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digging a grave site

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

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 (LCD) on hyperbaric oxygen therapy (HBOT). It should not have come as a surprise that the Centers for Medicare & Medicaid Services (CMS) is planning prepayment review for HBOT services. We have been struggling for months in New Jersey, Michigan and Illinois with preauthorization. What is frightening is that a large number of the denials we have seen are completely nonsensical, bureaucratically driven, and dangerous: a patient with osteoradionecrosis of the jaw, for example, was denied because she didn't have 30 days of standard of care; or perhaps the CMS keyword search engine selected out a proscribed adjective!

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industry representative meeting with physician

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

This blog comes to you written from the deck of the Independence of the Seas on the 2016 Wound Cruise. The conference on the ocean draws the best speakers in the world for obvious reasons. But like many educational events, some of the best discussions occur outside the conference area. A cold beer in my hand I posed the question to my sandal-donned colleagues: Should we allow industry representatives in the wound clinic?

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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.

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Evolution of the wound care specialist

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

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.

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Preparing for CMS PQRS measures deadline

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

An ancient Irish tradition dating back to St. Patrick permitted women to propose marriage to men on the additional day added during a leap year. The gender equality of modern society has turned this tradition into mere folklore, but it is hardly cause for concern here in Boston as we have no shortage of Irish traditions.

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value formula

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

Lawrence Mills introduced the concept of Value Analysis to the manufacturing industry a half century ago. The basic idea entails analyzing the function and importance of the various parts of a product as they relate to cost. He derived the following equation2:

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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."

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the emperor's new clothes

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

The Emperor's New Clothes was one of my favorite childhood stories. In this Hans Christian Anderson tale, two weavers clothe the emperor in what today would be referred to as "virtual finery." All of his ministers, advisers, factotums and subjects praise the beauty of the unseen linens until a small boy states the obvious truth, "Look, the Emperor is naked."

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

The American Professional Wound Care Association's (APWCA) annual meeting concluded in Philadelphia the last weekend in March. The meeting featured several novel ideas in wound care education. A hands-on competency session permitted attendees to place total contact casts, practice with two bedside grafting devices, assess vascular status, and become proficient in negative pressure wound therapy.

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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.

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