Hyperbaric Medicine

Thomas Serena's picture
hyperbaric oxygen therapy

by Thomas E. Serena MD, FACS, FACHM, FAPWCA

In 1950, J. Edgar Hoover published the first edition of the FBI’s most wanted list. Since that time, no less than 512 fugitives have been featured. Many surrendered after learning that their mug shots were hanging on every post office wall in the country. In medicine, we have an equally infamous public posting: The Office of Inspector General’s (OIG) work list. In 2017, it turns out that hyperbaric medicine services are "public enemy number one." But please, do not surrender just yet.

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Thomas Serena's picture
digging a grave site

by Thomas E. Serena MD, FACS, FACHM, FAPWCA

"Please don't bury me down in that cold, cold ground. I'd rather have them cut me up and pass me all around."
-John Prine

Fans of folk singer John Prine will recognize the homey lyrics describing his views on organ donation. Sitting at my desk a few weeks ago with John Prine twanging in my headphones, I began to slog through the new Noridan Local Coverage Determination on hyperbaric oxygen therapy.

Thomas Serena's picture
standardizing clinical trial endpoint

by Thomas E. Serena MD, FACS, FACHM, FAPWCA

Recently, I had the pleasure of attending Puccini's opera Turandot at New York's Metropolitan Opera House. In my favorite scene, young prince Calef comes upon a gruesome tableau: Potential suiters for the princess Turnadot must answer three questions correctly in order to win her hand. On the downside, one incorrect answer is rewarded with a beheading. Calef takes the challenge and answers all three questions flawlessly. Yet, the princess begs her father not to force her to marry the stranger. Calef intercedes saying that if she can guess his name before dawn he will release her from her obligation. Confident of conquest, he sings Nessun dorma (none shall sleep), the opera's most famous aria.

Thomas Serena's picture
Evolution of the wound care specialist

by Thomas E. Serena MD, FACS, FACHM, FAPWCA

"The average isn't average because its average. The average is average because its best." – J.B.S. Haldane

In 1972, Stephen J. Gould, the renowned paleontologist and masterful essayist, published the theory of punctuated equilibrium in which he challenged the long held belief that evolution occurred gradually over time. He knew that the creation of new species occurred when isolated populations of individuals faced environmental challenges to which they either adapted or perished. Gould asserted that this change happened rapidly when conditions favored it. Interspersed between the spikes in speciation are prolonged periods without change (equilibrium). In the case of the human species, globalization and a fairly stable environment have resulted in negligible change in our evolutionary history: we are enjoying equilibrium.

Thomas Serena's picture
authorization denied

by Thomas E. Serena MD, FACS, FACHM, FAPWCA

During the 2010 presidential campaign, Sarah Palin, the former governor of Alaska, quipped during a debate that then presidential candidate Obama's health care reform contained within it "death panels": bureaucrats with limited or no medical training making life and death decisions. She suffered interminable criticism for the comment and political fact checkers dubbed it the "lie of the year."

Cheryl Carver's picture
job safety training

by Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA, CLTC

I was thinking back to the days when I worked as a hyperbaric technologist. Hyperbaric medicine has significantly evolved over the past decade. Many things stick out in my mind, such as criteria for insurance payor reimbursement, hyperbaric dosing, and regulatory standards, to name a few. Those were the days when we had to fax hyperbaric research articles and case studies to the utilization review departments of insurance companies. 99% of the time, panel review board members didn't know what hyperbaric oxygen therapy was. I would also get asked, "Do you mean Bariatric?" (instead of hyperbaric). The legwork seeking prior authorization for HBO Therapy was dreadful during that time.

Thomas Serena's picture
Hyperbaric Chamber

by Thomas E. Serena MD, FACS, FACHM, FAPWCA

Pete Seeger died a year ago last January at the age of 94. Reading a tribute to the folk singer, I ran across his most memorable tune, "Where have all the flowers gone?" I have long enjoyed the numerous versions of this folk song recorded by dozens of artists. The fatalism of the lyrics and the circular verse form made it emblematic of a most unfortunate decade in American life: the 60s.

Lindsay Andronaco's picture

by Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

Many people do not realize that the two most common issues we see in hyperbaric oxygen (HBO) therapy patients are ear/barotraumas and a decrease in their blood glucose level. In general, HBO is very well tolerated and requires little other than a commitment to the treatment series.

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American College of Hyperbaric Medicine's picture

Consensus Panel
Thomas Serena MD, Helen Gelly MD, Greg Bohn MD, Jeffrey Niezgoda MD

Endorsed by The American College of Hyperbaric Medicine

Introduction
The rise in specialized wound and hyperbaric centers across the United States has resulted in an increased need for physicians to oversee Hyperbaric Oxygen Therapy (HBOT). However, there are no published national standards or recommendations for credentialing physicians for this service. The American College of Hyperbaric Medicine (ACHM) has drafted this document to guide hospital credentialing committees in this process. It represents the consensus opinion of leaders in the field of hyperbaric medicine in the United States. It is important to note that although this document applies to both hospital-based and non-hospital affiliated centers, they have separate requirements.

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Lindsay Andronaco's picture

by Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

The use of Hyperbaric Oxygen Therapy (HBOT), according to Medicare, is a modality in which the entire body is exposed to oxygen under increased atmospheric pressure. HBOT is a CMS covered adjunctive therapy and should be used in conjunction with standard care, which include modalities like surgery, debridement, medications, topical wound care and offloading the wound. It is also important to have plans of care that include monitoring nutritional status and glucose control to help ensure a positive outcome for the patient.

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