Dr Peter’s blog

New Jersey Congressional Senators

Today I received notice from the APTA (American Physical Therapy Association) beginning with the following:

On April 30^th Senators Blanche Lincoln (D-AR), Lindsay Graham (R-SC), and Arlen Specter (D-PA) introduced Senate companion legislation (S. 950), the Medicare Patient Access to Physical Therapists Act.

OK!!! S.950 has arrived and now needs to be passed. The House version is already underway; as my blog posted earlier today says. This bill too is now in need of promotion and passage. So this blog is short because it is companion to my comments of the previous blog. This companion to HR 1829 will mean Medicare patients can directly see a physical therapist if their state has passed a Direct Access to physical therapy law. That is 44 states. (Only Alabama, Alaska, Hawaii, Indiana, Michigan, and Oklahoma have not passed direct access legislation); Lets get it done!

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Call (Preferred), Fax, or e-mail (Getting to be preferred) and Tell them you want them to be a SPONSOR of S 950:

http://lautenberg.senate.gov/contact/index.cfm

DC Phone #202-224-3224 DC Fax #202-228-4054

http://menendez.senate.gov/contact/contact.cfm

DC Phone #202-224-4744 DC Fax #202-228-2197

New Jersey 8th Congressional District

The following is a memo Congressman Pascrell sent to his constituents who have email he knows about. I am putting this up as a public service; and also as a segué to what’s important to all  Medicare patients and all clinics like Suburban who treat them. I have posted my reply following it. I also would encourage any reader to contact their respective District Congress Person and ask him/her to sponsor the 2 bills I’ve mentioned.

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“April 29, 2009

Dear Mr. Barnett:

I recently became a member of the exclusive Health Subcommittee of the House Ways and Means Committee because the need to pass comprehensive health reform has always been critical to me. Prevention and wellness will be an important part of how we achieve this goal. Study after study has shown that preventive care, which helps prevents health problems or finds them before they become serious, is cost-effective and leads to fewer serious health episodes and lower health costs.

With this in mind, I would like to invite you to attend the 2009 Spring Health Fair at St. Mary’s Hospital in Passaic for a day of free health screenings. On Monday, May 4^th from 10 am to 1 pm, medical professionals will be on hand to provide information on tests, results, possible treatments, and on-site access to financial assistance in paying for prescription medications. The Health Fair will include blood pressure and glaucoma screenings, anxiety and pulmonary function assessments, and other screenings, assessments, and educational materials on a wide array of medical conditions.

Please set aside a moment to take advantage of this opportunity to protect and improve your health.  I look forward to seeing you at the 2009 Congressional Health Fair.

Sincerely,

Bill Pascrell, Jr.

Member of Congress”

——————————————————————————————————————————–

Thank you for the invitation. As you may remember I have been on your health advisory committee since its inception. The only non nurse, physician, or administrator member. I am out of town to the middle of next week.

However this is a very appropriate time for you to encourage the House to pass HR 43 The Medicare Access to Rehabilitation Services Act of 2009, permitting medical necessity and NOT requiring the very arbitrary and capricious $1840 cap as the limiting factor in healthcare coverage; and it addresses part of the very idea you are promoting; namely that medically necessary rehabilitation for seniors for “small” musculo-skeletal problems and balance deficits is better before the problems become big and expensive ones.

Additionally I would encourage you and your House colleagues to pass HR1829 ,Medicare Direct Access permitting seniors to directly access physical therapists “any time” they have a need, rather than “making” the process intimidate them to see their PCP first; costing more money, and strongly elevating their ire to have to spend money to “get permission” vis-à-vis “a prescription for physical therapy”.

Direct access to physical therapy is now law in 44 states; enough state’s rights affirmation to pass in both houses. Only Alabama, Alaska, Hawaii, Indiana, Michigan, and Oklahoma have not passed direct access legislation;

For the few times I have addressed you through this medium, I think you have never replied except as an automatic “got your message”. I have run my clinic (now 20 employees – down from 30 in 2008) in Cedar Grove for over 32 years, am a Doctor of physical therapy, board certified orthopedic clinical specialist, and a 6 year USAF missile launch officer veteran (1966-1972) serving in the rank of captain.

Please come to my office in Cedar Grove, whenever is suitable for you, (this is an election year in NJ for both houses and Governor and an opportunity for you to emphasize importance for NJ voters to get out to the polls and get them to be mindful of how important citizen feedback will be as municipality after municipality default on their medical coverage programs (and retirement benefits), something the current administration is trying to address.

