Chambers And Insurance

[lv2dive]

I think this question was answered a few posts back: in the US, a physician is required to be onsite. Therefore the consult model utilized in Truk (that you have referenced idk how many times in 24 hours) is not going to cut it in FL

 

[Kevrumbo]

I think this question was answered a few posts back: in the US, a physician is required to be onsite. Therefore the consult model utilized in Truk (that you have referenced idk how many times in 24 hours) is not going to cut it in FL

No Kate . . .

DDM said:

. . .Even those that advertise the ability to treat divers may not have experience - I've personally walked chamber staff through a treatment table 6 via the phone - which is why divers with "subtle" symptoms will (or should) be evacuated to a hyperbaric facility that takes emergencies, including divers, and not just an outpatient wound care clinic that has a hyperbaric chamber.

Recompression And Medical Ethics

DAN approved the Truk Recompression Treatment with remote consultation, and DAN's insurance underwriter's approved the reimbursement.

A Hyperbaric Specialist Physician can be consulted by phone; An Emergency Medicine Physician is physically there to provide Advanced Life Support as needed. . .

 

[lv2dive]

The last time I checked, Truk was not in the US. What DAN did or didn't approve for reimbursement has nothing to do with what is legally allowed in the US.

Please see below for Duke Dive Medicine's post (bolding is mine) which informed my thought process above. Admittedly it is in another of the (2 or 3?) threads on this topic rather than this particular thread; I apologize for any confusion.

Depending on the type of chamber, an inside attendant may not be required. Monoplace chambers hold only one person, the patient, and are generally used for less acutely ill patients, though some facilities treat critically ill, intubated patients in them. Multiplace chambers like the one at Duke hold more than one person; patients are accompanied by at least one attendant (not necessarily a physician, often an RN, paramedic or EMT), who will place the oxygen apparatus on the patient and intervene in emergencies.

The standard of care for hyperbaric oxygen therapy in the U.S. is that a physician must be present or immediately available during the treatment, so remote supervision, telemedicine and automated chambers would not meet that.

Best regards,
DDM

Link to thread: Recompression And Medical Ethics

 

[Kevrumbo]

The last time I checked, Truk was not in the US. What DAN did or didn't approve for reimbursement has nothing to do with what is legally allowed in the US. . .

Kate, I know this both as a Chamber Operator and a Patient undergoing HBOT Table 6:

A Hyperbaric Specialist Physician can be in telephone conference consult.

An Emergency Medicine Physician is physically there to provide Advanced Life Support as needed. . .

DAN's approval & insurance reimbursement policy for treatment in their vetted & sanctioned Recompression Chamber facility network is consistent whether in the US or overseas across the world. . .
________________

AMA CPT 99183 states physician attendance and supervision of hyperbaric oxygen therapy, per session. Confusion has resulted from this description because of the ambiguity created by including two descriptions that could be considered to reflect very different performance requirements. . .

1. The physician is physically present during the entirety of the treatment and uses that time to manage the patient’s overall care;
2. Physicians remain available to manage rare emergency situations but are not continually present or available. . .

For the remainder of this discussion, only requirements for physician billing for 99183 will be discussed.

Hyperbaric oxygen treatment supervision by an unrestricted licensed physician. For a physician to bill 99183, the requirements for direct supervision must be met. According to federal regulations, direct supervision for purposes of hospital outpatient services means that "the physician must be present and on the premises of the location and immediately available to furnish assistance and direction throughout the performance of the procedure." (42 C.F.R. § 410.27; CMS Transmittal B-01-28). For the physician, being in attendance during any key portion of each treatment session, seeing the patient before, during, or after the treatment, and being immediately available for any emergency or other assistance that is required during treatment should be sufficient for the physician to bill 99183. This interpretation is consistent with the relative value for this procedure assigned by CMS (then HCFA) in 1993 and allows the supervising hyperbaric medicine physician to treatment more than one patient at a time and to see wound care patients in the same or a contiguous area while supervising hyperbaric oxygen treatment. Although CMS (then HCFA) did make an attempt to define specific training and credentialing requirements for physicians supervising hyperbaric oxygen treatment in 1999, no specific requirements are in place at this time. It is the responsibility of each hospital medical staff to address minimum training, performance, and quality standards although professional organizations such as the Undersea and Hyperbaric Medical Society2 and the American College of Hyperbaric Medicine provide guidance in these areas. . .

(See article link)
(See also: Physician Assistant (PA) or Nurse Practitioner (NP) supervision of hyperbaric treatment – International ATMO, Inc.

 

[Duke Dive Medicine]

No Kate . . .


DAN approved the Truk Recompression Treatment with remote consultation, and DAN's insurance underwriter's approved the reimbursement.

A Hyperbaric Specialist Physician can be consulted by phone; An Emergency Medicine Physician is physically there to provide Advanced Life Support as needed. . .

