Exploring the Question of a Gender Reimbursement Gap

By Craig DeGarmo, MBA, MHA

 

This article by Craig DeGarmo is the first in a series of perspectives from experts working to address disparities in faculty compensation, and improve approaches to faculty recruitment and retention.

As the Chief Administrative Officer in the Department of Medicine at MedStar Georgetown University Hospital, one of my primary goals is to make sure faculty are fairly compensated, and ensure that the system protects against bias. Thus I read with interest the recent article Equal work for unequal pay: the gender reimbursement gap for healthcare providers in the United States (Postgrad Med J doi:10.1136/postgradmedj-2016-134094).

From an administrator’s perspective, several key elements are missing in the interpretation of the data:

You can’t compare specialties at different institutions

You can’t group specialties nationwide across specialties

There are different payer contracts across hospitals

You have to look at the billing complexity level when looking at physicians’ reimbursement

Following the Money

To look for disparities in physician reimbursement you have to identify many different layers. To see gender differences in billing you would have to look at patients with the same insurance, being seen for the same issue, billed under the same diagnosis code. You can’t compare billing across hospitals because every single organization has its own managed care office that controls all of the reimbursement contracts within their organization. To see if male physicians are reimbursed more than female physicians, you would have to investigate on a per-hospital basis. To identify potential gender differences in billing you would look at patients with the same insurance, being seen for the same issue, billed under the same diagnosis code.

The only way to identify a widespread gender-based reimbursement gap would be to provide a breakdown by:

Hospital

Specialty

Physician

Patient

Diagnosis code

Then, if a male physician and a female physician in the same hospital saw the same type of patient for the same diagnosis and billed the same cpt code under the same insurance and were reimbursed differently, you could identify gender disparity.

It’s important to note that there are no reimbursement differences between men and woman. There are only differences in reimbursement based off of the level of complexity that a physician is billing.

Fig 1: Reimbursement for various inpatient and outpatient CPT codes.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I have listed the Department of Medicine payer mix at MedStar Georgetown University Hospital.  As you can see the payer mix alone varies across specialties. Each specialty physician has a different payer mix and each hospital has different contracts for each payer.

Figures 2-23 (see below) reflect current reimbursement rates by payer by division with a breakout between Charges and Collections. I am just showing what the reimbursement rate across different divisions, grouping all physicians. The only way to identify gender disparity in reimbursement would be to look at specific patients seen for a specific diagnosis who saw both a male and female provider who billed the same billable level with the patient using the same insurance.

In closing:

1. You can’t compare specialties at different institutions

The reason why you can’t look at specialties across different institutions is that there are different payer contracts for each hospital in the country.

2. You can’t group specialties nationwide across specialties

You can’t group specialties because there are different contracts across institutions but you also need to look at the billing complexity level to validate any data.

3. There are different payer contracts across hospitals

It is no secret that there are different contracts negotiated across all insurances depending on geography. Reimbursement rates will differ at Georgetown compared to managed care contracts at other institutions.

4. You have to look at the billing complexity level when looking at physicians

In order to really dive into the data regarding equity in reimbursement you would have to know what’s going on at the hospital level.

Craig DeGarmo, MBA, MHA, Chief Administrative Officer - Department of Medicine, MedStar Georgetown University Hospital

Adjunct Professor Georgetown University, AIM President Elect; AAIM Board of Directors


Figures 2-23​ follow

Figures 2 and 3: Medicine Payer Mix (Charges and Payments)

 

 

 

 

 

 

 

 

 

Figures 4 and 5: General Internal Medicine

 

 

 

 

 

 

 

 

 

Figures 6 and 7: Hematology/Oncology

 

 

 

 

 

 

 

 

 

Figures 8 and 9: Cardiology​

 

 

 

 

 

 

 

 

 

Figures 10 and 11: Endocrinology

 

 

 

 

 

 

 

 

 

Figures 12 and 13: Hepatology

 

 

 

 

 

 

 

 

 

Figures 14 and 15: Hospitalist​

 

 

 

 

 

 

 

 

 

Figures 16 and 17: Infectious Disease

 

 

 

 

 

 

 

 

 

Figures 18 and 19: Nephrology

 

 

 

 

 

 

 

 

 

Figures 20 and 21: Pulmonary

 

 

 

 

 

 

 

 

 

Figures 22 and 23: Rheumatology

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This article by Craig DeGarmo is the first in a series of perspectives from experts working to address disparities in faculty compensation, and improve approaches to faculty recruitment and retention.

