Friday, January 06, 2006

Of Interest to all Hyperbaricists, letter from UHMS

Here is a letter from Don Chandler, Executive Director, UHMS. I believe that even if you are not a member of the UHMS - that you will find this material important and helpful.

"Here are some items that I believe you will find interesting.

Blue Cross/Blue Shield is (again) reclassifying what medical conditions they will approve for HBOT. Sometime in the early fall we learned that BC/BS of Idaho had reclassified some medical conditions from the traditionally accepted indications for adjunctive hyperbaric oxygen treatment from the "approved " to the "investigational" category. This concerned us greatly and we discussed a plan for a strategy to approach Idaho BC/BS during our last Board of Directors (BOD) meeting. Following the BOD meeting, Tom Workman showed the announcement to Dr. Dick Smerz, who was doing a hyperbaric facility survey for him. Dick said that he was familiar with the language from Idaho BC/BS because he had recently been informed of a similar action by BC/BS of Hawaii. This raised a "danger flag" in everyone's mind. Since that time, we have learned that one of the Blues in Pennsylvania has also taken a similar action. As reported by Dr. Bob Warriner the conditions reclassified by BC/BS of Idaho, Hawaii, and Pennsylvania into the "investigational" category are:

Carbon monoxide poisoning
Necrotizing soft tissue infections
Acute peripheral arterial insufficiency
Chronic refractory osteomyelitis an acute osteomyelitis refractory to standard medical management
Cerebral edema
Refractory mycoses (mucormycosis, actinomycisis, canidiobolus coronato)
Radiation necrosis (osteoradionecrosis and soft tissue radiation necrosis)

Your society has not been silent nor have we been taking the position of just an interested bystander with this issue. Our President, Dr. Lin Weaver had just recently formed a new committee to deal with such issues. The new committee is called Authorization, Utilization, Quality, and Reimbursement Committee (AUQR). AUQR is chaired by Dr. Ron Bangasser with members consisting of Tom Workman, Dr. Bob Warriner, and Dr. Jeff Niezgoda. Dr. Weaver acted quickly to activate this committee and also sought the assistance of Dr. Ben Slade, Dr. Laurie Gesell (Chair, HBOT Committee) and Dr. John Feldmeier. As I write this they are working hard to develop a position that will be presented to BC/BS at the national level. Even this week, some of the committee will be meeting with BC/BS in Hawaii to see what they can learn.

This is a classic example of how your society works for you, our members...and the several thousand who work in the field of Hyperbaric Medicine but are not members of the UHMS. We are working with the ACHM and HOTA as we plan the strategy to reverse this very disturbing BC/BS action. Please be assured that we have some of the best in the world working this issue. Give them a couple of weeks to get their strategy together and BC/BS will think they have a hornet loose in their bonnet. I will keep you informed as progress is made.

