From the September 2019 issue of HealthCare Business News magazine
We looked at payments in both non-facility-based (or freestanding, often private practice) radiation oncology clinics, as well as facility-based (or hospital-based, often academic) radiation oncology clinics, since distinctions in billing practices would cause any reimbursement in the non-facility-based setting to be higher due to the collection of technical fees by physicians who own the machines used to deliver radiation.
Delving into the details of the study, what we found was that of the 4,393 radiation oncologists submitting claims to Medicare, female physicians who worked in a non-facility-based setting submitted an average of 1,051 fewer charges and collected $143,610 less in revenue than male physicians. Female radiation oncologists working in a facility-based setting submitted on average 423 fewer charges and collected $26,735 less in professional revenue than their male counterparts.
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These discrepancies were even wider when making comparisons in the group of radiation oncologists submitting the most Medicare claims. Even among similarly highly productive radiation oncologists, female radiation oncologists in the facility-based setting collected on average $33,026 less than their male counterparts. In the non-facility-based setting, this gap was predictably wider, with similarly highly productive females collecting an average of $345,944 less than males.
It is important to note that observational studies such as ours cannot establish an exact cause for the differential practice and reimbursement patterns we report, but speculating on some of their driving factors is an important next step in determining how we might level the playing field.
The first question to ask is: are these differential findings even related to gender at all? It seems like an unavoidable conclusion, but it is possible that there are other extraneous factors that we did not control for in our study that are driving these results more significantly than provider gender.
If, however, gender is indeed influencing our findings, either directly or indirectly, this may be rooted in several factors. In terms of clinical activity, less clinical activity may be a natural consequence of the value-based labor choices that female practitioners make, particularly within a gender-structured society where women continue to be expected to shoulder the greater share of domestic responsibilities. However, less activity might also be tied to overt sexual discrimination leading to fewer referrals from surgical and medical oncologists. It is also possible that in designing their clinic schedules, women prioritize time spent with a given patient over number of patients seen, and that prioritizing quality over quantity results in fewer claim submissions to Medicare. And finally, there may be less billing support in practices attracting female providers, thereby resulting in a failure to capture services that are actually being provided.