Thursday, March 02, 2006

Newsletter from Don Chandler, Executive Director, UHMS

I felt that this letter contains information that would be valuable to everyone associated with diving and hyperbarics - whether or not they are members of the UHMS.

To all--

In this email you will find information on the following topics:

1. Our progress with the BC/BS issue.
2. Our work with the AMA - Torre Cassano reports
3. Fitness to Dive course is valuable training for physicians in several different ways.
4. Our annual scientific meeting in Orlando.
5. Our 40th anniversary meeting in Maui.
6. Our Dive Expedition off Kona, Hawaii prior to our 40th anniversary meeting.
7. Memoriam to Professor Brian Hills.

1. Our progress with the BC/BS issue. We received the following from the Chair of our BC/BS Task Force and I pass it on for your information. As you will see, we are taking an aggressive position to countering what some of the state "Blues" organizations have done in recent weeks. I must say, however, not all the Blues are at fault...BC/BS of Iowa/South Dakota recently posted their position on reimbursement for hyperbaric medicine treatments and seem to have their head on right. I paste here their latest as sent to us by Kris Jones:

From BC.BS of Iowa and South Dakota:
Hyperbaric Oxygen Therapy (HBO)

Medical Policy: 02.01.13
Original Effective Date: September 1999
Reviewed: January 2006
Revised: January 2006

This policy applies to all products unless specific contract limitations, exclusions or exceptions apply. Please refer to the member's benefit certificate language for benefit availability. Managed care guidelines related to referral authorization, and precertification of inpatient hospitalization, home health, home infusion and hospice services apply.



Hyperbaric oxygen therapy (HBO) is a technique of delivering higher pressures of oxygen to the tissues. Two methods of administration are currently available. In systemic hyperbaric oxygen administration, the patient is entirely enclosed in a pressure chamber and breathes oxygen at a pressure greater than 1 atmosphere (the pressure of oxygen at sea level). This technique relies on systemic circulation to deliver highly oxygenated blood to target tissues. Systemic hyperbaric oxygen therapy is used to treat wounds as well as systemic illnesses such as air or gas embolism, carbon monoxide poisoning, and clostridial gas gangrene.
Topical hyperbaric oxygen therapy is a technique of delivering 100% oxygen directly to an open, moist wound at a pressure slightly higher than atmospheric pressure. It is theorized that the high concentrations of oxygen diffuse directly into the wound to increase the local cellular oxygen tension, which in turn, promotes healing. The pressurized oxygen is delivered via an appliance secured over the wound site. Topical hyperbaric oxygen therapy has been investigated as a treatment of skin ulcerations due to diabetes, venous stasis, postsurgical infections, decubitus ulcers, burns, and frostbite.


Topical hyperbaric oxygen therapy is considered investigational for all applications.
Systemic hyperbaric oxygen therapy (HBO) may be considered medically necessary in the treatment of the following conditions:

Decompression sickness
Acute carbon monoxide poisoning
Gas gangrene (i.e., clostridial myonecrosis)
Crush injury with acute traumatic ischemia
Radiation necrosis (osteoradionecrosis and soft tissue radiation necrosis)
Acute osteomyelitis, refractory to standard medical treatment
Compromised skin grafts or flaps
Chronic non-healing wounds
Profound anemia with exceptional blood loss: only when blood transfusion is impossible or must be delayed
Acute cyanide poisoning
Air or gas embolism
Progressive necrotizing infections (necrotizing fascitis)
Acute peripheral arterial insufficiency
Chronic osteomyelitis refractory to conventional medical and surgical management
Acute traumatic peripheral ischemia
Actinomycosis, only when refractory to antibiotics and surgical treatment
Diabetic wounds of the lower extremities meeting all of the following criteria:
Type I or II diabetes mellitus
Wound classification as Wagner grade III or higher
History of failed standard wound therapy
Systemic hyperbaric Oxygen Therapy (HBO) is considered investigational for all indications not listed above including, but not limited to, the following diagnoses or circumstances:

Acute cerebral edema
Acute thermal burns
Other refractory mycoses, Conidiobolus coronata
Severe or refractory Crohn's disease
Migraine headache
Cerebral palsy
Acute coronary syndromes with percutaneous coronary interventions
Idiopathic sensorineural hearing loss
In vitro fertilization
Neurologic conditions
Cerebrovascular accident (436)
Bone graft (V45.89)
Acute carbon tetrachloride poisoning
Fracture healing
Hydrogen sulfide poisoning
Intra-abdominal and intracranial abscesses
Lepromatous leprosy
Pseudomembranous colitis (antimicrobial agent-induced colitis)
Multiple sclerosis
Retinal artery insufficiency, acute
Retinopathy, adjunct to scleral buckling procedures in patients with sickle cell peripheral retinopathy and retinal detachment
Pyoderma gangrenosum
Sickle cell crisis and/or hematuria
Head and spinal cord injury traumatic
Brown recluse spider bites
Now the latest from the Chair of our BC/BS Task Force, Dr. Bob Warriner:

My notes from the HOTA conference call regarding BCBS issues yesterday follow.

