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Reimbursement for Female-Specific Compared With Male-Specific Procedures Over Time. Obstet Gynecol 2021; 138:878-883. [PMID: 34736273 DOI: 10.1097/aog.0000000000004599] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/16/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate whether per-procedure work relative value units (RVUs) have changed over time and to compare time-based compensation for female-specific procedures compared with male-specific procedures. METHODS Using the National Surgical Quality Improvement Program files for 2015-2018, we compared operative time and RVUs for 12 pairs of sex-specific procedures. Procedures were matched to be anatomically and technically similar. Procedure-assigned RVUs in 2015 were compared with 1997. Procedure compensation was determined using median dollars per RVU provided in SullivanCotter's 2018 Physician Compensation and Productivity Survey. This was compared with specialty-specific McGraw-Hill per-RVU data from 1994. Statistical analysis was performed with chi-square and Kruskal-Wallis tests. RESULTS A total of 12,120 patients underwent 6,217 male-specific procedures and 5,903 female-specific procedures. Male-specific procedures had a median (interquartile range) RVU of 25.2 (21.4-25.2), compared with 7.5 (7.5-23.4) for female-specific procedures (P<.001). Male-specific procedures were 79 minutes longer (median [interquartile range] 136 minutes [98-186] vs 57 minutes [25-125], P<.001). Female-specific procedures were reimbursed at a higher hourly rate (10.6 RVU/hour [7.2-16.2] vs 9.7 RVU/hour [7.4-12.8], P<.001). However, male-specific procedures were better reimbursed ($599/h [$457-790] vs $555/h [$377-843], P<.001). Overall, per-procedure RVUs for male-specific surgeries have increased 13%, whereas, for female-specific surgeries, per-procedure RVUs have increased 26%. Reimbursement per RVU for male-specific procedures has decreased 8% ($67.30 to $61.65), whereas for female-specific procedures it has increased 14% ($44.50 to $52.02). CONCLUSION Increases in RVUs and specialty-specific compensation have resulted in more equitable reimbursement for female-specific procedures. However, even with these changes, there is a lower relative value of work, driven by specialty-specific compensation rates, for procedures performed for women-only compared with equivalent men-only procedures.
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Discrepancies Created by Surgeon Self-Reported Operative Time and the Effects on Procedural Relative Value Units and Reimbursement. Obstet Gynecol 2021; 138:182-188. [PMID: 34237766 DOI: 10.1097/aog.0000000000004467] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 04/08/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To demonstrate discrepancies between operative times in the ACS NSQIP (American College of Surgeons National Surgical Quality Improvement Project) and self-reported operative time from the American Medical Association's Relative Value Scale Update Committee (RUC) and their effect on relative value units (RVU) determination. METHODS This is a cross-sectional review of registry data using the ACS NSQIP 2016 Participant User File and the Centers for Medicare & Medicaid Services physician procedure time file for 2018. We analyzed total RVUs for surgeries by operative time to calculate RVU per hour and stratified by specialty. Multivariate regression analysis adjusted for patient comorbidities, age, length of stay, and ACS NSQIP mortality and morbidity probabilities. The surgeon self-reported operative times from the Centers for Medicare & Medicaid Services physician were compared with operative times recorded in the ACS NSQIP, with excess time from RUC estimates termed "overreported time." RESULTS Analysis of 901,917 surgeries revealed a wide variation in median RVU per hour between specialties. Orthopedics (14.3), neurosurgery (12.9), and general surgery (12.1) had the highest RVU per hour, whereas gynecology (10.2), plastic surgery (9.5), and otolaryngology (9) had the lowest (P<.001 for all comparisons). These results remained unchanged on multivariate regression analysis. General surgery had the highest median overreported operative time (+26 minutes) followed by neurosurgery (+23.5 minutes) and urology (+20 minutes). Overreporting of the operative time strongly correlated to higher RVU per hour (r=0.87, P=.002). CONCLUSION Despite reliable electronic records, the AMA-RUC continues to use inaccurate self-reported RUC surveys for operative times. This results in discrepancies in RVU per hour (and subsequent reimbursement) across specialties and a persistent disparity for women-specific procedures in gynecology. Relative value unit levels should be based on the available objective data to eliminate these disparities.
