DIFFERENCES IN COSTS OF TREATMENT FOR FOOT PROBLEMS BETWEEN PODIATRISTS AND ORTHOPEDIC SURGEONS

We examined charge data for health insurance claims paid in 1992 for p ersons under age 65 covered by a large California managed care plan. C harge and utilization comparisons between podiatrists and orthopedic s urgeons were made for all foot care and for two specific foot problems , acquired toe deformities and bunions. Podiatrists provided over 59% of foot care services for this commercial population of 576,000 people . Podiatrists charged 12% less per individual service than orthopedist s. However, podiatrists performed substantially more procedures per ep isode of care and treated patients for longer time periods, resulting in 43% higher total charges per episode. Hospitalization was infrequen t for all providers, although podiatrists had the lowest rates. In a m anaged care setting in which all providers must adhere to a preestabli shed fee schedule, regardless of specialty, the higher utilization by podiatrists should lead to higher overall costs. In some cases, strong utilization controls could offset this effect. We do not know if the utilization difference is due to actual treatment or billing differenc es. Further, we were unable to determine from the claims data if one s pecialty had better outcomes than the other.