On the call were myself, Dr. Lin Weaver, president of the UHMS, Jim Tyler, president of HOTA, Sue DeSantis, executive director of HOTA, and David Main and Edgar Bueno of Pillsbury Winthrop Shaw Pittman LLP. The call lasted about an hour. Edgar reviewed a previous telephone conversation with Debbie Yeager, RN, in the coverage office of Blue Cross Blue Shield of Northeast Pennsylvania. He reported that Debbie was “responsive” to the issues raised and asked repeatedly if there were examples of claims denied that could be reviewed. Actually, at this time, the Curative Center which raised the question with this “blue” has not submitted claims because of their interpretation of “investigational” as being equivalent to non-covered. While we do have claims denials for non-coverage from other “blues”, we do not have them at this time for BCBS NEPA. That having been said, we do have an open door here with an offer that the plan medical director, Dr. Leo Hartz (sp) is willing to meet with us.

Our documents are ready for submission, and I will forward them separately later today. Edgar is going back to Ms. Yeager with the specific question…does “investigational” mean that claims submitted will be uniformly denied or does it mean that claims in the investigational category will be viewed individually and might be paid. If the answer to the question is uniform denial then our meeting with the medical director is on the merit or lack of merit of the decision to move CO and radiation to the “investigational” category, and we have very good case here. If the answer is that claims would be considered individually, then our approach will be to ask what specific criteria will be applied to make the determination of coverage and that opens up all of the “investigational” diagnoses to the same process. We all doubt that this answer will be given as it opens a pandora’s box of potential requests for coverage for HBO in a variety of unsupported circumstances. The attorney’s feel that the inconsistent application of the evidence review process…accepting a Cochrane review in the case of CO and rejecting it in the case of radiation injury and the acknowledgement that CO, though investigational, is part of the standard of medical care…provide a number of opportunities for us to reverse the decision.

So, at this time, the plan is to have the follow up telephone call with Ms. Yeager. Based upon her responses an agenda and approach can be developed for a meeting with the plan medical director as a test case going forward with the other “blues.” Documents in support of our position will be sent out in advance of the meeting so that our time can be spent discussing the merits of our case and possible solutions rather than providing for “basic education” on the issues.

Separately, I will contact Hayes and provide them with the same response information and request a meeting with them to discuss their review process and recommendations going forward.

We will probably know the results of the telephone call later this week.

2. Our work with the AMA - Torre Cassano reports. Dr. Victoria Cassano is our representative to interact with the AMA and her latest report contains some news that I am sure you want to read. In another year we will be applying for a seat in the AMA House of Delegates. Here is her latest report:

A. Membership:

1. At the AMA annual meeting in June of 2004 UHMS was granted a seat in the Service and Specialty Society (SSS) of the American Medical Association. The membership requirements for representation in SSS are one half the requirements of representation in the House of Delegates (HOD). Membership requirements for AMA HOD representation are that 35% of society members eligible for AMA membership must be AMA members. Specialty Societies are granted representation in SSS with the understanding that within three years they will meet requirements for HOD. (Attached are all the requirements for representation in both HOD and SSS).

2. UHMS has 837 members eligible for membership in the AMA. Currently of these, 36.7% are AMA membership. This currently gives us on a 1.7% margin over the threshold (14 members). We are required to show both active recruitment of AMA membership and stay above the 35% threshold by the annual meeting in June 2007.

3. In order to ensure our representation I propose the following be initiated to increase AMA membership among our US physician members:

(a): An AMA issues column be written explaining the purpose and benefits of UHMS seeking representation in the AMA, and discussing items of interest from AMA meetings (e.g. CMMS reimbursement etc:)

(b): AMA membership information be distributed at all US Chapter meetings and at the annual meeting.

(c): A contact be established for your AMA representative with each Chapter’s leadership to assist in flow of information to chapter members regarding the AMA.

B. Representation:

1. I have represented UHMS at both the Annual 2004 and 2005 meetings. I will be attending the Interim 2005 meeting in Dallas November 3 to November 8.

