Women who are dermatologic surgeons and perform Mohs micrographic surgery (MMS) receive significantly less reimbursement than men who are dermatologic surgeons, although women surgeons performed significantly fewer MMS cases, according to study findings published in Dermatologic Surgery.
Researchers assessed sex-based reimbursement differences in dermatologic surgeons performing MMS with use of data from the Medicare Physician and Other Supplier Public Use File (PUF), which included billing data for all procedures performed by providers with a valid National Provider Identifier (NPI) and who submitted Medicare Part B noninstitutional claims in 2018. Data were obtained for each dermatology clinician and included NPI, sex, place of service, number of services submitted per Healthcare Common Procedure Coding System (HCPCS) code, and average payment amount per HCPCS code.
A total of 2581 dermatologic surgeons (21.4% of all active dermatologists in 2017) submitted claims for MMS excisions for Medicare beneficiaries in 2018. Women accounted for 31.5% (n=814) of surgeons who participated in Medicare, and men accounted for 68.5% (n=1767). Women performed 30.7% of cases (n=744) in the outpatient setting and 44.0% (n=70) of those in facility-based practices.
Surgeons submitted 889,124 MMS cases on Medicare beneficiaries, with women performing 211,867 (23.8%) of MMS cases. Women performed 195,877 (23.1%) of the 848,959 MMS cases in the outpatient setting and 15,990 (39.8%) of 40,165 MMS cases in facility-based settings. Women surgeons performed an average of 269 cases in 2018 compared with 392 cases by men surgeons, for a mean difference of -123 cases (95% CI, -151 to -96; P <.001).
Women surgeons were paid significantly less than men surgeons (mean difference, -$73,033; 95% CI, -$88,544 to -$57,523; P <.001). Women earned $0.64 for every dollar earned by men.
Women had a disproportionately greater share of the lowest productivity group (44.3%) and a lower share of the highest productivity group (17.7%). When stratified by productivity, no statistically significant mean or median number of payments in any group was observed.
Limitations of the study include the fact that payment data and the number of cases were limited to MMS-related services to Medicare beneficiaries as reported in the Medicare PUF, and dermatologist ages were not readily available.
Researchers conclude, “Our study provides insight into the disparity in clinical productivity and reimbursement between male and female dermatologic surgeons, further contributing to the limited literature on gender-based income disparities within dermatology. […] Further studies should be conducted to determine gender differences in charges submitted to commercial insurances, practice styles, years’ experience, and proportion of MMS-related services performed in each practice to help better understand differences in caseload and compensation.”
Motosko CC, Waldman A, Stevenson ML, Council ML. Gender differences in clinical practice and Medicare reimbursement among Mohs surgeons. Dermatol Surg. Published online March 6, 2023. doi:10.1097/DSS.0000000000003743