Thank you for your time,

Respectfully,

Peter Barnett, DPT, OCS

Owner and USAF Veteran 1966-1972.

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Call (Preferred), Fax, or e-mail (Getting to be preferred) and Tell him you want him to be a SPONSOR of HR 1829:

http://pascrell.house.gov/contact/

DC Phone #202-225-5751 DC Fax # 202-225-5782

These are my Grand Dog Beauties!

It’s cloudy, cool (47°), light breeze at 10 AM this morning, 03/25/09. Getting ready to rain, we’ve had some brief misting precipitation. Recently I’ve been visiting the park area designated to be a new Passaic County Park. I take my 2 black beauty rescued grand dogs. No doubt some birders would question why I would bring along a couple of sleek swift footed marauders if I’m trying not to scare off what I’m trying to observe. I think their somewhat regular presence may help to calm the wild life there from being too spooked by my or their presence. In the process I may get a better look at what’s there rather than having the fauna hiding so apprehensively. I think they may have flushed out a Woodcock last week but haven’t had luck verifying it since. Usually I see one or both of the Red Tail hawks. Tuesday, one – I think the female (looked like the larger of the two) – was finishing off a cotton tail as she quietly kept a little ahead of us successively alighting in 3 different trees as we approached. Once the Red Tails get used to my grand canine companions I think they’ll be more accepting and of course I am training the pups to be appropriate and not hyper in the environment as well.

There are some good open pathways initially made by  vehicles when the property was “under siege” for housing development. Also a herd of 5 deer have made many trails through the “bamboo” from last year. I often see them in the distance but am sure will always keep their distance from the dogs my daughter rescued 10 months ago.

Plenty of wood chuck (ground hog) holes on the property; some already active, others seeming to not be exited or entered yet. Today several singing male and non-singing female Song Sparrows abound (some in the woods - field transition area - and other plucking insects off the rocks in the Peckman Brook. I didn’t know Song Sparrows did that.

A few “left over” (they should soon be heading north) Slate Colored (dark-eyed) Juncos were in the tree undergrowth along the brook bank. White Throated Sparrows are still lingering but they too should be heading north with the Juncos.  Cardinals singing in competition with the Tufted Titmice will be here for the duration. Lots of Mourning Doves always spooked by those curious pups with their noses to the ground (life on earth is still pretty new to them too).

I’ve identified 2 Baltimore Oriole nests and maybe 4 Humming Bird nests from their last year’s attempts to increase their numbers. English Sparrows are adequately represented as are several House Finches and Gold Finches. They’ll be nesting here. The Red Winged Black Birds are vary vocal (they arrived about 3 weeks ago I think) and seem to be settling into this ecosystem. The usual English Starlings are present but not in over whelming numbers, as are the Common Grackles; a lot of them came in with the Red Winged Black Birds and Boat Tailed Grackles 3 weeks ago but seem to have dispersed. Cow birds arrived at Suburban with a similar bunch of black birds at the same time but haven’t seen them here in the park.

There are still more than 30 Robins in a 4:1 ratio of bright colored males to dull colored females. Last week a Coopers Hawk was hunting the area and presumably will co-exist with the Red Tails. Last week a pair of Eastern Phoebes were fly catching on the brook itself near the end closest to the ware houses. I am thinking this may be a good time to put up some Blue Bird houses as this terrain/ecosystem would seem to be ideal for them.

The acreage was all forested 4-5 years ago before the “clearing took place” where Downy, Hairy, and Red Bellied wood peckers, owls, and Yellow shafted Flickers may have found homes, but now Mother Nature has “adapted” the land for others. There are some suitable old trees on the Brook’s edge for them but only one time have I heard a Red Bellied in the area, and that was across the Brook and street (Cedar Grove Road).

I saw an Eastern Mocking Bird 6 weeks ago but have not seen nor heard one in the park since. A rule of birding is: if you hear one, you’ve seen one so visual isn’t required for documenting what “you’ve seen”.  I guess that’s something to offer in this blog for those who are interested……

Health care “recovery” at the outset.

Our President has his many detractors. Watching the news I think they fall into two categories: (1) politicians who don’t want him to succeed just for political reasons and (2) those with a very limited, personal, and immediate agenda; most especially any part of the a) financial sector and b) large manufacturers with thousands of employees making sunset/outdated/high energy consuming products.