2. Currently, in addition to our seat in the SSS, UHMS is a member of the Section Council on Preventive Medicine. We are seated here due to our certification by the American Board of Preventive Medicine. The section council is a vehicle through which we are able to advance any resolutions we might wish the HOD to consider. Because we do not yet have a seat in HOD, our resolutions must be brought to the floor of the House by either a state society or a specialty society. The section council on Preventive medicine includes ACPM, ACOEM, ASMA and a number of other specialty societies.

3. This fall, your representative was appointed to serve as a member of the SSS credentials committee.

C. Issues/ Resolutions:

1. As of this date UHMS has not submitted any resolutions for consideration by AMA HOD. We also have not supported/ opposed any resolutions as a society in either reference committee or in the SSS.

2. Your representative needs permission of the board to act within her discretion in supporting/opposing resolutions of interest to the society in section council, SSS and reference committee.

3. If there is/are issues that UHMS wishes to submit for deliberation, I will both draft the resolution for acceptance by the board and find an appropriate sponsor at the AMA.

D. Summary/Recommendations

1. That the proposals outlined in A. 3 be accepted by the board

2. That your AMA representative be granted permission to use her discretion in supporting/opposing resolutions of interest to the society at meetings of the section council, SSS and reference committees of the AMA HOD.

3. Fitness to Dive course is valuable training for physicians in several different ways. If you are a physician, a health practitioner nurse, or a public safety diver instructor, you should give some thought about attending our Fitness to Dive course. It is taught by physicians for physicians and we certify physician attendees as Diving Medical Examiners, but other categories of health professionals can benefit as well. For physicians, it is an excellent course to take prior to taking the specialty board exam for Undersea and Hyperbaric Medicine. Recently we have heard from several physicians who told us the course of "exceptionally helpful" to them...even one who did not pass the board exam said it was helpful. We have had nurse practitioners, DMT's, and EMT's who were engaged in doing/assisting with diver physicals attend our course and they likewise said it was a valuable course for them. Our next course in in Charleston, South Carolina at the Embassy Suites (near the airport) on March 16-19. There is still room for more attendees, but we can no longer guarantee that a room will be available. However, rooms are available at some of the other hotels that are close to the Charleston Convention Center and the airport. After Charleston, our next course will be at the NOAA Training Center in Seattle, Washington...this course will be on October 5-8, 2006. The classroom at the NOAA Training Center is limited to 30 attendees so get your reservation in as soon as possible. Just go to our website at and you will find the course listed with a way to register on line.

4. Our annual scientific meeting in Orlando. We're going to have a great meeting in Orlando! Our pre-courses have come together and we will be co-sponsoring one with Divers Alert Network (DAN) on breath-hold diving and one that is being organized by our Associates in concert with the Baromedical Nurses Association (BNA). The breath-hold diving course is a two-day course and will begin on Tuesday, 20 June. Tom Workman's ever popular annual course on preparing for facility accreditation will also be held on the 20th. The Associate/BNA course is a one-day course and will be held on Wednesday, 21 June. Our annual meeting is the usual Thursday through Saturday schedule, but we also will have two post-courses that should interest several of you. One will be taught by our attorney-faculty member of our Fitness to Dive course, Bobby Delise. He will teach a morning session along the same lines as he does for our course and will cover such topics as the legal ramifications of conducting return to work physicals, how some physicians make mistakes in performing physical exams for divers, and other selected topics about diving...all this in the morning session. The afternoon session of our legal post-course will be on the legal ramifications of practicing hyperbaric medicine and will cover topics that several of you have suggested...we can still accept topics for the afternoon session, so let us know what you would like to hear from our lawyer-friend. ATMO will also have a post-course aimed primarily at technicians working in the field of hyperbaric medicine. We already have over 100 abstracts for our three-day scientific meeting and expect several more during the month of March (even though we have to charge a late fee for the March abstracts - keep them coming!). You can register now (several have) by going onto our website at and you will see where to click. By the way, we are working on several ideas to have at our Orlando meeting that should pique your interest...we are thinking of offering a discount of the registration fee at Maui if you register for the Maui meeting during our Orlando meeting. Also, we may be raffling some DisneyWorld tickets, some airline tickets to our Maui meeting, some reduced room rates for our Maui meeting, and several other ideas we are bouncing off the walls right now. All of this and science, too...yes, we're going to have a great meeting in Orlando!

