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  • New CPT Codes for EMG Effective January 1

    The 2012 version of CPT includes 3 add-on codes and introductory language for needle electromyography (EMG) performed in conjunction with nerve conduction studies. This document includes a description of the new codes and guidance for their use. The codes are available for physical therapists (PTs) to report effective January 1, 2012. However, PTs should check payer policy to determine coverage of the codes.

    New in the Literature: Sit-to-Stand Test (Clin Rehabil. 2011 Nov 11. [Epub ahead of print])

    The 5-repetition sit-to-stand test is a reliable and valid test to measure functional muscle strength in children with spastic diplegia, say authors of an article published online in Clinical Rehabilitation.  

    For this study, the authors tested 108 children with spastic diplegia and 62 with typical development, ages 5-12 years, in the hospital, laboratory, or home. For test-retest reliability, 22 children with spastic diplegia were tested twice within 1 week. The main measure was the time needed to complete 5 consecutive sit-to-stand cycles as quickly as possible.

    The intraclass correlation coefficients of intra-session reliability and test-retest reliability were 0.95 and 0.99 respectively. The minimal detectable difference was 0.06 rep/sec. The convergent validity of the 5-repetition sit-to-stand test was supported by significant correlation with 1-repetition maximum of the loaded sit-to-stand test, isometric muscle strength, scores of Gross Motor Function Measure, and gait function (r or rho = 0.40-0.78). For known group validity, children with typical development and children classified as Gross Motor Function Classification System level I performed higher rates of 5-repetition sit-to-stand than children classified as level II; children classified as level II performed higher rates than level III.

    US Health Care Delivery System Not Fit for Modern Times, Says Berwick

    The United States has "set up a [health care] delivery system that is fragmented, unsafe, not patient-centered, full of waste, and unreliable," Donald Berwick, MD, told Kaiser Health News on Monday. "Despite the best efforts of the workforce, we built it wrong. It isn't built for modern times."

    Berwick, who stepped down from his post as administrator of the Centers for Medicare and Medicaid Services (CMS) earlier this month, said health reform is changing how physicians and hospitals are paid and care is delivered care through such new arrangements as Accountable Care Organizations (ACOs). But he said it is unclear whether such efforts would produce results quickly enough to hold off critics, including most Republicans, who want to make more radical changes that would shift more of the burden to beneficiaries.

    Berwick said during his tenure at CMS his most challenging decisions involved state requests to cut Medicaid benefits and writing regulations to encourage physicians and hospitals to form ACOs to work more closely, while not making the requirements overly burdensome.

    He also criticized state efforts to limit hospital coverage for Medicaid recipients, currently under review by federal regulators. Hawaii has proposed a 10-day coverage limit on some enrollees; Arizona has proposed a 25 day limit. "If a patient needs twenty days, the patient should get twenty days," he said.

    The best way to provide care is through "managed care done right," Berwick said, but if states are not ready to take on the responsibility, it can lead to restrictions that prevent people from getting the care they need.