S1491 Gender Gap in Total CMS Reimbursements for Gastroenterologists: A Medicare Claims Analysis

Abstract

Introduction: Despite increased demand for gastroenterology services, in 2017 only 17.6% of gastroenterologists were women. On average, physicians receive approximately 19% of their income from treating Medicare patients. The aim of this study was to evaluate the total amount of CMS reimbursements for gastroenterologists and identify any differences between male and female providers after adjusting for multiple factors previously identified to affect differences in salary. Methods: The CMS Physician and Other Supplier Public Use File (POSPUF) Database displays Part B claims organized by provider. For each unique NPI registered under “Gastroenterology” the total standardized amount reimbursed by Medicare was extracted for 2019. One univariate and one multivariate-adjusted linear regression model were used to analyze gender and CMS reimbursement. Reimbursement amounts greater than 97.5 percentile and less than 2.5 perdentile were excluded. The multivariate model evaluated gender after adjusting for region, practice setting, number of services performed, average complexity and age of Medicare beneficiaries, and physician experience. Results: For 2019, there were 2577 female and 11215 male gastroenterologists. Men had higher median total payments ($94416.28 vs $56014.14), higher median total services (1047 vs 633) and higher median unique HCPCS codes billed (39 vs 32). Men also had higher median years of experience since graduation (28 vs 17). Of the 13,792 gastroenterologists billing to Medicare in 2019, 13,500 (97.9%) had data regarding number of years of experience (2503 females, 10997 males). This subset was used for the linear regression models. The univariate unadjusted model demonstrated that female gastroenterologists received less total CMS reimbursement than their male counterparts (log b = −0.42 [−0.46 to −0.39]). After adjusting for region, practice setting, number of services performed, average complexity and age of Medicare beneficiaries, and number of years of physician experience, female gastroenterologists still received less CMS payments (log b = −0.15 [−0.18 to −0.12]). Conclusion: Much of the discussion regarding gender pay gaps can be subjective. However, even after adjustment for multiple factors, female gastroenterologists are receiving less CMS payments, which can comprise a significant portion of their annual income. Further objective data is warranted to provide a more accurate understanding of reimbursement inequity and help drive change from a national level to address gender-pay gaps.