I watched his late afternoon public session 2 weeks ago where he allowed various “stakeholders” in health care to briefly “expound” on their individual takes of the early afternoon session. Of course physical therapy wasn’t mentioned directly, but indirectly it touched on a very basic tenet of the one medical profession best identified with preventive medicine: Physical Therapy. How about the money? Well even just verbalizing is a start. Some of the “verbalizers” he called on included: pediatricians, nurses, some major industrial leaders, PCP’s national president, and among others, Senate Republican, Charles Grassley from Iowa, one of the 535 Congressional members who might have some real insight into healthcare fraud, abuse, and needs. He has been a chief proponent for years for the health related contributions of the physical and occupational therapy professions.

As time elapses steering the large team of horses pulling all of our Nation’s myriad problems along, time can be spent looking at 21^st centuryhealthcare benefits related to musculo-skeletal injuries of the ever increasing number of retiring seniors: (1) those not being able to retire (or be retired – NOW!) but rather having to get part time jobs; some of which have physical requirements with the potential for musculo-skeletal injury; (2) or staying physically fit through some sort of consistent exercise regimen from which they will develop over-use injuries or worse; leading to a visit with their local physical or occupational therapist.

Our current National Health Plan (Medicare) already somewhat provides for that coverage but Congress needs to pass legislation currently before both Houses: S46 and HR43; the permanent repeal of the $1840 therapy cap. It places a restrictive hardship on active seniors, who with exercise injuries and joint replacements, may require care well in excess of the current dollar amount cap due to the falls, repetitive sprains, strains, and over-use injuries which do and will occur with their aging but active life styles and needs.

When passed, the government allowance for therapy will be in alignment with its Healthy People 2010 program and its soon to be revealed, Healthy People 2020.

I was reading an OT’s blog on her thoughts about the Cervical Spine: http://occupationaltherapist.com/blog/annie/?p=57 with some amusement and concern.

I’ve been keeping in touch with rehabilitation issues for over 35 years. PT’s vs. DC’s. - Physiatrists vs. PTs. - ATC’s vs. PTs. - Nurses vs. PTs in home care, and of course OTs vs. PTs. Well, you know, it’s all about turf more than skill, medicine, or rehabilitation. Of all the state and federal laws I have watched in combat with my state and national associations, it never really comes down to Health alone. There’s good and bad everything; not to sound like Donald Rumsfeld, but there are good good professionals and bad bad professionals, there are good professional professionals and bad non-professional professionals.

I want to thank Annie, the OT, for bringing this up.

So how about this OT-PT issue. For perspective, can we even define the terms “adjustment”, “manipulation”, and “mobilization” based on osteopathic, chiropractic, and PT/OT definition of terms? The professions are still suing each other, in almost every state no less, (since it is state practice act laws not federal practice act laws to decide) and no doubt lots of hard earned professional association dues going into them.

Heck, the physical therapy profession can’t even decide if there are 3 or 4 mobilization grades (plus manipulation - grade 5?). What is a certified manual therapist (CMT), orthopedic manual therapist (OMT), certified orthopedic manual therapist (COMT), fellow of the American Association of Orthopedic Manual Physical Therapists (FAAOMPT), Rocabado Certified Manual Therapist (RCMT), Mechanical Diagnosis and Therapy® (MDT Cert), Maitland Certified Manual Therapist (MCMT) and many more?

All professions have “doctors” PhD’s, DEd’s, DSc’s, MD’s, DPT’s, OTD’s, DO’s DC’s, DPM’s, OD’s; and not one of those degreed professions can argue infallibility in degree bestowing. (Don’t get me started on Harvard MBA’s.)

Not to make light of the extra schooling (classroom and clinic/practical) necessary to assume responsibility for a person’s neck, but let’s face it, many practitioners “lose it” (competency) after a while. At least many states are making “some” if only minimal headway in legally enforcing higher practitioner standards through CEU’s.

No one should perform a procedure (even on a car engine) if they don’t know what they are doing. Ditto the human body. Let’s be honest. In our clinics or at bedside some of our “colleagues” should leave well (pun intended) enough alone. I see it regularly, yet we can hide in the licensing acts where “best practice” is not a law; albeit a safe standard and perhaps malpractice proof. We have the un-attending insurance company “authorization police” determining medical necessity from within their patient absent vacuum.