Kev, you're misquoting me. The person that was on the other end of the phone line was the supervising physician for the treatment that the patient in question was undergoing. Kate is correct in her assertion. Even on Catalina, a physician is flown out via rotary wing aircraft to personally supervise the treatment (as you well know). Yes, it may not be a board-certified hyperbaric physician, but it's still a physician with some experience in diving medicine who is personally present at the treatment site and can intervene if something goes awry.

Your advocacy for a grass-roots chamber movement in North Florida is laudable, don't get me wrong, I'm all for it, but whoever does it has to go in with eyes wide open re the legal and medical aspects of doing so.

Best regards,
DDM

 

[Kevrumbo]

Kev, you're misquoting me. The person that was on the other end of the phone line was the supervising physician for the treatment that the patient in question was undergoing. Kate is correct in her assertion. Even on Catalina, a physician is flown out via rotary wing aircraft to personally supervise the treatment (as you well know). Yes, it may not be a board-certified hyperbaric physician, but it's still a physician with some experience in diving medicine who is personally present at the treatment site and can intervene if something goes awry.

Your advocacy for a grass-roots chamber movement in North Florida is laudable, don't get me wrong, I'm all for it, but whoever does it has to go in with eyes wide open re the legal and medical aspects of doing so.

Best regards,
DDM

DDM there's also this:
Physician Assistant (PA) or Nurse Practitioner (NP) supervision of hyperbaric treatment – International ATMO, Inc.

(Btw -thanks for coming over here! I've been sanctioned with non-posting privilege in that other thread "Recompression and Medical Ethics")

 

[Duke Dive Medicine]

That might go away if CMS has its way. There's a proposed local coverage determination that may supersede that.

Best regards,
DDM

 

[Kevrumbo]

That might go away if CMS has its way. There's a proposed local coverage determination that may supersede that.

Best regards,
DDM

Fair enough . . .but as of my Oct 2008 treatment in Truk's multiplace Chamber (actual picture), there was an Emergency Medicine Physician on-call but not present, a Nurse/Tender, the Chamber Operator/Director; and I also verbally gave informed consent by telephone to HBOT Specialist Glen Hawkins MD in Australia. DAN was also consulted and approved the treatment, and reimbursed Hyperbaric Health Australia $3000 plus $500 Physicians fee (and Dr. Hawkins wasn't even physically there!) -although it took a year for DAN's insurance underwriters' to cut two checks of $1750. Two days later, I was in Honolulu Queens Medical Center and Kuakini Hyperbaric Dept under the care of Dr. Richard Smerz DO, getting a work up to Rule Out DVT/PE --left lower leg Ultrasound, Thoracic CT Scan diagnostics along with another round of HBOT table 6, and my primary health insurance covered that follow-on bill in full within two months. . .

Anyway, the point is a Physician -preferably an ER Doc with some Hyperbaric training- should be available, and can also be in remote telecom consult with a Hyperbaric Specialist Physician.

 

[Kevrumbo]

. . .
Your advocacy for a grass-roots chamber movement in North Florida is laudable, don't get me wrong, I'm all for it, but whoever does it has to go in with eyes wide open re the legal and medical aspects of doing so.

Best regards,
DDM

At least one diver seems inspired over there:

Quoting from Florida statutes:
“Any person, including those licensed to practice medicine, who gratuitously and in good faith renders emergency care or treatment…shall not be held liable for any civil damages…where the person acts as an ordinary, reasonably prudent person would have acted under the same or similar circumstances.”

Bottom line: if the chamber is operated by VOLUNTEERS (not paid staff), the "bar" needed to EVEN FILE a suit is evidence of gross negligence.

The operative questions are:

1. Will Florida Cave Divers who spend $$$ a year on their own equipment be willing to donate a couple % of their personal budget to sponsoring a chamber.

2. Will Florida Cave Divers who spend (God knows how many) hours on their personal skills training (and partying) be willing spend a few hours learning how to be chamber operators. We have LOTS of fire/ems/medical personnel in our ranks.

3. With a pager system, will Florida Cave Divers living within 1 hr of High Springs (just for argument's sake) be willing to take time off to go assist a fellow diver who needs their help?

The way I see it, if the community can agree on items 1-3, the rest is just paperwork.

Forrest mentioned that there was a previous attempt at establishing a Cave Country Chamber that failed when 1 person absconded with the funds. Maybe it's time to try again, WITH a few financial safeguards in place.

I'm 1,400 miles from cave country, and I get down there once a year (maybe). I will put up the first $500, tell me who to make the check out to.

I've spent 40+ years helping those in need, and I have no intention of stopping now!

Chambers recompressing diver's database

 

[lv2dive]

The post quoted above is from someone who acknowledged they live 1400 miles from cave country. There is discussion in that thread about the logistical and legal issues as well.

FL is reeling from recently settled and still-pending litigation in relation to deaths... Lawsuits most view as frivolous and a waste of money for the defendants. There is little appetite to create another avenue for exposure.