Variations in medicare reimbursements among surgical oncologists who are US versus international medical graduates

Introduction: We sought to assess the variations in practice metrics and billing practices among US Medical Graduates (USMGs) and International Medical Graduates (IMGs) in surgical oncology who serve a fee-for-service population.

Methods: Medicaid Services Medicare fee-for-service provider utilization and payment files were used to obtain publicly available data between January 1, 2021, and December 31, 2021. Comparisons were conducted using the t-test for parametric variables and Wilcoxon rank-sum for nonparametric variables.

Results: A total of 952 surgical oncologists (IMGs: n = 102 [10.7%]) were included in the analytic cohort. The average risk score among beneficiaries treated by IMGs was higher than USMGs (1.70 [0.04] vs. 1.46 [0.02], p < 0.001) and IMGs also had a higher total number of unique codes (47.0 [IQR: 36.0-69.0] vs. 38.0 [IQR: 24.0-60.0], p < 0.05). IMG surgical oncologists had higher payment-per-service amounts ($236.56 [10.34] vs. $196.20 [$2.65]; p < 0.05), charge-per-service amounts ($1242.48 [$83.14] vs. $1014.89 [$26.13]; p < 0.05), and higher total submitted charges ($400,373.26 [$342,978.45] vs. $360,020.29 [$523,675.91]; p < 0.05). IMGs provided a higher percentage of procedural services (34.1% vs. 27.9%; p < 0.001) and treatment services (2.1% vs. 1.9%; p < 0.001) versus USMGs. Female surgical oncologists, particularly female IMGS, billed lower annual mean Medicare charges (female IMGS: $295,383 vs. male IMGs: $424,407 vs. female USMGs: $294,168 vs. male USMGs: $414,543; p < 0.001).

Conclusions: IMGs provided more procedural services, cared for patients with a higher average risk score, and performed a greater variety of procedures compared with USMGs. Consequently, IMGs had higher mean annual charges, payment-per-service, and charge-per-service amounts.