ImportanceGender inequities and limited representation are an obstacle to surgical workforce diversification. There has been limited examination of gender-based disparities in billing practices among surgeons.ObjectiveTo evaluate variations in practice metrics and billing practices among female and male surgeons and identify factors associated with gender disparities in Medicare reimbursements.Design, Setting, and ParticipantsThis retrospective cross-sectional study used publicly available Medicare Fee-for-Service Provider Utilization and Payment data from January to December 31, 2021, to identify demographics, annual services provided, and financial payments and charges for general surgeons, surgical oncologists, and colorectal surgeons. Data were analyzed from November 2023 to February 2024.ExposureThe primary exposure of interest was surgeon gender (ie, female or male).Main Outcomes and MeasuresThe annual total submitted charges and payments submitted in 2021 by female and male surgeons were assessed. Additionally, the total number and types of services provided each year and the number of beneficiaries treated were examined. Multivariable linear regression models were used to evaluate the association of surgeon gender with payments, number of services, and beneficiaries.ResultsA total of 20 549 general surgeons (5036 [24.5%] female; 15 513 [75.5%] male), 1065 surgical oncologists (450 [42.3%] female; 615 [57.7%] male), and 1601 colorectal surgeons (432 [27.0%] female; 1169 [73.0%] male) were included. Across all surgical subspecialties, female surgeons billed fewer mean (SE) Medicare charges (general surgeons: 30.1% difference; $224 934.80 [$3846.97] vs $321 868.50 [$3933.57]; surgical oncologists: 27.5% difference; $277 901.70 [$22 857.37] vs $382 882.90 [$19 566.06]; colorectal surgeons: 21.7% difference; $274 091.70 [$10 468.48] vs $350 146.10 [$8741.66]; all P < .001) and received significantly lower mean (SE) reimbursements (general surgeons: 29.0% difference; $51 787.61 [$917.91] vs $72 903.12 [$890.35]; surgical oncologists: 23.6% difference; $57 945.18 [$3853.28] vs $75 778.22 [$2622.75]; colorectal surgeons: 24.5% difference; $63 117.01 [$2248.10] vs $83 598.53 [$1934.77]; all P < .001). On multivariable analysis, a reimbursement gap remained across all 3 surgical subspecialties (general surgeons: –$14 963.46 [95% CI, –$18 822.27 to –$11 104.64] [P < .001]; surgical oncologists: –$8354.69 [95% CI, –$15 018.12 to –$1691.25] [P = .01]; colorectal surgeons: –$4346.73 [95% CI, –$7660.15 to –$1033.32] [P = .01]).Conclusions and RelevanceIn this cross-sectional study, there was considerable gender-based variation in practice patterns and reimbursement among different surgical subspecialties serving the Medicare population. Differences in mean payment per service were associated with variations in billing and coding strategies among female and male surgeons.

中文翻译：

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不同外科亚专业之间医疗保险报销的性别差异


重要性性别不平等和代表性有限是外科劳动力多元化的障碍。对外科医生计费实践中基于性别的差异的检查有限。目的评估女性和男性外科医生在实践指标和计费实践中的差异，并确定与医疗保险报销中性别差异相关的因素。设计、设置和参与者这项回顾性交叉研究分段研究使用了 2021 年 1 月至 12 月 31 日公开的医疗保险按服务收费提供者利用和付款数据，以确定普通外科医生、肿瘤外科医师和结直肠外科医生的人口统计数据、每年提供的服务以及财务付款和收费。分析了 2023 年 11 月至 2024 年 2 月的数据。 暴露 感兴趣的主要暴露是外科医生性别（即女性或男性）。 主要成果和措施 对女性和男性外科医生在 2021 年提交的年度总费用和付款进行了评估。此外，还审查了每年提供的服务总数和类型以及接受治疗的受益人人数。使用多变量线性回归模型评估外科医生性别与付款、服务次数和受益人的关系。 结果共有 20 549 名普通外科医生（5 036 名[24.5%] 女性；15 513 名[75.5%] 男性）、1 065 名肿瘤外科医师其中包括 450 名 [42.3%] 女性；615 名 [57.7%] 男性）和 1601 名结直肠外科医生（432 名 [27.0%] 女性；1169 名 [73.0%] 男性）。在所有外科亚专科中，女性外科医生收取的平均 (SE) 医疗保险费用较低（普通外科医生：差异 30.1%；224 934.80 美元 [3846.97 美元] 对比 321 868.50 美元 [3933.57 美元]；肿瘤外科医师：差异 27.5%；277 901.70 美元 [22 857.37 美元] 对比 382 美元882.90 [19 566 美元。06]；结直肠外科医生：差异 21.7%； $274 091.70 [$10 468.48] vs $350 146.10 [$8741.66]；所有P< .001) and received significantly lower mean (SE) reimbursements (general surgeons: 29.0% difference; $51 787.61 [$917.91] vs $72 903.12 [$890.35]; surgical oncologists: 23.6% difference; $57 945.18 [$3853.28] vs $75 778.22 [$2622.75]结直肠外科医生： 63 117.01 美元 [2248.10 美元] 对比 83 598.53 美元 [1934.77 美元] 差异；所有 P < 0.001）。根据多变量分析，所有 3 个外科亚专科仍存在报销缺口（普通外科医生：–$14 963.46 [95% CI，–$18 822.27 至 –$11 104.64] [P < .001]；外科肿瘤科医生：–$8354.69 [95% CI , –$15 018.12 至 –$1691.25] [P = .01]；结直肠外科医生：–$4346.73 [95% CI，–$7660.15 至 –$1033.32] [P = .01])。结论和相关性在这项横断面研究中，服务于医疗保险人群的不同外科亚专业之间的实践模式和报销存在相当大的基于性别的差异。每次服务平均付款的差异与女性和男性外科医生的计费和编码策略的差异有关。