5. Our 40th anniversary meeting in Maui. Our 40th anniversary meeting in Maui, June 14-16, 2007 is going to be a Hawaiian blow-out! It is going to be so memorable that you will be recalling it for years to come. We are planning two on asthmatics and diving and the other on TCOM...these carry such high interest that we are going to have them on separate days so they will not compete for attendees. We will begin with "Are Asthmatics Fit to Dive" on Tuesday, June 12 and TCOM on Wednesday, June 13. Different from our lunch lecture in Orlando on TCOM, the pre-course at Maui will be all day, On Wednesday evening we have scheduled a reception in a luau setting that will include a Hawaiian show. Lisa has negotiated for some rooms at the government per diem rate (today it is $160)...these rooms will be reserved for our Associates and our government employee/military members...they will be offered on a first-come, first-serve basis and Lisa will be taking the reservations. We will let you know when these rooms are available for reservations. As in Orlando...all this and science, too! I will not be surprised if we get near 200 abstracts for our 40th anniversary meeting. By the way, I am working on a 40 year history of the UHMS that we will publish as a hand-out at the meeting. Dr, Chris Lambertsen, our first President, has given me lots of information about the early years and during our move from our Kensington property, I found loads of information that will likewise be useful. Indeed, our 40th anniversary meeting in Maui is going to be a Hawaiian blow-out! You will not want to miss it.

6. Our Dive Expedition off Kona, Hawaii prior to our 40th anniversary meeting. I told you earlier in one of my mass emails that we had engaged the Kona Aggressor, a live-aboard dive boat for a marine expedition. It is a one week charter from Saturday to Saturday, including airport transfer. It will be a diving cruise around Kona, Hawaii to areas best suited for the experience of the group with respect to prevailing weather conditions. All meals and snacks, excluding Friday evening, are provided. Complimentary bar service is also provided on board. All tanks, weights, weight belt, and air refills, consistent with safe diving practices, excluding Nitrox, are provided. The cost is $2195 for a two-bunk room and $1995 for a four-bunk room. There are 10 two-bunk rooms and one four-bunk rooms for a total of 14 divers maximum. Already reservations are being made. We have 6 slots sold and only 8 remaining open. To reserve your spot, telephone Dr. Richard Smerz, Medical Director of the Hyperbaric Treatment Center in Honolulu. His number is: 808-587-3425. Once you make reservations, Lisa will contact you about our payment schedule. We will submit a CME package to our Education Committee and presuming they approve it, we will be offering CME credit hours along with this outstanding dive opportunity. Call Dick today and reserve your spot!

7. Memoriam to Professor Brian Hills.

Vale Professor Brian Hills passed away on 13th of January this year after a long battle with cancer.

I am sure few on this list need enlightenment on Brian's pioneering work in this area and his battle to have dual phase/bubble models accepted at a time when dissolved gas theory dominated the scene.

His work (along with LeMessurier) in capturing the data from the Broome pearl shell divers led to the development of his seminal 1966 thesis "A Thermodynamic and Kinetic Approach to Decompression Sickness". This was followed in 1977 by his book "Decompression Sickness". He was literally a man ahead of his time and an individual of great intellectual courage and imagination, fighting against the entrenched dogma of the USN dominated times.

After years of being vigorously rebuffed by the neo-Haldanian orthodoxy of the day, Brian left the field of decompression on the late 70s to (once again) pioneer research, this time in the field of surfactant, where his team in Brisbane made many great discoveries, some of which are just now approaching groundbreaking commercialisation.

I had the honour to meet Brian several years ago and although already suffering from his illness I had the pleasure of his company for an entire day throughout which he was a delight to speak with and still retained a razor sharp mind.

Right now, I ask that you spare a moment of thought for one of the great original minds in Australian science and particularly in the field of decompression which has lost one of it's true pioneers.

** Our thanks go out to Dr Andrew Fock of Melbourne for bringing this sad news to Dean Laffan's attention…who sent it on to us. Thank you Dean.

Note from Don Chancler, added March 15, 2006
To all--

Just a quick note to let you know that if you haven't made your hotel reservations for our annual meeting in Orlando, June 22-23 you should do so as soon as possible. Over half the rooms are already taken...we have not had such an early showing of reservations during the five years I have been in the position as Executive Director. The convention manager at the Disney World Hilton was so excited today when she looked at our rooming list, she made a special phone call to Lisa just to tell her about it.

Remember that our discounted room rate at the Hilton is good for three days before and three days after our meeting. If we fill our entire block of rooms we can increase the number, but only if the hotel hasn't already sold the rooms. Our discounted rate will also not be in force for rooms reserved after 22 May 2006. Our overflow hotel is the nearby Grosvenor Hotel and the discounted rate there will not be in force after 19 May 2006.

Again, I encourage you to make your reservations soon. If we fill our blocked rooms, we will do all we can to increase the number at the discounted rate, but we cannot guarantee this. An early reservation is therefore the prudent thing to do.