GYNECOLOGIC ONCOLOGY 64, 372–377 (1997) ARTICLE NO. GO964607 Is Adam Worth More Than Eve? The Financial Impact of Gender Bias in the Federal Reimbursement of Gynecologic Procedures BARBARA A. GOFF, M.D.,* HOWARD G. MUNTZ, M.D.,² AND JOANNA M. CAIN, M.D.‡ *University of Washington Medical Center, Department of Obstetrics and Gynecology, Box 356460, Seattle, Washington 98195; ² Virginia Mason Medical Center, 1100 Ninth Avenue, Box 900, Seattle, Washington 98111; and ‡Milton S. Hershey Medical Center, Department of Obstetrics and Gynecology, Box 850, Hershey, Pennsylvania 17033 Received June 20, 1996 value units (RVU). The RVU for each service are supposed Purpose. On January 1, 1992, Congress implemented a Medi- to reflect the resources involved in furnishing three compo- care payment system based on relative value units (RVU). The nents of a physician’s service: (1) work, (2) practice expense, RVU multiplied by a dollarconversion factor sets the reimburse- and (3) malpractice costs. These three components are added ment for all procedures covered by Medicare and many other to form the total RVU for each procedure listed in the CPT private insurers. This study was undertaken to evaluate discrepan- manual. The total RVU multiplied by a dollar conversion cies in federal reimbursement forgender-specific procedures. factor sets the reimbursement for all procedures covered Methods. Using the December 1995 Federal Register and the by Medicare and many other insurance carriers. The dollar regional Medicare conversion factor ($40.08/RVU), we compared conversion factor is set by the Health Care Financing Admin- the work RVU and total reimbursement of 24 groups of gender- istration (HCFA) for each geographic area. There is an addi- specific surgical procedures. The groups were matched as carefully tional conversion factor, based upon whether the service as possible so that the amount of work and level of difficulty would provided is surgical or nonsurgical. The final reimbursement be similar, if not identical. Some examples of comparisons are as follows: biopsy of male vs female genitals, hysterectomy vs formula is payment Å RVU 1 geographic adjustment factor prostatectomy, staging for ovarian vs testicular cancer, and exen- (for the fee schedule area) 1 conversion factor (for type of teration for cervical vs prostate cancer. service) [1]. Results. In the 24 matched procedures, the male-specific pro- The original work RVU for most CPT codes were devel- cedures were reimbursed at a higher amount in 19 (79%) cases. The oped by a research team at the Harvard School of Public female-specific procedures were reimbursed at a higheramount in Health, in cooperation with the HCFA. Only 400 of the over 3 (12%) cases (P Å 0.004). There was no difference in reimburse- 7000 CPT codes were measured in a resource-based survey ment for two of the comparisons. Overall, we found that male- by a group of experts for work value units (WVU). Estimates specific procedures are reimbursed at an amount which is 44% of WVU were assigned to the remaining unmeasured CPT higher than female-specific procedures. Comparison of work RVU codes by extrapolation of services considered to be similar revealed that male-specific procedures were assigned highervalues [2, 3]. Practice and malpractice costs were computed by the in 19 cases and, overall, male gender-related surgeries had work HCFA by applying specialty-specific practice cost percent- RVU that were 50%higher than female gender-related surgeries. Conclusion. There is significant gender bias against the Medi- ages to the 1991 national average Medicare-allowed charge care reimbursement of female-specific services. This results in a for each service [4, 5]. Neither practice nor malpractice costs lower net reimbursement for gynecologic procedures. In addition, are currently resource-based. since many private sectorinsurance carriers now use the resource- Recently, Cherouny and Nadolski [6] reported that ob- based relative value scale system, this gender bias is further po- stetric and gynecologic invasive services were underval- tentiated.  1997 Academic Press ued by the resource-based relative value scale (RBRVS) when compared with urologic and general surgical inva- sive procedures. Our project was undertaken to evaluate INTRODUCTION the discrepancies of federal reimbursement for gender- On January 1, 1992, Congress implemented a Medicare related cancer procedures and to assess the financial im- pact of any gender bias. payment system for physician services based on relative 372 0090-8258/97 $25.00 Copyright  1997 by Academic Press All rights of reproduction in any form reserved.