Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota.
Department of Orthopaedic Surgery, TRIA Orthopedic Center, Bloomington, Minnesota.
Foot Ankle Spec. 2024 Apr;17(2):137-145. doi: 10.1177/19386400211062456. Epub 2021 Dec 7.
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.
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.
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.
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.
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本研究旨在探讨在治疗踝关节骨折的手术固定中，选择植入物的决策是否会影响手术费用的报销额度。
通过回顾电子病历，使用当前操作术语 (CPT) 代码，从单一保险公司的数据库中确定了 2010 年至 2017 年间治疗的所有踝关节骨折病例。通过将植入物记录与单一合同机构收费主数据库进行交叉参考来确定植入物的成本。采用时间驱动作业成本法（TDABC）技术来确定整个 1 年治疗期间所有活动的护理成本。统计分析包括多元线性回归和拟合优度分析。
共有 249 名患者符合纳入标准。植入物的成本范围为 173 美元至 3944 美元，平均为 1342 美元±751 美元。TDABC 估计的护理成本范围为 1416 美元至 9185 美元，平均为 3869 美元±1384 美元。最后，护理费用的总报销金额在 1335 美元至 65645 美元之间，平均为 13954 美元±9445 美元。植入物的成本占每次手术估计的 TDABC 护理成本的 34.7%。在住院环境中，植入物成本占 TDABC 的百分比估计为 36.2%，在门诊环境中为 33%，这是两种环境中仅次于手术成本的第二高比例。我们发现，在门诊环境中，每节省 1 美元的植入物成本，净收入就会增加 1.93 美元，而在住院环境中，每节省 1 美元的净收入就会增加 1.03 美元，这一结果接近显著水平。
术中决策（表现为植入物选择）与踝关节骨折手术固定所产生的收入之间存在直接关系。在手术过程中考虑植入物成本可以促进采用机构成本控制措施，并促使医疗保健价值的提高。
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