Medicare Practice and Payment Differences by Neurosurgeon Gender —Reply

In Reply The primary point seemingly raised by Manchikanti and colleagues is that the observed payment disparity between male and female neurosurgeons may reflect differences in the location of services being rendered, namely facility vs nonfacility settings. While this is undoubtedly an important consideration, the evidence they offer to support this supposition is unclear. First, they state that “all female neurosurgeons exclusively operated in facility settings.” In contrast, our results demonstrate that approximately 60% of the services rendered by male and female neurosurgeons occurred in outpatient (nonfacility) settings. Based on this analysis, neither men nor women can be consider ed exclusively facility or nonfacility neurosurgeons. Moreover, the assertion that office overhead payments were mistakenly included as part of physician payments requires clarification. Fees are generally higher in the nonfacility setting to account for the expenses incurred by the physician practi ce. However, this does not represent a separate component in the dataset and therefore cannot be methodologically included or excluded in our analysis. Notably, because female neurosurgeons rendered more services in the nonfacility setting, the higher fees would only mask some of the payment gap. As such, the assertion that a proper analysis would have minimized the payment gap is unsupported. However, even if we assume that the suggested minor difference of $4 to $5 per service is correct, t...
Source: JAMA Surgery - Category: Sports Medicine Source Type: research