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. 2021 Dec 1;6(12):1432-1439.
doi: 10.1001/jamacardio.2021.3385.

Gender Differences in Medicare Payments Among Cardiologists

Inbar Raber  1 , Mahmoud Al Rifai  2 , Cian P McCarthy  3 , Muthiah Vaduganathan  4 , Erin D Michos  5 , Malissa J Wood  3 , Yvonne M Smyth  6 , Nasrien E Ibrahim  3 , Aarti Asnani  1 , Roxana Mehran  7 , John W McEvoy  5   6   8
Affiliations

Gender Differences in Medicare Payments Among Cardiologists

Inbar Raber et al. JAMA Cardiol. .

Abstract

Importance: Women cardiologists receive lower salaries than men; however, it is unknown whether US Centers for Medicare & Medicaid Services (CMS) reimbursement also differs by gender and contributes to the lower salaries.

Objective: To determine whether gender differences exist in the reimbursements, charges, and reimbursement per charge from CMS.

Design, setting, and participants: This cross-sectional analysis used the CMS database to obtain 2016 reimbursement data for US cardiologists. These included reimbursements to cardiologists, charges submitted, and unique billing codes. Gender differences in reimbursement for evaluation and management and procedural charges from both inpatient and outpatient settings were also assessed. Analysis took place between April 2019 and December 2020.

Main outcomes and measures: Outcomes included median CMS payments received and median charges submitted in the inpatient and outpatient settings in 2016.

Results: In 2016, 17 524 cardiologists (2312 women [13%] and 15 212 men [87%]) received CMS payments in the inpatient setting, and 16 929 cardiologists (2151 women [13%] and 14 778 men [87%]) received CMS payments in the outpatient setting. Men received higher median payments in the inpatient (median [interquartile range], $62 897 [$30 904-$104 267] vs $45 288 [$21 371-$73 191]; P < .001) and outpatient (median [interquartile range], $91 053 [$34 820-$196 165] vs $51 975 [$15 622-$120 175]; P < .001) practice settings. Men submitted more median charges in the inpatient (median [interquartile range], 1190 [569-2093] charges vs 959 [569-2093] charges; P < .001) and outpatient settings (median [interquartile range], 1685 [644-3328] charges vs 870 [273-1988] charges; P < .001). In a multivariable-adjusted linear regression analysis, women received less CMS payments compared with men (log-scale β = -0.06; 95% CI, -0.11 to -0.02) after adjustment for number of charges, number of unique billing codes, complexity of patient panel, years since graduation of physicians, and physician subspecialty. Payment by billing codes, both inpatient and outpatient, did not differ by gender.

Conclusions and relevance: There may be potential differences in CMS payments between men and women cardiologists, which appear to stem from gender differences in the number and types of charges submitted. The mechanisms behind these differences merit further research, both to understand why such gender differences exist and also to facilitate reductions in pay disparities.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Vaduganathan has received research grant support or served on advisory boards for American Regent, Amgen, AstraZeneca, Bayer AG, Baxter Healthcare, Boehringer Ingelheim, Cytokinetics, Lexicon Pharmaceuticals, Relypsa, and Roche Diagnostics; speaker engagements with Novartis and Roche Diagnostics; and participates on clinical end point committees for studies sponsored by Galmed and Novartis. Dr Michos has served on advisory boards for Novartis, Esperion, Amarin, and AstraZeneca. Dr Smyth has received presentation honoraria from Amgen, Bayer, Daiichi Sankyo, Menarini, and Novartis outside the submitted work. Dr Ibrahim has received presentation honoraria from Novartis and Roche Diagnostics. Dr Asnani reported grants from the National Institutes of Health and consults for Cytokinetics and AstraZeneca outside the submitted work. Dr Mehran has received institutional research funding from AstraZeneca, Bayer, Beth Israel Deaconess Medical Center, Bristol Myers Squibb/Sanofi, CSL Behring, DSI, Eli Lilly and Company/Daiichi Sankyo, Medtronic, Novartis, and OrbusNeich; is a consultant to Boston Scientific, Abbott Vascular, Medscape, Siemens Medical Solutions, Regeneron Pharmaceuticals (no fees), Roivant Sciences, and Sanofi; is an institution consultant (payment to institution) with Abbott Vascular and Spectranetics/Philips/Volcano Corporation; is on the executive committee for Janssen Pharmaceuticals and Bristol Myers Squibb; receives institutional (payment to institution) advisory board funding from Bristol Myers Squibb and Novartis; data and safety monitoring board membership funding to institution from Watermark Research; has less than 1% equity with Claret Medical (part of Boston Scientific, a company that makes medical devices) and less than 1% equity with Elixir Medical (a company that makes drug-eluting stents). No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Median Total Medicare Payments for Men and Women Cardiologists in 2016
P < .001 for both the inpatient and outpatient settings.
Figure 2.
Figure 2.. Median Total Number of Medicare Charges for Men and Women Cardiologists in 2016
P < .001 for both the inpatient and outpatient settings.
Figure 3.
Figure 3.. Gender Differences in Center for Medicare & Medicaid Services (CMS) by State in 2016
Positive values (red) reflect men having higher CMS payments, while negative values (blue) reflect women having higher CMS payments in a given state. The actual differences in mean CMS payments between men and women (per $1000) are displayed, ranging from −$31 483 in Vermont to $101 953 in Louisiana. Hawaii and Alaska are not included.
See this image and copyright information in PMC

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