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Meyr AJ, Mateen S, Skolnik J, Van JC. Evaluation of the Relationship Between Aspects of Medical Complexity and Work Relative Value Units (wRVUs) for Foot and Ankle Surgical Procedures. J Foot Ankle Surg 2021; 60:448-454. [PMID: 33958040 DOI: 10.1053/j.jfas.2020.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 02/03/2023]
Abstract
Work relative value units (wRVUs) have been assigned to current procedural terminology codes in an effort to help establish physician compensation. However, the ability of these to accurately and efficiently capture the time, technical, and perioperative managerial aspects required of various procedures has recently been called into question for several surgical subspecialties. Therefore, the objective of this investigation was to evaluate various measures of medical complexity against wRVUs for foot and ankle surgical procedures. The 2018 American College of Surgeons National Surgical Quality Improvement Program database was utilized to identify and extract data related to the perioperative medical complexity of 16 foot and ankle surgical current procedural terminology codes. We observed a "weak" positive relationship between wRVUs and operation time as defined by a correlation coefficient of 0.234 (p < .001). Other variables associated with medical complexity in the perioperative period were found to significantly vary between wRVUs categories, but these differences were neither consistently nor directly associated with assigned relative values. We conclude that wRVUs might not always represent an efficient means for determining compensation for foot and ankle surgical procedures.
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Affiliation(s)
- Andrew J Meyr
- Clinical Professor, Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, Pennsylvania.
| | - Sara Mateen
- Resident, Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, Pennsylvania
| | - Jennifer Skolnik
- Resident, Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, Pennsylvania
| | - Jennifer C Van
- Clinical Associate Professor, Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, Pennsylvania
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Affiliation(s)
- Michelle Cohen
- Department of Family Medicine (Cohen), Queen's University, Kingston, Ont.; Division of Family Medicine (Cohen), Trenton Memorial Hospital, Trenton, Ont.; Department of Family and Community Medicine (Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Kiran), University of Toronto; MAP Centre for Urban Health Solutions (Kiran), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran), University of Toronto, Toronto, Ont.
| | - Tara Kiran
- Department of Family Medicine (Cohen), Queen's University, Kingston, Ont.; Division of Family Medicine (Cohen), Trenton Memorial Hospital, Trenton, Ont.; Department of Family and Community Medicine (Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Kiran), University of Toronto; MAP Centre for Urban Health Solutions (Kiran), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran), University of Toronto, Toronto, Ont
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Orenstein LAV, Nelson MM, Wolner Z, Laugesen MJ, Wang Z, Patzer RE, Swerlick RA. Differences in Outpatient Dermatology Encounter Work Relative Value Units and Net Payments by Patient Race, Sex, and Age. JAMA Dermatol 2021; 157:406-412. [PMID: 33595596 PMCID: PMC7890528 DOI: 10.1001/jamadermatol.2020.5823] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/28/2020] [Indexed: 11/14/2022]
Abstract
Importance Clinical productivity measures may be factors in financial incentives for providing care to specific patient populations and thus may perpetuate inequitable health care. Objective To identify the association of patient race, age, and sex with work relative value units (wRVUs) generated by outpatient dermatology encounters. Design, Setting, and Participants This cross-sectional study obtained demographic and billing data for outpatient dermatology encounters (ie, an encounter performed within a department of dermatology) from September 1, 2016, to March 31, 2020, at the Emory Clinic, an academic dermatologic practice in Atlanta, Georgia. Participants included adults aged 18 years or older with available age, race, and sex data in the electronic health record system. Main Outcomes and Measures The primary outcome was wRVUs generated per encounter. Results A total of 66 463 encounters among 30 036 unique patients were included. Patients had a mean (SD) age of 55.9 (18.5) years and were predominantly White (46 575 [70.1%]) and female (39 598 [59.6%]) individuals. In the general dermatologic practice, the mean (SD) wRVUs per encounter was 1.40 (0.71). In adjusted analysis, Black, Asian, and other races (eg, American Indian or Native American, Native Hawaiian or Other Pacific Islander, and multiple races); female sex; and younger age were associated with fewer wRVUs per outpatient dermatology encounter. Compared with general dermatologic visits with White patients, visits with Black patients generated 0.27 (95% CI, 0.25-0.28) fewer wRVUs per encounter, visits with Asian patients generated 0.22 (95% CI, 0.20-0.25) fewer wRVUs per encounter, and visits with patients of other race generated 0.19 (95% CI, 0.14-0.24) fewer wRVUs per encounter. Female sex was also associated with 0.11 (95% CI, 0.10-0.12) fewer wRVUs per encounter, and wRVUs per encounter increased by 0.006 (95% CI, 0.006-0.006) with each 1-year increase in age. In the general dermatologic practice excluding Mohs surgeons, destruction of premalignant lesions and biopsies were mediators for the observed differences in race (56.2% [95% CI, 53.1%-59.3%] for Black race, 53.2% [95% CI, 45.6%-63.8%] for Asian race, and 53.6% [95% CI, 40.4%-77.4%] for other races), age (65.6%; 95% CI, 60.5%-71.4%), and sex (82.3%; 95% CI, 72.7%-93.1%). In a data set including encounters with Mohs surgeons, the race, age, and sex differences in wRVUs per encounter were greater than in the general dermatologic data set. Mohs surgery for basal cell and squamous cell carcinomas was a mediator for the observed differences in race (46.0% [95% CI, 42.6%-49.4%] for Black race, 41.9% [95% CI, 35.5%-49.2%] for Asian race, and 34.6% [95% CI, 13.8%-51.5%] for other races), age (49.2%; 95% CI, 44.9%-53.7%), and sex (47.9%; 95% CI, 42.0%-54.6%). Conclusions and Relevance This cross-sectional study found that dermatology encounters with racial minority groups, women, and younger patients generated fewer wRVUs than encounters with older White male patients. This finding suggests that physician compensation based on wRVUs may encourage the provision of services that exacerbate disparities in access to dermatologic care.