I can see how CHT may pertain only to the wrist and hand. Or does it include the elbow? The shoulder? Well, excerpting from the Hand Therapy Certification Commission (HTCC) web site http://www.htcc.org/about/index.cfm :

In fact OTs and PT’s treat hands every day whether CHT or not. I certainly am one who encourages practitioners to have certifiable certifications by valid accrediting bodies. I’m certified and recertified in orthopedics by the APTA Board of Specialties.

OT’s are allowed by law in New Jersey (and many other states) to treat the upper extremity regardless of CHT guidelines. One could not fulfill the law unless it is so; as stated in the NJ practice act: http://www1.aota.org/state_law/lawprofile.asp?QStatus=Y&ST=Y “purposeful, task-oriented activities for the client to improve, restore and/or maintain optimal performance of life skills roles and functions including work, recreation, leisure skills and activities of daily living; ”

So I wonder why the OT profession has not sought to also include the cervical spine insofar as it pertains to UE function as part of the upper quarter. Certainly to screen the shoulder it is de rigueur to include the upper quarter and hence the cervical spine. With weakness (radiculopathy) one’s “functions including work, recreation, leisure skills and activities of daily living” would require knowing something about that. If I may be so brash as to suggest many professionals, licensed to treat the cervical spine, have regularly missed at least one important symptom of a patient’s complaint (in the history or physical exam) before the patient is referred to Suburban.

I am confident a random check of many providers would not pass nerve root testing of the upper extremity, even if covered in their formal education. Therefore it is about what a profession is trained to do and what measure(s) can be taken to ensure competence. This of course gets a little sticky with OT perhaps because we all know the neck bone’s connected to the back bone.

In my practice, I am the “enforcer-decider” about qualifications of those who work for me and in that way I represent the professions check and balance for best practice. It began the day I left Columbia University in 1973. To survive, private rehabilitation clinics are often forced into rehabilitation niches. In addition to consulting the Healthy People 2010 goals http://www.healthypeople.gov/lhi, I have been able to add Pediatrics and Vestibular therapy and I have also hired an Occupational Therapist who brings not only the usual OT talents to Suburban, but also Hippo Therapy. I try to keep OT-PT issues in perspective.

I monthly receive an e-mail of the internet from my web site found in the search engines, from somewhere in the country Washington state, Virginia, New York , New Jersey, Colorado, California, Massachusetts, to name some I recall. I decided it may be a good instructional blog for those wondering how I respond. This is one I sent this morning to someone in New York State.

Hi,

Thank you for your inquiry. The following web site of my national association may be your best bet. It is the link for “Find a Therapist”. The value of this site is, anyone listed is a dues paying member with the latest information in our health care setting. Non-members are “losers”.

1) As you search the zip code areas also select “specialty” as orthopedic. You may list 30 on a page.

2) Look for an orthopedic clinical specialist (OCS) which will be a green symbol looking like a downward pointing arrowhead in a circle (it’s apparently the APTA logo). If they are a DPT (Doctor of PT) and graduated as a physical therapist more than 10 years ago, an additional plus.

3) If they have a web site, “look at it” and see if it looks serious and personal or just a template type. A “serious” web site may suggest a strong administration with integrity of credentials. (Don’t fall for corporate web sites: very flashy but bottom line corporate goals; not health goals.)

4) If the therapist has a posted c.v. (curriculum vitae) so much the better because you are looking for TMJ credentials. Some will list TMJ but no real training.

5) If the web site (and the practice it represents) is truly serious you will have a chance, like this one, to correspond and ask their credentials. Even make a phone call or stop by an office you are considering, if convenient.

6) If your dentist is not a TMJ specialist, be sure your dentist or the therapist can recommend one. If they can’t, something is wrong.

7) In 80% of circumstances, you’ll need an appliance (from the dentist) and it will need at least 2 adjustments over the initial 2-3 weeks, if it the therapy is working correctly. If the appliance is uncomfortable it needs adjusting. NO appliance should be uncomfortable!!!

20% of the time the therapist can work out your problem if it is a sudden occurrence.

9) POSTURE is almost always an issue and you will not respond unless you do the proper exercises (usually a “3 minute drill”) six times a day plus a short home exercise program (HEP in or lingo) twice a day (usually using some sort of elastic…we use Theraband).

10) With a dentist overseeing your care, my average length of treatment is 4-6 sessions and nearly 30 minutes of therapist “hands on” each session. Depending on other aspects, you may benefit from an additional ½ - ¾ of an hour more of supervised exercises.

