Re: An opportunity for change.6

[Guest guest]

Where is it written that a hospital can not treat off-label?

KP Stoller, MD

Assistant Clinical Professor, Pediatrics

UNM, School of Medicine

Medical Director, Hyperbaric Medical Center of New Mexico

www.hbotnm.com

[Guest guest]

That's what having patients sign a waiver is all about!

KP Stoller, MD

Assistant Clinical Professor, Pediatrics

UNM, School of Medicine

Medical Director, Hyperbaric Medical Center of New Mexico

www.hbotnm.com

If you find out exactly where this is written down, please let me know. I can

tell you that when I opened our hyperbaric department in the fall of 2000, I was

told by our business office that we could not charge Medicare patients

out-of-pocket for things the Medicare expressly denied. Since the CIM 35-10

expressly forbids coverage for things not specifically listed as 'covered', I

was told I could not consider off-label for Medicare patients. Most private

insurers follow Medicare's lead, so that ruled them out for the most part as

well. Even if I could treat off-label out-of-pocket, this list is well aware

that out-of-pocket at a hospital means paying the full 'list-price' charge

without the benefit of 'contractual agreements' to reduce that charge. This is

why I've been following the Lucette Lagnado articles in The Wall Street Journal

as they are leading to changes wherein CMS is beginning to allow carefully

worded 'contracts' with the uninsured/underinsured so they get a price break.

See " New York State Hospital Agree to Cut Prices for Uninsured, " by Lucette

Lagnado, The Wall Street Journal, February 2, 2004, paragraph 9: " One [bill in

the New York state legislature] would peg payments by needy uninsured to the

amounts hospitals collect from Medicare or private plans. Another would impose

much more patient-friendly controls on an $840 million state-administered pool

available to hospitals to cover the costs of caring for the uninsured. "

ston

Re: [ ] re: an opportunity for change.6

Where is it written that a hospital can not treat off-label?

KP Stoller, MD

Assistant Clinical Professor, Pediatrics

UNM, School of Medicine

Medical Director, Hyperbaric Medical Center of New Mexico

www.hbotnm.com

[Guest guest]

,

How does UHMS exercise its control over hospital based HBO clinics. Why do

hospital-based clinics follow rules and regulations set forth by UHMS., if in

fact it is UHMS doing the regulating. Or does UHMS exercise control through

the insurance companies ;and governmental health care services such as

medicare/medicaid.

Evidently tere is a regulatory agency hidden somethere which exercises

control. In o;;ther words how is the money issued and controlled in government

cases and with civilian insurance companies.

I Know it was the Committee of 21 in UHMS which determined the indications

which weree to be reimbursed but I was never able to determine where the legal

authority originated. Manson

[Guest guest]

Re: [ ] An opportunity for change.6

,

How does UHMS exercise its control over hospital based HBO clinics. Why do

hospital-based clinics follow rules and regulations set forth by UHMS., if in

fact it is UHMS doing the regulating. Or does UHMS exercise control through

the insurance companies ;and governmental health care services such as

medicare/medicaid.

Evidently tere is a regulatory agency hidden somethere which exercises

control. In o;;ther words how is the money issued and controlled in government

cases and with civilian insurance companies.

I Know it was the Committee of 21 in UHMS which determined the indications

which weree to be reimbursed but I was never able to determine where the legal

authority originated. Manson

--from Bill Duncan:

(Thanks Dr Bill, as I haven't had time to respond)

: I think I can answer all of your first question, and part of your

second. The second is first. My MSN account is accessed through the MSN

website and hotmail. Unfortunately my messages do not appear on the lists

unless someone posts it for me because I cannot convert to text and therefore my

messages are not posted. Now usually posts for me or I send plain text

from my home computer.

Now for the first question. How did UHMS become the authority, and who gave it

to them? It is straightforward. The government depends upon the Medical

Specialty Associations to know, govern and police their own medical specialty.

There are differences between medical specialties and conflicts at times, and

the government really doesn't like to take sides, though it often inadvertently

does. They simply depend upon scientific self-interest to govern the affairs of

the specialty associations. Over the past 9 years I've met almost every one of

these associations, colleges, academies, boards and societies in virtually every

medical specialty. They are medical professionals trying to treat patients,

protect their turf from encroachment, use the government to gain advantage, use

the Congress to gain protection from the Executive branch, and always after more

money for biomedical research or insurance reimbursement. The level of noise is

substantial.