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Affiliation(s)
| | | | - Zachary Wolner
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Miriam J. Laugesen
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York
| | - Zhensheng Wang
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia
| | - Rachel E. Patzer
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia
| | - Robert A. Swerlick
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
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Dossa F, Simpson AN, Sutradhar R, Urbach DR, Tomlinson G, Detsky AS, Baxter NN. Sex-Based Disparities in the Hourly Earnings of Surgeons in the Fee-for-Service System in Ontario, Canada. JAMA Surg 2020; 154:1134-1142. [PMID: 31577348 DOI: 10.1001/jamasurg.2019.3769] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Sex-based income disparities are well documented in medicine and most pronounced in surgery. These disparities are commonly attributed to differences in hours worked. One proposed solution to close the earnings gap is a fee-for-service payment system, which is theoretically free of bias. However, it is unclear whether a sex-based earnings gap persists in a fee-for-service system when earnings are measured on the basis of hours worked. Objective To determine whether male and female surgeons have similar earnings for each hour spent operating in a fee-for-service system. Design, Setting, and Participants This cross-sectional, population-based study used administrative databases from a fee-for-service, single-payer health system in Ontario, Canada. Surgeons who submitted claims for surgical procedures performed between January 1, 2014, and December 31, 2016, were included. Data analysis took place from February 2018 to December 2018. Exposures Surgeon sex. Main Outcomes and Measures This study compared earnings per hour spent operating between male and female surgeons and earnings stratified by surgical specialty in a matched analysis. We explored factors potentially associated with earnings disparities, including differences in procedure duration and type between male and female surgeons and hourly earnings for procedures performed primarily on male vs female patients. Results We identified 1 508 471 surgical procedures claimed by 3275 surgeons. Female surgeons had practiced fewer years than male surgeons (median [interquartile range], 8.4 [2.9-16.6] vs 14.7 [5.9-25.7] years; P < .001), and the largest proportion of female surgeons practiced gynecology (400 of 819 female surgeons [48.8%]). Hourly earnings for female surgeons were 24% lower than for male surgeons (relative rate, 0.76 [95% CI, 0.74-0.79]; P < .001). This disparity persisted after adjusting for specialty and in matched analysis stratified by specialty, with the largest mean differences in cardiothoracic surgery (in US dollars: $59.64/hour) and orthopedic surgery ($55.45/hour). There were no differences in time taken by male and female surgeons to perform common procedures; however, female surgeons more commonly performed procedures with the lowest hourly earnings. Conclusions and Relevance Even within a fee-for-service system, male and female surgeons do not have equal earnings for equal hours spent working, suggesting that the opportunity to perform the most lucrative surgical procedures is greater for men than women. These findings call for a comprehensive analysis of drivers of sex-based earning disparities, including referral patterns, and highlight the need for systems-level solutions.