As the Chief Administrative Officer in the Department of Medicine at MedStar Georgetown University Hospital, one of my primary goals is to make sure faculty are fairly compensated, and ensure that the system protects against bias. Thus I read with interest the recent article Equal work for unequal pay: the gender reimbursement gap for healthcare providers in the United States (Postgrad Med J doi:10.1136/postgradmedj-2016-134094).

From an administrator’s perspective, several key elements are missing in the interpretation of the data:

You can’t compare specialties at different institutions

You can’t group specialties nationwide across specialties

There are different payer contracts across hospitals

You have to look at the billing complexity level when looking at physicians’ reimbursement

Following the Money

To look for disparities in physician reimbursement you have to identify many different layers. To see gender differences in billing you would have to look at patients with the same insurance, being seen for the same issue, billed under the same diagnosis code. You can’t compare billing across hospitals because every single organization has its own managed care office that controls all of the reimbursement contracts within their organization. To see if male physicians are reimbursed more than female physicians, you would have to investigate on a per-hospital basis. To identify potential gender differences in billing you would look at patients with the same insurance, being seen for the same issue, billed under the same diagnosis code.

The only way to identify a widespread gender-based reimbursement gap would be to provide a breakdown by:

Hospital

Specialty

Physician

Patient

Diagnosis code

Then, if a male physician and a female physician in the same hospital saw the same type of patient for the same diagnosis and billed the same cpt code under the same insurance and were reimbursed differently, you could identify gender disparity.

It’s important to note that there are no reimbursement differences between men and woman. There are only differences in reimbursement based off of the level of complexity that a physician is billing.

Fig 1: Reimbursement for various inpatient and outpatient CPT codes.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I have listed the Department of Medicine payer mix at MedStar Georgetown University Hospital.  As you can see the payer mix alone varies across specialties. Each specialty physician has a different payer mix and each hospital has different contracts for each payer.

Figures 2-23 (see below) reflect current reimbursement rates by payer by division with a breakout between Charges and Collections. I am just showing what the reimbursement rate across different divisions, grouping all physicians. The only way to identify gender disparity in reimbursement would be to look at specific patients seen for a specific diagnosis who saw both a male and female provider who billed the same billable level with the patient using the same insurance.

In closing:

1. You can’t compare specialties at different institutions

The reason why you can’t look at specialties across different institutions is that there are different payer contracts for each hospital in the country.

2. You can’t group specialties nationwide across specialties

You can’t group specialties because there are different contracts across institutions but you also need to look at the billing complexity level to validate any data.

3. There are different payer contracts across hospitals

It is no secret that there are different contracts negotiated across all insurances depending on geography. Reimbursement rates will differ at Georgetown compared to managed care contracts at other institutions.

4. You have to look at the billing complexity level when looking at physicians

In order to really dive into the data regarding equity in reimbursement you would have to know what’s going on at the hospital level.

Craig DeGarmo, MBA, MHA, Chief Administrative Officer - Department of Medicine, MedStar Georgetown University Hospital

Adjunct Professor Georgetown University, AIM President Elect; AAIM Board of Directors


Figures 2-23​ follow

Figures 2 and 3: Medicine Payer Mix (Charges and Payments)

 

 

 

 

 

 

 

 

 

Figures 4 and 5: General Internal Medicine

 

 

 

 

 

 

 

 

 

Figures 6 and 7: Hematology/Oncology

 

 

 

 

 

 

 

 

 

Figures 8 and 9: Cardiology​

 

 

 

 

 

 

 

 

 

Figures 10 and 11: Endocrinology

 

 

 

 

 

 

 

 

 

Figures 12 and 13: Hepatology

 

 

 

 

 

 

 

 

 

Figures 14 and 15: Hospitalist​

 

 

 

 

 

 

 

 

 

Figures 16 and 17: Infectious Disease

 

 

 

 

 

 

 

 

 

Figures 18 and 19: Nephrology

 

 

 

 

 

 

 

 

 

Figures 20 and 21: Pulmonary

 

 

 

 

 

 

 

 

 

Figures 22 and 23: Rheumatology

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