This afternoon, the House of Representatives decided not to vote on the Reid-McConnell Amendment to the Middle Class Tax Relief and Job Creation Act of 2011 (HR 3630), which was passed by the Senate and provided a 2-month fix to the Sustainable Growth Rate (SGR) and the therapy cap exceptions process along with other Medicare provisions. Instead, the House voted to create a conference committee to negotiate the differences between the House and Senate passed bills.

If the House and Senate cannot come to an agreement on a package before December 31 the therapy cap will go into effect without an exceptions process on January 1, 2012. Furthermore, a scheduled 27.4% cut to provider payments under the Medicare physician fee schedule will be implemented.

It is critical that Congress address these devastating caps and cuts as soon as possible. APTA members are urged to contact their members of Congress to express their support for a package that contains a 2-year extension of the SGR fix and therapy cap exceptions process as outlined in the House bill.

If you're not currently part of APTA's Grassroots Network, PTeam, sign up today. PTeam will be the main source of information for legislative updates and breaking news on the effort to pass legislation to extend the therapy cap exceptions process and avoid the 27.4% cut.

As recently reported in News Now, physical therapists (PTs) will be able to participate in reporting a new measure in 2012—the Functional Outcome Assessment Measure (#182)—as part of the Physician Quality Reporting System (PQRS). Measure 182 is designed for patients with documentation of a current functional outcome assessment using a standardized functional outcome assessment tool and documentation of a care plan based on identified functional outcome deficiencies. A new podcast describes which patients are eligible for the measure and outlines the codes PTs should use in their reporting. A transcript and slideshow accompany the prerecorded podcast, which includes a case scenario of a patient who presents for an initial evaluation with a chief complaint of low back pain.      

To help APTA members successfully participate in PQRS, the association has developed an audit tool that allows PTs to assess their performance in reporting throughout the year and automatically calculates the success rate for each measure that is reported through claims. An audit tool podcast walks listeners through the tool and provides an example of how a clinic manager uses the tool to assess the performance of 3 physical therapists in reporting for the medication measure. A transcript and slideshow accompany the podcast.

Although the effects of physical fitness training on death, dependence, and disability after stroke are unclear, there is sufficient evidence to incorporate cardiorespiratory training that involves walking within poststroke rehabilitation programs to improve speed, tolerance, and independence during walking, say authors of a meta-analysis published in November in the Cochrane Database of Systematic Reviews. 

The authors searched the Cochrane Stroke Group Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, SPORTDiscus, and 5 additional databases. They also searched ongoing trials registers, handsearched relevant journals and conference proceedings, screened reference lists, and contacted experts in the field.

Selection criteria included randomized trials comparing either cardiorespiratory training or resistance training, or both, with no intervention, a nonexercise intervention, or usual care in stroke survivors. Two review authors independently selected trials, assessed quality, and extracted data. The authors analyzed data using random-effects meta-analyses. Diverse outcome measures limited the intended analyses.

The analysis included 32 trials, involving 1,414 participants, which comprised cardiorespiratory (14 trials, 651 participants), resistance (7 trials, 246 participants), and mixed training interventions (11 trials, 517 participants). Five deaths were reported at the end of the intervention and 9 at the end of follow-up. The majority of the estimates of effect were not significant. Cardiorespiratory training involving walking improved maximum walking speed (mean difference [MD] 8.66 meters per minute), preferred gait speed (MD 4.68 meters per minute), and walking capacity (MD 47.13 meters per 6 minutes) at the end of the intervention. These training effects were retained at the end of follow-up. Mixed training, involving walking, increased preferred walking speed (MD 2.93 meters per minute) and walking capacity (MD 30.59 meters per 6 minutes), but effects were smaller and there was heterogeneity among the trial results. There were insufficient data to assess the effects of resistance training. The variability in the quality of included trials hampered the reliability and generalizability of the observed results.

The Supreme Court will hear 5.5 hours of oral arguments on the health care reform law March 26-28, 2012, according to Reuters.

On March 26 the court will hear 1 hour of arguments on whether the legal challenges to the requirement that all Americans buy insurance must wait until after that part of the law has taken effect in 2014 and the penalty for failing to comply is imposed.

The court is slated to hear 2 hours of arguments on March 27 on the constitutional issue that is "at the heart of the battle -- whether Congress overstepped its powers by adopting the insurance purchase requirement known as the individual mandate," Reuters says.

On March 28, the court will hear 90 minutes of arguments on whether the rest of the law can survive if the mandate is struck down. On that same day, it will hear 1 hour of arguments on whether Congress "improperly coerced the states to expand the Medicaid program."

A ruling is expected by the end of June 2012.

On Saturday, the Senate passed the Middle Class Tax Relief and Job Creation Act of 2011 (HR 3630) with amendment that would extend several Medicare provisions for 2 months, requiring Congress to take up the issues again in February 2012. Specifically, the Senate's amendment would extend the therapy cap exceptions process by continuation of the current KX modifier at $1,880 and keep the Medicare Physician Fee Schedule Sustainable Growth Rate (SGR) at the current payment rate until February 29, 2012. The Geographic Practice Cost Index (GPCI) also would be extended at the current level until March 1, 2012.  

The House version of the bill, which passed December 13, addressed the Medicare provisions for 2 years with modifications to the cap exceptions process that included a manual review. The House is expected to vote on the Senate's bill late today.   

If you're not currently part of APTA's Grassroots Network, PTeam, sign up today. PTeam will be the main source of information for legislative updates and breaking news on the effort to pass legislation to extend the therapy cap exceptions process and avoid the 27.4% cut.

Even though the prevalence of knee pain has risen during the last 20 years, obesity and osteoarthritis account for only part of the increase, according to a Medscape Medical News  article based on a study published this month in Annals of Internal Medicine.

For this analysis, researchers evaluated results from 6 National Health and Nutrition Examination Surveys (NHANES) conducted between 1971 and 2004, and from 3 exam periods in the Framingham Osteoarthritis (FOA) Study carried out between 1983 and 2005. Participants in both studies were asked whether they experienced knee pain most days. In addition, participants in the FOA study underwent bilateral weight-bearing radiographs of their knees to assess the presence and extent of osteoarthritis. Radiographs were combined with self-reported knee pain to define symptomatic knee osteoarthritis.

The researchers found that from 1974-1994, several ethnic groups in the NHANES study, namely, non-Hispanic white and Mexican-American men and women and black women, experienced a 65% increase in age- and BMI-adjusted knee pain. Among FOA participants, the prevalence of age- and BMI-adjusted knee pain and symptomatic osteoarthritis approximately doubled in 20 years among women, and tripled among men.

Remarkably, the researchers saw no such trend among FOA participants in terms of the prevalence of radiographic evidence of osteoarthritis. "[T]he age- and BMI-adjusted prevalence of radiographic knee osteoarthritis did not substantially change over this same period for men  and actually may have decreased for women," the article says.

An accompanying editorial says clinicians should "carefully consider, from the signs and symptoms of the patient presenting with knee pain, a broad differential diagnosis. Not all knee pain in middle-aged and older adults is the result of osteoarthritis."