11) New York is a direct access :

NY- 2006 Provisions Treatment can be rendered by a Licensed PT without a referral

for 10 visits or 30 days, which ever comes first.

Licensed PT must have practiced PT on a full-time basis for no

less than three years; be of at least twenty-one years of age.

PT must provide written notification that services without a

referral might not be covered by the patient’s health plan or

insurer; notification must state that said services might be

covered by health plan or insurer with a referral. Must keep a

copy of the written notification in the patient’s file.

http://www.apta.org/AM/Template.cfm?Section=Find_a_PT&Template=/APTAAPPS/FindAPT/findaptsearch.cfm

If you wish to run by me your search results, you may e-mail me. I am not a “cranio-facial or maxillo-cranio-facial association” member, but if you find one that is, it is likely a good credential as well.

Happy Ground Hog Day.

I think Bill Murry put this day more prominently on the map but Punxsutawney, according to slate.com (http://www.slate.com/id/2210144),  “(whose name derives from a Native American phrase meaning “town of sandflies“) claims pre-eminence in groundhog-based divination, apparently because during the past 118 years the town has put more effort into it than anybody else.”

Anyway, it is hard to believe we’ve already come to this day in 2009 for Punxsutawney Phil’s pronouncement, when the days getting longer, the Titmice started singing the end of December, and the Cardinals pineal glands started them courting around here 2 weeks ago, on a very cold crisp Monday morning.

Today Jeanne and I started our day at Marble Collegiate Church on the corner of 5^th and 29^th,  with Arthur Calinadro’s “final hour” as its pastor. Then Jeanne took me for breakfast to a place she found yesterday while she was roaming around the West Village in SoHo: Cubana Café at 110 Thompson Street, btwn Prince and Spring. Great ambiance. You’ll have to Google it because their web site doesn’t seem to work. The Google map is excellent, so finding shouldn’t be any trouble.

I fully recommend it for those looking for a reasonably priced Cuban menu, below street level, colorful ambiance with non-blaring mariachi band and Spanish music in the ebackground, and quite the friendly service. We plan to return with our gourmet trained son after church in 2 weeks. We have our oldest grandson’s birthday next week; so we’ll do church, pick up our son a couple of blocks north and west of Cornell Weill Center, and scurry back to NJ for the priority celebration. We’ll leave the following week to do our bit in support of and for the Cubana Café, enjoying what will be a pleasing repast in a good local business in famed lower Manhattan; and who knows? We might be greeted with a sunny mild weather day, permitting a morning walk “in the Village” after.

Hungry? Try it!

44th President of  the United States of America

I have to post something today. I think I would like to reflect on the up coming inauguration. I think few would argue this is historical for the United States in a grand, over-the-top sort of way. I have given thought to this for over a year once I realized John McCain sounded like a politician and not like the independent war hero individual he has been in other attempts to get into the Whitehouse. I also am not into dirty campaign tricks and “swift boating” stuff. As a veteran I had had enough of GWB after his first term.

Barack Obama appealed to me after my first choice got eliminated over a year ago. He proves to the world the USA isn’t just for good ole white boys anymore (being one myself). It proved we can look past skin color in the USA. He is married with a beautiful family. Michelle is gorgeous, well spoken, and early on aligned herself with veterans’, which includes their families, problems, and needs. They have 2 beautiful children, as the Kennedy’s did, who can be models to all the children of the world. Somehow it seems easy to see them as an American family and not as a “black American” family.

