One sentence summary (400 characters): Central groove lesions are associated with a deeper trochlear sulcus, and more congruous cartilage morphology. This may lead to more central trochlear stress. The paucity of trochlear dysplasia in this group of isolated PF lesions suggests that cartilage wear patterns may be more often bipolar in patients with trochlear dysplasia.
Background: The purpose of this study was to investigate whether decision-making regarding implant selection affects the reimbursement margins for the surgical fixation of ankle fractures. Methods: All ankle fractures treated between 2010 and 2017 within a single-insurer database were identified via Current Procedural Terminology codes by review of electronic medical record. Implant cost was determined via the implant record cross-referenced with the single contract institutional charge master database. The Time-Driven Activity-Based Costing (TDABC) technique was used to determine the costs of care during all activities throughout the 1-year episode of care. Statistical analysis consisted of multiple linear regression and goodness-of-fit analyses. Results: In all, 249 patients met inclusion criteria. Implant costs ranged from $173 to $3944, averaging $1342 ± $751. The TDABC-estimated cost of care ranged from $1416 to $9185, averaging $3869 ± $1384. Finally, the total reimbursed cost of care ranged between $1335 and $65 645, averaging $13 954 ± $9445. The implant costs occupied an estimated 34.7% of the TDABC-estimated cost of care per surgical encounter. Implant cost, as a percentage of the overall TDABC, was estimated as 36.2% in the inpatient setting and 33% in the outpatient setting, which was the second highest percentage behind surgical costs in both settings. We found a significant increase in net revenue of $1.93 for each dollar saved on implants in the outpatient setting, whereas the increase in net revenue per dollar saved of $1.03 approached significance in the inpatient setting. Conclusion: There is a direct relationship between intraoperative decision-making, as evidenced by implant choices, and the revenue generated by surgical fixation of ankle fractures. Intraoperative decision-making that is cognitive of implant cost can facilitate adoption of institutional cost containment measures and prompt increased healthcare value. Level of Evidence: Level III: Retrospective cohort study
Category: Ankle; Trauma; Other Introduction/Purpose: Implant selection may provide an opportunity to reduce costs and improve value in healthcare, but most orthopaedic surgeons are unfamiliar with the cost of surgical implants. Large variation has been reported in the overall cost of the surgical treatment of ankle fractures, largely due to variations in implant selection. The purpose of this study is to evaluate the relationship between implant selection and the Reimbursed Cost of Care (RCC) over the total cost-of-care over the entire care episode. Methods: A single payer database was queried for isolated ankle fractures from 2010-2017. Patient characteristics, implant cost, RCC and total cost of care for one-year episodes were collected. Total cost of care was determined via Time Driven Activity Based Costing (TDABC). Analysis consisted of multivariable linear regression and goodness-of-fit tests. The relative proportion of the implant cost to the RCC was defined as Ic/RCC. Results: Construct costs (Inpatient: $1563.30 vs Outpatient: $1143.00; p<0.01)TDABC cost of care (Inpatient: $3670.90 vs Outpatient: $2941.90; p<0.01)RCC (Inpatient: $17350.00 vs Outpatient: $10895.80; p<0.01) were all significantly lower for the outpatient setting. Construct costs constituted an estimated 38.8% of the total TDABC cost and 14.5% of the RCC. The difference between RCC and implant costs presented a significant negative trend with the total construct costs for outpatient procedures (B=-$1.54; p=0.03), but non-significant for inpatient (B=-$0.37;p=0.79). Conclusion: This study investigated the effect of implant cost on the total cost of care in surgically treated ankle fractures. We found an overall higher reimbursed cost of care (RCC) in the outpatient setting and a higher TDABC cost of care in the inpatient setting, reinforcing the trend towards outpatient surgical management. Implant selection proved not only a significant portion of the overall cost of care, but a driver of overall revenue.
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