Category: Ankle; Ankle Arthritis; Arthroscopy; Bunion; Hindfoot; Lesser Toes; Midfoot/Forefoot; Sports; Trauma; Other Introduction/Purpose: With the increasing complexity of physician reimbursement models, understanding reimbursement trends is crucial to the financial sustainability of orthopaedic practices nationwide. Inflation-adjusted Medicare physician reimbursement for total joint arthroplasty has decreased by approximately 33% from 2000 to 2019. Recent trends in orthopaedic foot and ankle reimbursement are unknown. Thus, our study sought to analyze trends in Medicare reimbursement rates from 2000 to 2020 for common orthopaedic foot and ankle surgical procedures. Methods: The financial database of a single academic tertiary care center was queried to identify the CPT codes most frequently utilized in orthopaedic foot and ankle care. Next, the Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was queried for the top 30 CPT codes utilized, and physician reimbursement data extracted. Monetary data was subsequently adjusted for inflation utilizing the consumer price index and reported in 2020 US dollars (USD). Average annual and the total percent change in reimbursement were calculated for included procedures. Results: After adjusting for inflation, the average physician reimbursement decreased by 31.6% for all included foot and ankle procedures from 2000 to 2020, with 23/30 codes decreasing by more than 30%. The greatest decrease in reimbursement observed from 2000 to 2020 was for open treatment of calcaneal fracture at 48.3% ($2,254.17 to $1,164.97), followed by flexor tendon repair at 48.2% ($741.02 to $357.39), and open treatment of pilon fracture at 43.9% ($2,451.37 to $1,076.36). Conclusion: Over the past two decades, physician reimbursement for foot and ankle procedures has dramatically decreased by up to 48.3%. Continued downward trends in orthopaedic foot and ankle physician reimbursement may lead to decreased access to quality foot and ankle care.
Preflight prototype differential accelerometers for STEP are being developed at Stanford under NASA funding. Subsystem development in progress includes work on thin-film superconducting circuits deposited on cylinders, SQUID-based superconducting position measurement and electrostatic positioning and charge control. A thorough programme of testing and qualification of the subsystems is an essential part of the experiment. We have built a flux microscope and magnetometer probe to study magnetic flux motion, one of the limiting factors in the accelerometers; a position sensor study facility; a tipper table for testing and qualification of bearings in three degrees of freedom and a `mechatronics' lab for the manufacture of critical circuits on cylinders. A rigorous testing programme is a necessary part of any space experiment because it is presently impossible, or prohibitively expensive, to repair any failure after the experiment is in orbit. This is particularly true of fundamental physics experiments such as STEP and GP-B in which the sensitivity of the apparatus depends directly on the absence of gravity. Thus the apparatus cannot be tested at full sensitivity until it is in orbit. The STEP development work at Stanford is directed toward a partial answer to this problem, which guarantees that the instrument will at least function and tests it to the extent possible on the ground.
This paper describes the design, fabrication, and testing of a low-temperature detector mount system which provides thermal isolation between detector electronics, operating at 80 kelvins, and a quartz telescope at 2.5 kelvins. The detector will be used to acquire and track the guide star for the Gravity Probe B Relativity Mission. The detector mount makes use of flex circuit technology for the critical thermal isolator. The detector mounts are configured in a redundant manner through the use of a beamsplitting optic. The entire package mounts to a quartz post through a semi-kinematic mount. Design consideration is given to electromagnetic interference and low-remanent magnetic moment. The detector mounts use a flex cable for electrical connections, as well as thermal grounding. The principal benefit of this design is the ability to operate relatively warm pre-amplifier electronics in a low-temperature environment with minimal disruption to a cryogenic system.Test results have shown this detector mount capable of dissipating less than 2 milliwatts with an 80 K temperature differential.
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