Study: Medicare pays less for female-specific service
Study: Medicare pays less for female-specific service
Despite recent improvements in reimbursement rates, Medicare still pays physicians who perform female-specific medical procedures less than those performing male-specific procedures, according to a recent study by Barbara A. Goff, MD, of the University of Washington Medical Center, Seattle.
Among 24 gender-matched procedures with similar amounts of work and difficulty, reimbursement rates for male-specific procedures were higher nearly 80% of the time. For female-specific procedures, however, payment rates were greater than similar men’s procedures in only 12% of the CPT codes studied.
Overall, male-specific procedures are reimbursed by Medicare at a 44% higher rate than female-specific procedures, Goff contends.
Goff says the main reason for this discrepancy is a persistent gender bias in both Medicare’s work relative value units (RVUs) and total RVUs for obstetric and gynecologic invasive procedures, compared to urology and male-specific surgical procedures.
Relative value units are supposed to reflect the resources involved in furnishing three components of a physician’s service for any procedure: work, practice expense, and malpractice costs. These are added together to arrive at the total RVUs for each procedure. The RVUs are then multiplied by a dollar conversion factor setting the reimbursement for procedures covered by Medicare and often used as a baseline by private insurers for their own reimbursement rates.
In a related study, practice expenses for obstetrics and gynecology were found to be the third-highest of all specialties, and the malpractice expenses second-highest. (Hsiao WC, Dunn DL, Verrill DK. Assessing the implementation of physician payment reform. N Engl J Med 1993; March:928-933.) However, the study calculated that Medicare reimbursed only 60% of obstetrics and gynecology practice expenses, compared with 91% for urology and 106% for general surgery.
Rebecca Kelly, director of medical practice economics at the American College of Obstetricians and Gynecologists (ACOG), says while there are still many female-specific procedures that are paid less than male-specific procedures to which they are equal in needed skill and work, "significant process has been made in correcting this situation."
Noting the Goff study was based on 1996 HCFA rates, "we were able to get significant changes, particularly in the work component of RVUs in 1997, especially in gynecology surgery," says Goff. However, discrepancies still exist in the practice expense and malpractice parts.
ACOG now is working to ensure there is an appropriate linking of payment data as HCFA reviews its proposed Resource-Based Relative Value Scale-based practice expense rule. "Without proper linking, we’d be in much the same place when it comes to gender-specific procedures. With it the differences will not be as bad," notes Kelly.
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