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Affiliation(s)
- Fahima Dossa
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, St Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrea N Simpson
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of Minimally Invasive Gynecologic Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Obstetrics and Gynecology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - David R Urbach
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - George Tomlinson
- Department of Epidemiology and Biostatistics, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Allan S Detsky
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
| | - Nancy N Baxter
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, St Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
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7
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Benoit MF, Ma JF, Upperman BA. Comparison of 2015 Medicare relative value units for gender-specific procedures: Gynecologic and gynecologic-oncologic versus urologic CPT coding. Has time healed gender-worth? Gynecol Oncol 2016; 144:336-342. [PMID: 28024653 DOI: 10.1016/j.ygyno.2016.12.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 12/01/2016] [Accepted: 12/06/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND In 1992, Congress implemented a relative value unit (RVU) payment system to set reimbursement for all procedures covered by Medicare. In 1997, data supported that a significant gender bias existed in reimbursement for gynecologic compared to urologic procedures. The present study was performed to compare work and total RVU's for gender specific procedures effective January 2015 and to evaluate if time has healed the gender-based RVU worth. METHODS Using the 2015 CPT codes, we compared work and total RVU's for 50 pairs of gender specific procedures. We also evaluated 2015 procedure related provider compensation. The groups were matched so that the procedures were anatomically similar. We also compared 2015 to 1997 RVU and fee schedules. RESULTS Evaluation of work RVU's for the paired procedures revealed that in 36 cases (72%), male vs female procedures had a higher wRVU and tRVU. For total fee/reimbursement, 42 (84%) male based procedures were compensated at a higher rate than the paired female procedures. On average, male specific surgeries were reimbursed at an amount that was 27.67% higher for male procedures than for female-specific surgeries. Female procedure based work RVU's have increased minimally from 1997 to 2015. CONCLUSION Time and effort have trended towards resolution of some gender-related procedure worth discrepancies but there are still significant RVU and compensation differences that should be further reviewed and modified as surgical time and effort highly correlate.
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Affiliation(s)
- M F Benoit
- Division of Gynecologic Oncology, 11511 NE 10th St, Bellevue WA 98004, United States.
| | - J F Ma
- Division of Urology, 11511 NE 10th St, Bellevue WA 98004, United States.
| | - B A Upperman
- Specialty Coder, 11511 NE 10th St, Bellevue WA 98004, United States.
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Carnes M, Morrissey C, Geller SE. Women's health and women's leadership in academic medicine: hitting the same glass ceiling? J Womens Health (Larchmt) 2009; 17:1453-62. [PMID: 18954235 DOI: 10.1089/jwh.2007.0688] [Citation(s) in RCA: 181] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The term "glass ceiling" refers to women's lack of advancement into leadership positions despite no visible barriers. The term has been applied to academic medicine for over a decade but has not previously been applied to the advancement of women's health. This paper discusses (1) the historical linking of the advances in women's health with women's leadership in academic medicine, (2) the slow progress of women into leadership in academic medicine, and (3) indicators that the advancement of women's health has stalled. We make the case that deeply embedded unconscious gender-based biases and assumptions underpin the stalled advancement of women on both fronts. We conclude with recommendations to promote progress beyond the apparent glass ceiling that is preventing further advancement of women's health and women leaders. We emphasize the need to move beyond "fixing the women" to a systemic, institutional approach that acknowledges and addresses the impact of unconscious, gender-linked biases that devalue and marginalize women and issues associated with women, such as their health.
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Affiliation(s)
- Molly Carnes
- School of Medicine & Public Health, Department of Medicine, and Center for Women's Health Research, University of Wisconsin-Madison, Wisconsin 53715, USA.
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Bird CE, Shugarman LR, Lynn J. Age and gender differences in health care utilization and spending for medicare beneficiaries in their last years of life. J Palliat Med 2002; 5:705-12. [PMID: 12572969 DOI: 10.1089/109662102320880525] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Men's and women's health care experiences differ as they age. While increasing attention has been focused on gender differences in health status, prevalence of illnesses, and access to quality care among older adults, little is known about differences in their health care in the last years of their lives. This paper uses claims data for a 0.1% random sample of Medicare beneficiaries who died between January 1, 1994 and December 31, 1998 to assess age and gender differences among Medicare-eligible adults in their utilization of health care services in the last year of life. Overall, age is much more important than gender in explaining most of the variation in end-of-life care. The combination of being a Medicare beneficiary and being sick enough to die appears to attenuate gender disparities in health care services utilization.
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Affiliation(s)
- Chloe E Bird
- RAND Corporation, Santa Monica, California 90407, USA.
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10
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Donnell RF. Changes in medicare reimbursement: impact on therapy for benign prostatic hyperplasia. Curr Urol Rep 2002; 3:280-4. [PMID: 12149158 DOI: 10.1007/s11934-002-0049-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Medicare spending accounts for 17% of all health spending and therefore exerts a significant influence on health care spending policies. Medicare policies such as Diagnostic Related Groups and the Resource Based Relative Value System have resulted in profound changes in health care delivery in the United States. These resource-allocation methods are one of the major sources of controversies between managers, doctors, politicians, and social scientists. Financial disincentives associated with these resource-allocation policies have effectively rationed select therapies, particularly transurethral resection of the prostate (TURP). As a consequence, TURP, once the second most common surgical procedure billed to Medicare and comprising 38% of major surgical procedures performed by urologists, is increasingly challenged by medical therapy and minimally invasive surgical therapies that may be associated with lower efficacy and durability. This article examines the history of Medicare policies and their influence on TURP.
