03/11/2026    Sev Hrywnak, DPM, MD

Why have podiatrist’s surgical fees decreased over the past 10 years?

Doing surgery is not the financial answer!

* Payer pressure and cost containment
Private insurers and government programs
have pushed for lower reimbursement rates for
procedures, often through fee schedule updates and
value-based contracts. Global budgeting and
utilization controls in some regions limit total
spending, compressing per-procedure fees.

* Shift to value-based and bundled payments
Bundled payments for episodes of care
incentivize cost efficiency, which can reduce the
negotiated amount paid per surgery as part of a
total-care package. Emphasis on outcomes and
standardized pathways tends to favor predictable,
lower per-procedure fees over high, variable
charges.

* Increased supply and competition
Ambulatory surgery centers (ASCs) performing
foot/ankle procedures increase market competition.
ASCs and outpatient settings often command lower
negotiated rates than hospital-based surgeries,
pulling overall fees downward.

* Technological and procedural efficiency
Advancements in minimally invasive
techniques, implants, and perioperative care can
reduce resource use, length of stay, and
complication rates, influencing reimbursement to
reflect efficiency gains. Standardized coding and
streamlined workflows reduce variability and can
lead to uniform, often lower, valuation of common
procedures.

* Coding, billing, and administrative factors
Revisions to CPT codes and Relative Value
Units (RVUs) can compress reimbursement for
certain podiatry procedures. Higher administrative
burden, denials, and prior-authorization hurdles
can erode net earnings per case.

* Shifts in payer mix and leverage
A growing share of patients may be covered
by plans with historically lower reimbursement
(e.g., high-deductible plans, certain public
payers). Hospital-employed podiatrists or groups
negotiating within large health systems may accept
standardized rates aligned with system-wide
bargaining power.

* Policy and regulatory changes
Reforms aimed at reducing waste and fraud,
price transparency initiatives, and payer
consolidation can influence pricing dynamics and
compress fee growth. Medication, implant, and
durable medical equipment. Pricing reforms
indirectly affect overall procedure economics.

* Economics of elective foot/ankle surgery
Demand fluctuations, elective surgery wait
times, and regional cost differences can create a
downward pressure on average fees in some markets.
Competition from non-surgical or non-traditional
care pathways for foot/ankle issues can influence
the perceived value of surgical interventions.

* Alternative revenue and business model shift
Some practitioners diversify with ancillary
services, telemedicine, quality incentives, or
hospital affiliations, which can dilute the
emphasis on per-procedure fee growth.

Sev Hrywnak, DPM, MD, Chicago, IL, Linkedin

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