Hyperbaric Oxygen Therapy

by Kelly Byrd-Jenkins, CWS

What you do in the outpatient center is not easy, and not everyone is doing it. In many cases, they'd prefer to let us decipher this challenging demographic's path to healing. Patients we're entrusted to serve are complex in their needs, diagnoses, and compliance with our treatment plans. We see them frequently, often over extended periods of time, and due to the very nature of their mixed, long-standing wound etiologies, we don't always get to see complete and total healing for quite some time. These are etiologies we aren't managing, but must factor in to be effective. Considerable time is spent equipping these patients for personal success by coordinating resources and providing education. And for the patient whose end goal is stability, we recognize that outcome as success each time we see them.

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

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.

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!

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.

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.

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."

By The Alliance of Wound Care Stakeholders

The Alliance of Wound Care Stakeholders submitted formal comments in response to the Novitas draft local coverage determination (LCD) for Hyperbaric Oxygen Therapy (HBOT) DL35021.

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. Ninety-nine percent of the time, panel review board members didn't know what hyperbaric oxygen therapy (HBOT) was. I would also get asked, "Do you mean 'bariatric'?" (instead of hyperbaric). The legwork seeking prior authorization for HBOT was dreadful during that time.

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.