Reimbursement for Female-Specific Compared With Male-Specific Procedures Over Time

Area of Science:

• Health Economics
• Surgical Outcomes
• Gender Disparities in Medicine

Background:

• Work relative value units (RVUs) are a key component of physician reimbursement in the United States.
• Previous analyses suggest potential gender-based disparities in compensation for medical procedures.
• Understanding changes in RVUs and compensation over time is crucial for equitable healthcare payment.

Purpose of the Study:

• To evaluate changes in per-procedure work RVUs for male- and female-specific surgical procedures over time.
• To compare time-based compensation between male- and female-specific procedures.
• To identify trends in reimbursement equity for sex-specific medical interventions.

Main Methods:

• Utilized National Surgical Quality Improvement Program data from 2015-2018 for 12 pairs of matched sex-specific procedures.
• Compared procedure-assigned RVUs from 2015 with historical data from 1997.
• Calculated procedure compensation using median dollars per RVU and compared with historical specialty-specific data.

Main Results:

• Male-specific procedures had significantly higher median RVUs (25.2 vs 7.5) and longer operative times (136 vs 57 minutes) than female-specific procedures.
• Female-specific procedures had a higher reimbursed hourly rate (RVU/hour), but male-specific procedures yielded higher overall reimbursement per hour ($599/h vs $555/h).
• Per-procedure RVUs increased by 13% for male and 26% for female procedures; reimbursement per RVU decreased 8% for male and increased 14% for female procedures.

Conclusions:

• Increases in RVUs and compensation have led to more equitable reimbursement for female-specific procedures.
• Despite improvements, a disparity in the relative value of work persists, favoring male-specific procedures due to specialty-specific compensation rates.
• Further adjustments in compensation models may be needed to fully address gender-based inequities in surgical reimbursement.