Abstract
Purpose :
We aim to study differences in anti-VEGF injection Medicare payouts, services, and beneficiaries on a per-provider-basis for male and female retina specialists from 2012-2016.
Methods :
Medicare Fee-For-Service (FFS) Provider Utilization and Payment Data datasets were utilized to analyze CPT codes among retina specialists. Codes for intravitreal injections, aflibercept, bevacizumab, and ranibizumab were analyzed, sorted by gender. 5-year trends between the two groups were assessed on a per-provider basis using general linear mixed effect models with random intercepts to account for within-provider correlation.
Results :
For aflibercept injections, number of services performed per female provider was 71.2% that of a male ophthalmologist in 2012. The total payment difference between female and males was $102,175 per provider in 2012, and this gap widened by $18,292 yearly (95% CI [-162599.17, -41760.47], [-33060.35, -3524.38] respectively). Regarding bevacizumab injections, patterns remained consistent as female specialists saw a $6,805 dollar decrease per provider, representing a 10% decrease over the five years (p < 0.001). For ranibizumab, female providers observed a 5% decrease in Medicare beneficiaries and a $15,460 decrease in payments per provider over the 5 years (p < 0.001).
Conclusions :
Analysis of anti-VEGF injectable medications serves as an indicator of female involvement in the recent uptick in lucrative anti-VEGF treatments. While male and female providers saw considerable increases in aflibercept services and payments gaps between male and female reimbursements widened significantly. Taken collectively, we observe that even though women are choosing ophthalmology at greater rates over the years, the gap is increasing among lucrative anti-VEGF injections in sub-specialties like retinal surgery. These differences may be explained in disparities in private practice connections and varying referral networks been male and female specialists. Thus, while more women are pursuing a career in ophthalmology, the rates of sub-specialization in competitive fellowship programs such as retina and oculoplastic surgery may still favor male candidates. Analysis of large-scale Medicare datasets provides a tangible report card on how effective our attitudes and policies are in cultivating equal opportunity.
This is a 2020 ARVO Annual Meeting abstract.