More on Malpractice Insurance.
Dr. Bob Goad reports that Doctors Company has been his malpractice insurer since 1993 and he considers them superb and with highly competitive rates.
Berry Baker forwarded an email he got from an insurer friend of his who said: "I have a market for HBOT physicians. Physicians Insurance Company (PIC) and their reinsurers have agreed to accept HBOT physicians in Florida and Texas. PIC only writes on an admitted basis (protects policyholders if company becomes insolvent). PIC had very good rates, but they only take about 70% of the physicians that apply...Rates are based on Physician's Specialty if they are practicing HBOT only part time. If they are HBOT full time, a rate for General Practice/non-surgical will be used." This comes from Chris Baxter in Pensacola FL (800) 641-8865.
Dr. Ron Bangasser heard from his Paralegal in California. She stated that NorCal covers Wound Care and HBO as Family Practice with Surgery Assisting. Ron reports that he has had that coverage for years and that Wound Care and HBO did not change or add anything to that coverage.
Dr. Bonnie Bock informed me that she was with Doctors Company, but then changed to CAP MT a year ago due to cost and service. She reports that both companies are HBO friendly and she is classed as an internist, with no added fees.
Dr. Tom Bozzuto wrote that he was in an Emergency Medicine group Florida and they were covered by Mag Mutual. For those who did HBO/Wound Care under their ER coverage, there was no additional premium.
Dr. Richard Sadler reported that he is a practicing thoracic and vascular surgeon and he does HBO one morning each week using three monoplace chambers. His malpractice policy covers him for all of this activity in a "wraparound" policy. He uses MMIC.
More on CO Poisoning Following the Hurricanes.
Robin Shafer RRT/CHT who is the Safety Supervisor at the Christus St. Elizabeth Hyperbaric and Wound Care Center in Beaumont, Texas sent me some information well worth passing on to you. Much of Robin's report follows:
"We had two male patients that were sleeping in a mobile home with a generator at the far end of the trailer. The first night with this arrangement they were okay. On the second night, they think that the wind shifted. One of the men woke up and felt strange. When he tried to stand, his legs felt rubbery and out of control. He could not awaken his friend, so called 911. On arrival the friend was still unconscious, but woke up (somewhat) just prior to his first HBO treatment. We treated these two guys in our two monoplace chambers, as we had not yet had a chance to check out the multiplace chamber after the storm. They both and several treatment here and were released to return to other areas, so we're not sure of the total number of treatments they had.
Then we had two more guys who were in a hotel in Jasper , TX. They were from Mississippi and were doing seismographic work in the area. The hotel had lost power (as had every other place in the area). The hotel staff placed a generator right outside the mens room. The older gentleman said he know that was dangerous , so he moved it away before going to bed. Later that evening someone (probably hotel staff) moved it back. When the other workers tried to get them up to go to work in the morning they were unable to get a response from them. They finally got the staff to open the door and both were unconscious. On arrival to our facility probably about 3 hours had passed. The younger victim had c/o nausea and vomiting, but the older one was unconscious and posturing. By he end of the first treatment the older one was responding slightly to his name. They had BID treatments for several days and were finally released to go back to Mississippi for follow-up. Although the older patient (they were 19 and 47) had several other events related to his CO exposure (MI and renal infarct), he seemed to be recovered completely mentally.
One other event was a family of 5, also staying in a mobile home, who presented with headaches and nausea. This was a man and kids ranging from 2-9. They all recovered well (perhaps more warning about the use of generators near mobile homes should be given). The highest CO level recorded in our patients was 13, but they had all been on O2 for varying periods of time on arrival All the patients after the first two were treated in our multiplace chamber (12 patient unit made by Gulf Coast Hyperbarics)."
Julio Garcia, Center Director of the Center for Wound Care and Hyperbaric Medicine at the Springhill Medical Center in Mobile, AL sent me a copy of an article that ran in the Mobile (AL) Register. The following excerpts from the article written by Penelope Mc Clenny are worth reading:
"Renee Funk, an epidemiologist with he Atlanta-based CDC, and Deidre Crocker, and epidemiological intelligence officer with the agency, spent two weeks in Mobile ...interviewing several of the more than 20 patients who were treated at Springhill Medical Center for carbon monoxide poisoning following the Aug. 29 storm.
In the days after Katrina, the hyperbaric medicine department at Springhill became packed with carbon monoxide victims, said Julio Garcia, a registered nurse and director of the department. The hospital uses its hyperbaric chamber to treat those poisoned from carbon monoxide with pressurized oxygen.
While some of the ill people had operated generators inside their homes, Funk and Crocker discovered that other victims thought they had placed generators in safe areas.
So many poisonings had occurred, even though people knew not to keep them indoors. 'That's one of concerns,' Funk said. 'Most people had them in carports or porches.'
Garcia, who worked with the CDC scientists and local health department officials during their review of the situation, said he was surprised by some of the information that they uncovered.
'What we found to be the biggest contributing (factor) is that it is not well-defined what is a well-ventilated area,' Garcia said. 'It is not as simple as you think, Really...they thought they were doing the right think.'
In a number of cases, people put generators in covered areas close to their homes to protect them from rain, or placed them in nearby outdoor areas to guard against theft, Garcia said.
A generator that's too close to a house..especially near an open window or vent...poses dangers because of the high concentrations of gas that it emits.
'They actually produce more carbon monoxide that a car,' Funk said. Funk and Crocker said they will use the information they gathered in Mobile to encourage more public awareness campaigns about generator safety. For instance out of all the Mobile-area victims they interviewed, few said they used carbon monoxide detectors while their generators were operating. Those that did have dectors had dead batteries, Funk said. Funk and Crocker are planning on working with the Consumer Product Safety Commission to ensure that instructions on generators clearly explain where to keep them in proximity to a home. The epidemiologists also plan to talk to retailers, urging them to group generator-related supplies together in their stores.
'If they see the CO detector and the extra long extension cord, they are more likely to pick them all up at once," Funk said.
The Mobile County Health Department is considering holding news conferences on generator safety at the start of next year's hurricane season, according to Melissa Tucker, the department epidemiologist who worked with the CDC scientists.
"I don't know what it's going to take to make people understand that people can get hurt or killed from carbon monoxide poisoning,'Tucker said"

We wonder, too, Melissa, we wonder too...but certainly more of what the CDC and the Mobile County Health Department says they will do certainly will help. Thanks for doing what you do to save lives!

That's all for now, folks. The best to you!

Don"