In fact I think many of us have already started looking at the new administration as just that (American) and not related to race or ethnicity at all. In today’s world he has Muslim roots, is not obviously white (but has a white mother and white and black grand parents) so will not be stereotyped on the world stage as just another USA president of the same cloth and motivation as most of our white presidents. He came up in a single parent household (his mother died way-way too prematurely) when his father abdicated parental responsibility and was raised by his (white) grandmother. How many children black and white can relate to that in the USA? Plenty!  He will have “equal” footing with those particular Muslim leaders (all statistics agree about 20% of the world’s population is Muslim) who will only speak to a male counterpart (Hillary would be at some a disadvantage there just because of that). He is certainly smart (even if you don’t know what the Harvard Law Review is; being president of it sounds pretty smart anyway). He seems relaxed, unperturbed, and calm under fire or pressure; a quality we need in the Whitehouse – someone who can think on his feet. Even in the campaign he didn’t jump on de jour bandwagons. He presciently opposed the Iraq war on the grounds it wasn’t well thought out (even though he was not yet a US Senator). He has a world view from personal reflections because he lived in Indonesia (a predominantly Muslim world even then) and in Hawaii (it became a state in 1959 he was born 1961), not to mention his roots to the Heartland state of Kansas, schooled in LA, NYC, and lived in Chicago (he knows about “American” city living) and about educational settings here and abroad, including being “tutored” by his mother. He likes to read and he knows “American” history (those who don’t are doomed to repeat it). He loves and plays basketball, not exactly an “un-American” past time of considerable cross cultural roots (Bill Bradley played for Princeton, the Olympics 1964 team [captain], the Knickerbockers, is in the hall of fame, was a US Senator, and ran for President). He had a lot of prominent relationships long before he went into politics. He was a college teacher and knows about higher education and its importance to the future of the USA. He is green and thinks green. He is strong in character and can go toe-to-toe with anyone and will run an Executive Branch with plenty of venting and vetting in his cabinet meetings. HE IS CHARISMATIC with a great and easy smile. His self confidence is so exuding you don’t even know he has an ego.

I’m sure I could go on for a day referencing many other comparable and incomparable traits; but I have to go to work. Excuse me! Did I mention the internet (not “internets”). He sure knows his way around it. This man is so 21^st century with a Blackberry he unashamedly admits he is going to miss, he used the internet to get elected (how 21^st century was that? Read about how that started.) and wants broadband in all schools

“Because to help our children compete in a 21st century economy, we need to send them to 21st century schools. As we renew our schools and highways, we’ll also renew our information superhighway. It is unacceptable that the United States ranks 15th in the world in broadband adoption. Here, in the country that invented the internet, every child should have the chance to get online, and they’ll get that chance when I’m President – because that’s how we’ll strengthen America’s competitiveness in the world.”         Quoted from his Saturday address December 6, 2008.

January 20^th will be a momentous USA historical event. No one should miss it. I can’t wait to hear how many schools don’t watch it!!! Don’t worry. I plan to ask. AND Suburban will be closed on the 20th because no employee of mine should miss the actual moment of the oath…not see a rerun. Then we’ll celebrate at Ocha in Caldwell.

God Bless everyone in the USA, including the new Administration.

“The Medicare Access to Rehabilitation Services Act (H.R. 43/S. 46).”

To all our Medicare patients and their family members “not-yet-but-one-day-will-be-Medicare-patients”, it is time again to be heard:

The following information is redacted from information sent to me as a member of the American Physical Therapy Association (APTA).

Currently there are two therapy caps, one for physical therapy and speech language pathology and one for occupational therapy. The therapy caps are set at $1840 per beneficiary per year. The therapy cap applies to all Medicare beneficiaries in all Part B health care settings, except hospital outpatient departments. Beneficiaries that exceed their therapy cap may have to choose between forgoing necessary care or paying 100% of the cost out-of-pocket over their Medicare coverage. Senior citizens who suffer from a stroke, or have Parkinson’s disease, spinal cord injuries or osteoporosis are more likely to be the type of patient needing such care.

Every year Congress considers a short-term step to prevent the therapy cap from being enacted. Although this results in protecting beneficiaries’ access to rehabilitation care, this legislation is not passed until very late in the year. This disrupts the continuity of care to Medicare patients because therapists must adjust their plan of care to their patients.

It’s time to eliminate this flawed policy by passing legislation that ensures access to outpatient rehabilitation services for the most vulnerable Medicare beneficiaries.

This is an excellent link for more expanded discourse on what the Therapy Caps are: FAQs about the Therapy Cap (.pdf)

On January 6^th, Congressmen Xavier Becerra (D-CA), Mike Ross (D-AR), and Roy Blunt (R-MO), and Senator John Ensign (R-NV) and eleven other Senators introduced “The Medicare Access to Rehabilitation Services Act (H.R. 43/S. 46).” This legislation will repeal the cap on therapy services for Medicare beneficiaries once and for all. If Congress does not take action by December 31, 2009, the therapy cap will again be imposed on Medicare-covered physical therapy, occupational therapy, and speech language pathology services. All of Suburban’s contacts (patients and their family members “not-yet-but-one-day-will-be-Medicare-patients”,) need to take action NOW to ensure the cap does not go back (regress) into place.