of overcoding or undercoding among the sexes was also not addressed in this study, and could be illuminating. As is the case with any single-payer database, limitations in the POSPUF preclude adjusting for potential confounders, including differences between male and female radiation oncologists in non-Medicare payer mix, disease sites treated, years in practice, and distributions of patients with dual eligibility for Medicare and Medicaid.…”

Section: Discussionmentioning

confidence: 97%

Assessment of Differences in Clinical Activity and Medicare Payments Among Female and Male Radiation Oncologists

Valle

Weng²,

Jagsi

et al. 2019

JAMA Netw Open

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Importance Although physician sex is known to influence salary even after controlling for productivity, sex-based differences in clinical activity and reimbursement among radiation oncologists are poorly understood. Objectives To evaluate differences by sex in productivity, breadth of practice, and payments and to characterize Medicare reimbursement by sex among similarly productive groups of radiation oncologists. Design, Setting, and Participants A retrospective cohort study was conducted using the January 1 to December 31, 2016, Centers for Medicare & Medicaid Services Physician and Other Supplier Public Use File (POSPUF) to identify charge and payment information for individual radiation oncologists. Clinicians were part of a population-based sample of US radiation oncologists who bill Medicare in both non–facility-based (NFB) and facility-based (FB) practice settings. Analysis was conducted from June 5 to 25, 2018. Main Outcomes and Measures Outcome measurements included physician productivity (measured by number of Medicare charges), physician payments (reported as total Medicare payments as well as mean payments per charge submitted and per beneficiary treated), and physician breadth of practice (measured by number of unique Medicare billing codes) in NFB and FB settings. Results A total of 4393 radiation oncologists (1133 women and 3260 men) were included in the POSPUF in 2016. Compared with their male counterparts, female physicians in the NFB setting submitted a mean of 1051 fewer charges (95% CI, –1458 to –644; P < .001), collected a mean of $143 610 less in revenue (95% CI, –$185 528 to –$101 692; P < .001), and used a mean of 1.32 fewer unique billing codes (95% CI, –2.23 to –0.41; P = .004). Compared with their male counterparts, female radiation oncologists in the FB setting submitted a mean of 423 fewer charges (95% CI, –506 to –341; P < .001), collected a mean of $26 735 less in revenue (95% CI, –$31 910 to –$21 560; P < .001), and submitted a mean of 1.28 fewer unique billing codes (95% CI, –1.77 to –0.78; P < .001). Women represented 46 of the 397 most highly productive radiation oncologists in the FB setting (11.6%) and collected a mean of $33 026 less (95% CI, –$52 379 to –$13 673; P = .001) than men who were similarly productive. In the NFB setting, women represented 54 of the 326 most highly productive radiation oncologists (16.6%) and collected $345 944 (95% CI, –$522 663 to –$169 225; P < .001) less than similarly highly productive men. Women collected a mean of $8.49 less per charge (95% CI, –$14.13 to –$2.86; P = .003) than men in the NFB setting. Conclusions and Relevance This study sugges...

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Gender Differences in Physician Service Provision Using Medicare Claims Data

Cited by 32 publications

References 25 publications

Exploration of Gender-Specific Authorship Disparities in the Pain Medicine Literature

Exploration of Gender-Specific Authorship Disparities in the Pain Medicine Literature

Billing by residents and attending physicians in family medicine: the effects of the provider, patient, and visit factors

Assessment of Differences in Clinical Activity and Medicare Payments Among Female and Male Radiation Oncologists

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