Gender Pay Disparities in Medicare Reimbursement Impact Neurosurgeons

October 12, 2023 - Gender pay disparities persisted for neurosurgeons between 2013 and 2020, with women receiving 44 percent less in annual payments than men, a study published in JAMA Surgery revealed.

Researchers used CMS Medicare Fee-for-Service Provider Utilization and Payment Data from January 1, 2013, to December 31, 2020, to assess Medicare reimbursement among neurosurgeons and identify gender-based pay disparities.

The study sample included 6,052 neurosurgeons—5,540 men and 512 women. Between 2013 and 2020, the number of neurosurgeons serving Medicare beneficiaries grew from 4,361 to 4,897, with the number of female neurosurgeons rising from 268 to 408.

Female neurosurgeons submitted 48.32 percent less in annual Medicare charges and received 44.08 percent less in annual payments, researchers found. This disparity remained after excluding the top and bottom 2.5 percent of earners.

Female neurosurgeons billed fewer mean total services and unique service codes and treated fewer beneficiaries than men. The mean payment per service was 11.40 percent less for females ($217.65) than for males ($245.65). Women also tended to have fewer years in practice compared to men.

After controlling for volume and experience, women still received $24,885.29 less than men per year.

Researchers assessed practice composition among 5,356 men and 483 women who performed 11 or more identically coded services. Around 4,000 men performed at least 11 annual services reimbursed at more than $313.65, while 261 women did the same. The highest paying services accounted for 6.53 percent of all services performed by women compared to 11.40 percent of services provided by men.

Women were less likely to perform highly reimbursed services like procedures and diagnostic imaging tests. Instead, they tended to perform evaluation and management (E/M) services.

The top ten most common procedures for female neurosurgeons comprised 52.80 percent of their procedural volume and had an allowed amount sum of $6,131.10, or $116.12 per one percent. Meanwhile, the top ten most common procedures for men accounted for 58.96 percent of their procedural volume with an allowed amount sum of $8,531.80, or $144.70 per one percent.

In addition, women submitted $497.22 less in charges and were paid $24.61 less per service compared to men, according to the study.

Researchers suggested that variability in billing and coding practices may contribute to lower compensation for women.

“While future analysis is necessary and warranted to validate gender-based discrepancies in coding, this area is targetable through short-term educational interventions and longitudinal mentorship,” the study stated.

For example, programs can incorporate billing and coding training into residency education.

The gender pay disparity may also stem from a lack of peer support for women neurosurgeons, which can lead to reduced leverage in a hospital community, less administrative support, and a lower capacity for interaction and negotiation with payers.