Price and Prejudice: Hospitals Getting Less for Procedures on Women than for Men

Procedures that hospitals undertake on women are reimbursed at a lower rate than similar procedures involving men, a new study finds, and that is raising alarms.

“Price and Prejudice: Reimbursement of Surgical Care on Male Versus Female Anatomies” in the Journal of Women’s Health spells it out in detailed dollars-and-cents.

“Procedures on female anatomy,” according to the report—co-authored by three physicians from Mount Sinai Health System in New York, the Fox Chase Cancer Center at Temple University in Philadelphia, and Boston’s Brigham and Women’s Hospital—“are reimbursed at an average of 30 percent less than those performed on male anatomy—even when the surgeries are anatomically comparable, amounting to an average difference of $75.73 per surgery.”

Sounds like nothing much, but multiply it by thousands of patients over the years, and you can see that, as the doctors note, given the lower reimbursement, hospitals may put women second when it comes to allocating time for tests and treatments.

The situation is likely, and eventually, to lead to poorer preventive care and outcomes for female patients. To make their point, the doctors cite a 2019 study analyzing data from 7 million patients over 21 years and found that, “on average, women were diagnosed with bladder cancer two and a half years later than men.”

In short, they write that women usually wait longer for gynecologic procedures and treatments due to limited access to surgical time and resources, which is likely to lead to chronic pain and worsened health outcomes. Finally, at the most basic level of practice, because gynecologic surgeons are paid at lower rates, new generations of medical students may simply opt for a specialty other than OB/GYN, thus further reducing women’s access to care.

How did this happen? Deliberately. In the 1990s, the Centers for Medicare and Medicaid Services (CMS) introduced the RVU (Realistic Value Units) system of billing codes to standardize medical billing. Their idea was sound. They set out to come up with a way to determine exactly how much a procedure or visit is worth in terms of the time and expertise it requires. Their solution set three different RVUs. Work RVUs represent the relative amount of “physician work” required to perform a particular service or procedure. “Practice expense RVUs” cover the cost of running a clinic or hospital. “Malpractice RVUs” address the cost of malpractice insurance linked to specific treatments and or services. Put them all together and you get the total RVU, which should be the same no matter the patient’s gender.

But it isn’t. Despite decades of attention to this issue of payment, the study found no significant change in reimbursement rates over the past 20 years. Right from the start, specialties such as urology and orthopedic surgery, which are dominated by male patients and practitioners, earned higher RVUs and higher paydays. For example, as the authors note, the CMS guidelines give an orthopedic surgeon the same pay for a 30-minute procedure that a gynecologic surgeon would get for a four-hour laparoscopic surgery to remove excess endometrial tissue.

What’s to be done? The three doctors recommend broadening the advocate alliance.

First: Invite the patients and their doctors into the issue. That means encouraging both professional organizations such as the American Women’s Medical Association and civic groups such as NOW (National Organization for Women) to increase their advocacy for women’s health by pushing electeds and the appropriate agencies to join in demanding regulatory reforms that increase reimbursement for female-specific procedures.

Second: Encourage doctors, nurses, hospital personnel, and their allies to work within the system to petition the government agencies CMS and the Department of Health and Human Services to re-evaluate and re-value OB/GYN procedures to reflect the actual complexity, time, and expertise involved in comparable male- and female-specific procedures

Otherwise, without all-hands-on-deck, women will continue to face delays, inadequate treatment, and poorer health outcomes.