Presentation Authors: Catherine Nam*, Frances Kim, Christopher Filson, Atlanta, GA
Introduction: Though increasing, female urologists make up < 10% of the urologist workforce. Surveys suggest female patients prefer female urologists when available. We described variation in urologic care for Medicare beneficiaries based on provider gender.
Methods: We used Medicare Provider Payment database to evaluate provider payments for urologists in 2016 who provided care for fee-for-services Medicare beneficiaries. We assessed payments, services, and work relative value units (wRVU) based on provider gender. Urologists were linked to hospital markets based on ZIP code of primary practice address. We categorized services as urodynamic-related (CPT 51725-51792), gynecologic (CPT 56000-58999), and female-specific lower urinary tract operations. We identified top 20 procedures based on total payments and provider gender. We use appropriate parametric and non-parametric testing to compare differences based on provider gender.
Results: Among 8,665 urologists receiving Medicare payments in 2016, 7,944 (91.7%) were male and 721 (8.3%) female. Overall, 103/306 (33%) hospital markets did not have female urologists, and another 79/306 (26%) had one female urologist. Female urologists saw a lower proportion of cancer patients (16% vs 22% male urologists, p < 0.001) but a greater proportion of female patients (53% vs 24% male urologists, p < 0.001). Female urologists had a greater proportion of wRVU from urodynamics (2.1% vs 0.8% male, p < 0.001) and gynecologic surgery (0.8% vs 0.1% male, p < 0.001). Female providers received fewer payments per beneficiary ($70.12 vs $72.37 male, p=0.03) and fewer payments per wRVU $58.25 vs $60.04 male, p < 0.001). For the top twenty services for total payments, evaluation and management services were the highest paying type of services (57% male, 60% female) (Figure). Oncology services were next highest-paying for male urologists ($204M, 23%) whereas urodynamics-related services were the next highest paying category for female urologists ($10M, 20%).
Conclusions: There are significant differences between practice and payment patterns between male and female urologists caring for Medicare fee-for-service beneficiaries. Understanding time trends and geographic variation in these findings will be important in the future.
Source of Funding: American Cancer Society [MSRG-18-1-CPHPS for CPF]