Trends in gynecologic surgery reimbursement and physician pay

Relative value units (RVUs) are a primary metric composed of several components including physician work, practice expenses, and insurance costs, that drive physician reimbursement. There is known RVU variation across medical specialties, with gynecology generating relatively lower RVUs and consequently, lower overall reimbursement compared to other surgical specialties. The objective of this review is to describe historical and current trends in gynecologic surgery and physician reimbursements, including pertinent sex-related biases.

Disparities persist in reimbursement for female-specific compared to male-specific procedures. RVUs do not reflect changes in patient complexity.

Shifts toward minimally invasive (MIS) and outpatient procedures, inaccuracies in RVU assignments, and Medicare budget constraints have led to decreasing reimbursement for gynecologic surgery. Gynecologic procedures are frequently undervalued, and there is a persistent disparity in reimbursement for paired sex-specific procedures. Addressing reimbursement challenges is critical to preserving access to high-quality gynecologic surgical care. Proposed solutions include using objective work measures to determine RVU assignments, shifting toward an outcomes-based payment model, and eliminating sex-specific codes.