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Affiliation(s)
- Robert F Donnell
- Division of Urology, The Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
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Goff BA, Muntz HG, Cain JM. Comparison of 1997 Medicare relative value units for gender-specific procedures: is Adam still worth more than Eve? Gynecol Oncol 1997; 66:313-9. [PMID: 9264582 DOI: 10.1006/gyno.1997.4775] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND On January 1, 1992, Congress implemented a Medicare payment system based on relative value units (RVUs). The total RVU (which is made up of work, practice, and malpractice RVUs) is multiplied by a dollar conversion factor to set the reimbursement for all procedures covered by Medicare. In a previous study, we found that significant gender bias exists in Medicare reimbursement for female-specific services. Recently, HCFA approved increases (beginning January 1997) in the work RVU for many gynecologic procedures. This study was undertaken to compare work and total RVUs for gender-specific procedures effective January 1, 1997. METHODS Using the May 1996 Federal Register, we compared work and total RVUs for 24 pairs of gender-specific procedures. The groups were matched so that the amount of work and level of difficulty would be similar, if not identical. We validated our selection of procedures for comparison by also evaluating the average time required to perform these procedures. RESULTS Comparison of work RVUs for the 24 paired procedures revealed that in 19 cases (80%), male-specific procedures had a higher RVU; in 3 cases (12%), female-specific procedures were higher; and in 2 cases, there was no difference. On average, work RVUs were 49% higher for urologic procedures than for gynecologic procedures. Comparison of total RVUs revealed that in 20 cases (83%), urologic procedures had a higher total RVU and in 3 cases (12%), gynecologic procedures were higher. On average, male-specific surgeries are reimbursed at an amount which is 37% higher than that for female-specific surgeries. CONCLUSION Recent increases in work RVUs for many gynecologic procedures have resulted in improved reimbursement. However, even with these improvements, significant gender bias still exists in the Medicare reimbursement of female-specific procedures. This gender bias is further magnified as more private insurance carriers use the system to set reimbursement.
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Affiliation(s)
- B A Goff
- University of Washington Medical Center, Department of Obstetrics and Gynecology, Seattle 98195, USA
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12
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Goff BA, Muntz HG, Cain JM. Is Adam worth more than Eve? The financial impact of gender bias in the federal reimbursement of gynecological procedures. Gynecol Oncol 1997; 64:372-7. [PMID: 9062137 DOI: 10.1006/gyno.1996.4607] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE On January 1, 1992, Congress implemented a Medicare payment system based on relative value units (RVU). The RVU multiplied by a dollar conversion factor sets the reimbursement for all procedures covered by Medicare and many other private insurers. This study was undertaken to evaluate discrepancies in federal reimbursement for gender-specific procedures. METHODS Using the December 1995 Federal Register and the regional Medicare conversion factor ($40.08/RVU), we compared the work RVU and total reimbursement of 24 groups of gender-specific surgical procedures. The groups were matched as carefully as possible so that the amount of work and level of difficulty would be similar, if not identical. Some examples of comparisons are as follows: biopsy of male vs female genitals, hysterectomy vs prostatectomy, staging for ovarian vs testicular cancer, and exenteration for cervical vs prostate cancer. RESULTS In the 24 matched procedures, the male-specific procedures were reimbursed at a higher amount in 19 (79%) cases. The female-specific procedures were reimbursed at a higher amount in 3 (12%) cases (P = 0.004). There was no difference in reimbursement for two of the comparisons. Overall, we found that male-specific procedures are reimbursed at an amount which is 44% higher than female-specific procedures. Comparison of work RVU revealed that male-specific procedures were assigned higher values in 19 cases and, overall, male gender-related surgeries had work RVU that were 50% higher than female gender-related surgeries. CONCLUSION There is significant gender bias against the Medicare reimbursement of female-specific services. This results in a lower net reimbursement for gynecologic procedures. In addition, since many private sector insurance carriers now use the resource-based relative value scale system, this gender bias is further potentiated.
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Affiliation(s)
- B A Goff
- University of Washington Medical Center, Department of Obstetrics and Gynecology, Seattle 98195, USA
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Affiliation(s)
- S Miles
- University of Minnesota Center for Biomedical Ethics, Minneapolis 55414-3075, USA
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