Gender Differences in Medicare Payments among Cardiologists

Inbar Raber, Mahmoud Al Rifai, Cian P. McCarthy, Muthiah Vaduganathan, Erin D. Michos, Malissa J. Wood, Yvonne M. Smyth, Nasrien E. Ibrahim, Aarti Asnani, Roxana Mehran, John W. McEvoy

Research output: Contribution to journalArticlepeer-review


Importance: Women cardiologists receive lower salaries than men; however, it is unknown whether US Centers for Medicare & Medicaid Services (CMS) reimbursement also differs by gender and contributes to the lower salaries. Objective: To determine whether gender differences exist in the reimbursements, charges, and reimbursement per charge from CMS. Design, Setting, and Participants: This cross-sectional analysis used the CMS database to obtain 2016 reimbursement data for US cardiologists. These included reimbursements to cardiologists, charges submitted, and unique billing codes. Gender differences in reimbursement for evaluation and management and procedural charges from both inpatient and outpatient settings were also assessed. Analysis took place between April 2019 and December 2020. Main Outcomes and Measures: Outcomes included median CMS payments received and median charges submitted in the inpatient and outpatient settings in 2016. Results: In 2016, 17524 cardiologists (2312 women [13%] and 15212 men [87%]) received CMS payments in the inpatient setting, and 16929 cardiologists (2151 women [13%] and 14778 men [87%]) received CMS payments in the outpatient setting. Men received higher median payments in the inpatient (median [interquartile range], $62897 [$30904-$104267] vs $45288 [$21371-$73191]; P <.001) and outpatient (median [interquartile range], $91053 [$34820-$196165] vs $51975 [$15622-$120175]; P <.001) practice settings. Men submitted more median charges in the inpatient (median [interquartile range], 1190 [569-2093] charges vs 959 [569-2093] charges; P <.001) and outpatient settings (median [interquartile range], 1685 [644-3328] charges vs 870 [273-1988] charges; P <.001). In a multivariable-adjusted linear regression analysis, women received less CMS payments compared with men (log-scale ß = -0.06; 95% CI, -0.11 to -0.02) after adjustment for number of charges, number of unique billing codes, complexity of patient panel, years since graduation of physicians, and physician subspecialty. Payment by billing codes, both inpatient and outpatient, did not differ by gender. Conclusions and Relevance: There may be potential differences in CMS payments between men and women cardiologists, which appear to stem from gender differences in the number and types of charges submitted. The mechanisms behind these differences merit further research, both to understand why such gender differences exist and also to facilitate reductions in pay disparities..

Original languageEnglish (US)
Pages (from-to)1432-1439
Number of pages8
JournalJAMA cardiology
Issue number12
StatePublished - Dec 2021

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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