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
*More podiatrists, clinics, and 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
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