10/19/2022    Kathleen Toepp Neuhoff, DPM

The High Cost of Being a Foot and Ankle Surgeon (Vincent Marino, DPM)

I have appreciated the discussion on the costs of
hospital surgery vs clinical outpatient care and
certainly agree that income per hour is much
higher in the office vs the OR. As was pointed
out, some of this is because of the fees. Some of
it is also because of the inefficiencies of OR
surgeries. This can be improved by using
surgericenters and scheduling back to back
procedures. However, the hourly reimbursement rate
is also improved by performing many procedures
such as exostectomies or hammer digit correction
in your office.

Even if you cannot meet the criteria for a
surgericenter, it is not difficult to dedicate a
room to sterile surgery. Infection rates are
generally lower in this environment than in
hospital ORs. Many patients are willing to have
procedures done with local anesthesia and COVID-19
fears made many patients prefer an office surgery
to a hospital surgery.

With a good staff, the patient is roomed, consent
and initial prep done while you continue to see
patients. You pop in to meet with the patient,
and give the local anesthesia, then see another
outpatient, then scrub in, perform the surgery,
have your scribe chart the surgery note while you
do the surgery, and return to your outpatients
while your staff discharges the patient, reviews
the post-op instructions, takes post-op
radiographs and schedules the next appointment.
Although the patient is probably in your office
for over an hour, your total time in the OR may be
10 to 20 minutes which makes the fee paid much
more acceptable.

One of the concerns I have with our surgical
residency programs is that residents rarely have
the opportunity to perform surgeries in offices
and will not be comfortable doing so. The cost of
their education is so high that they need every
advantage possible. Finally, it is important that
we remember the main stakeholders in our care are
our patients.

Clearly for certain procedures such as tarsal
tunnel and rearfoot reconstructive surgeries
hospital or surgericenters are the only reasonable
option. Also, a patient who prefers that
environment or who prefers MAC or general
anesthesia should have their preference honored
even for a minor procedure. Fortunately, the
variety of work we can do in podiatry not only
make it fun, it also protects us a little bit from
the "fee adjustments" made to surgery fees by
Medicare and insurance carriers.

Kathleen Toepp Neuhoff, DPM, South Bend, IN

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