{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T17:58:58Z","timestamp":1787162338445,"version":"build-2736575974"},"reference-count":23,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T00:00:00Z","timestamp":1638835200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot &amp; Ankle Specialist"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>In all, 249 patients met inclusion criteria. Implant costs ranged from $173 to $3944, averaging $1342 \u00b1 $751. The TDABC-estimated cost of care ranged from $1416 to $9185, averaging $3869 \u00b1 $1384. Finally, the total reimbursed cost of care ranged between $1335 and $65 645, averaging $13 954 \u00b1 $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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Level III: Retrospective cohort study<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19386400211062456","type":"journal-article","created":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T04:36:02Z","timestamp":1638851762000},"page":"137-145","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Can Reducing Implant Costs Increase Revenue for Surgically Treated Ankle Fractures: Time-Driven Activity-Based Costing for 1-Year Episode of Care"],"prefix":"10.1177","volume":"17","author":[{"given":"Will","family":"Freking","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bandele","family":"Okelana","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur","family":"Only","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, TRIA Orthopedic Center, Bloomington, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Logan","family":"McMillan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kendra","family":"Kibble","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harsh","family":"Parikh","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Shearer","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6653-2451","authenticated-orcid":false,"given":"Brian","family":"Cunningham","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,12,7]]},"reference":[{"key":"e_1_3_2_2_2","volume-title":"The Burden of Musculoskeletal Diseases in the United States (BMUS)","author":"United States Bone and Joint Initiative","year":"2014","unstructured":"United States Bone and Joint Initiative. 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Harv Bus Rev. 2004;82(11):131-138, 150.","journal-title":"Harv Bus Rev"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-015-4214-0."},{"issue":"1","key":"e_1_3_2_13_2","first-page":"E7","article-title":"Analysis of direct costs of outpatient arthroscopic rotator cuff repair","volume":"45","author":"Narvy SJ","year":"2016","unstructured":"Narvy SJ, Ahluwalia A, Vangsness CTJr. Analysis of direct costs of outpatient arthroscopic rotator cuff repair. 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