2028 - Analysis of Sex Inequities in Medicare and Industry Payments in Radiation Oncology

P. T. Courtney, E. Y. Liu, M. Xiang, P. S. Venkat, L. Valle, M. L. Steinberg, and A. Raldow; Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA

Purpose/Objective(s): Previous work has identified differences in Medicare and industry payments by sex within the field of radiation oncology, with female radiation oncologists receiving proportionally fewer and numerically lower payments. As a result, increased emphasis has been placed on resolving these inequities. We evaluated more recent Centers for Medicare & Medicaid Services (CMS) payment data to determine if these disparities have improved. Materials/

Methods: We merged the CMS Physician and Other Supplier Public Use File with the CMS Open Payments dataset for the year 2021 to identify Medicare charges and reimbursement and reported industry payments for individual radiation oncologists. Industry payment types per CMS include research and general. We compared these values between male and female radiation oncologists, using two-sample t-tests for means, Wilcoxon rank-sum tests for medians, and chi-square tests for categorical variables. We also calculated physician productivity by number of unique Medicare claims submitted and created quintile productivity groups for analysis.
Results: We identified 4,280 radiation oncologists (1,150 [26.9%] female, 3,130 [73.1%] male). Regarding Medicare claims in all settings, female providers accounted for 18.5% of total charges submitted and 18.3% of total reimbursements received, and had significantly lower median ($110K) reimbursements compared with their male counterparts (median $345K, p<0.001). These patterns were also present in both the facility and non-facility based settings. Female providers represented 30.6% of the lowest productivity quintile compared with 20.3% representation in the highest productivity quintile. Within the highest productivity group, female providers similarly had significantly lower median reimbursements ($485K) compared with their male counterparts (median $562K, p<0.001). Regarding industry payments, female providers comprised 22.5%, 22.1%, and 21.7% of all providers who received any, general, or research payments, respectively. Similarly for total monetary value of industry payments, female providers accounted for 21.8%, 8.0%, and 22.2% of all, general, and research payments, respectively. Within sex groups, a lower proportion of female providers received any (39.0% vs 49.4%, p<0.001), general (36.9% vs 47.7%, p<0.001), and research (4.4% vs 5.9%, p=0.06) industry payments. Female providers received significantly lower median total ($96 vs $147) and general ($85 vs $134) industry payments (both p<0.001); however, median research payments were numerically higher for female providers ($89K vs 60K, p=0.85).
Conclusion: Sex inequities in Medicare and industry payments have generally remained stagnant in radiation oncology, aside from possible parity in monetary value of industry research payments received, despite increased awareness. Continued attention is needed to determine the etiology of and address these disparities.