The answer to your question of where UHMS got their authority is they were

simply there. It is partially outlined in Vance Trimble's book, " Hyperbaric

Oxygen: The Uncerain Miracle. " In fact acute traumatic brain injury could be

treated until I believe 1998 under cerebral edema, which the UHMS had removed

from the list. It was there for 10 years. They simply had the " authority " as

THE medical specialty society dealing with hyperbaric medicine.

In my opinion they squandered their advantage to our true determent. Internal

turf wars actually suppressed the miracle that hyperbaic oxygen is for the past

50 years.

I was amazed when the FDA told me they no longer believed the UHMS on coverage

issues and were demanding scientific evidence before approving more indications

from the UHMS for the chamber label. The reason given was Blue-Cross/Blue

Shield had evaluated the science with their evidience based medicine task force

and kept 8 of the 13 indications and added 8 that were not on the list. That

action by BCBSA shattered the perceived authority of the UHMS, and was I'm sure

is one of the reasons why Medicare turned down hypoxic wounds when the UHMS

submitted it.

What CMS wanted was evidence, and that is what they received from the IHMA. The

IHMA turned in 129 references, listed on the CD coming to you in the mail as a

member of the IHMA, and available at the Florida symposium. With that evidence,

assembled by Dr. Harch, CMS approved diabetic foot wounds. Harranging

doesn't work, but evidence does. That is the secret to getting private and

public insurance reimbursement.

The UHMS's opposition to treatment of brain injury is the most irrational

behavior I've ever seen on the part of any medical speciality society. It is

irrational because the science is clear. THERE IS MORE EVIDENCE FOR TREATMENT

OF BRAIN INJURY THAT ALL BUT 4 OF THE UHMS'S 13 APPROVED INDICATIONS. You see,

you publish scientific research so you can permit others to try your experiment

to see if they got the same result. It is a simple fact that EVERYONE WHO

FOLLOWS THE NEUBAUER-HARCH DIVE TABLES FOR TREATMENT OF CHRONIC BRAIN INJURY AND

FOLLOWS THE BLOCKS OF 40 PROTOCOLS HAS RESULTS. An examination of next week's

symposium agenda demonstrates that well.

How much result from treatment always depends upon how much brain tissue is

available for recovery, how long ago the injury took place, the severity of the

original injury, etc. Acute treatment is absolutely the best, preferably within

an hour (according to the emergency medicine docs like Van Meter out

there) and certainly before hypoxic neuronal death takes place. (That window of

opportunity is actually longer than most people think.)

In fact, Dr. Van Meter has brought both pigs back after 20 minutes of cardiac

arrest, with no apparent residual neurological damage. This work is based on a

diving accident treated a number of years ago.

Ask an emegency room doc what the FIRST DRUG is and they'll tell you oxygen. It

therefore makes logical sense that if you safely deliver 7 - 15 times as much

oxygen to oxygen-starved tissues, before neuronal death takes place, you'll have

positive results. As I stated earlier, the UHMS's opposition is completely

irrational and certainly is not logical.

It is much as a recent discussion we had with a government official

demonstrated. We were examining the evidence for acute hyperbaric treatments,

and the Rockswold study shows a 57% reduction in mortality in 35 year olds. it

had been argued that the study wasn't done one the elderly, so irrelevant to

that population. I just asked a small question, " Doc, does this make sense to

you? Hyperbaric oxygen reduced mortality in 35 year olds by 57% but old people

don't need it? " He looked at me and said, " No, it doesn't make sense. If

anything, they need it more. "

I saw a humorous rejection letter to a recent hyperbaric article submitted to a

journal. It said basically, " This is just more hype for them to make money.

Visit any hyperbaric website and you'll see some story of a miracle patient as

part of their hype. There is no evidence.... " I just laughed. First, this guy

resents that he has no miracle patients to show so he can make money (and

believe me he makes more per hour than the hyperbaric doctor does.) Secondly,

the fact that " every " clinic has some story like this should give you a clue.

Anecdotal evidence is still evidence and is the SOURCE of later " scienific "

evidence. Almost all of surgerical practice is anecdotal evidence. Plus, if

this treatment was fraud, you'd have every parent out there who paid their money

out of their pocket, run to the attornies general in every state demanding their

money back and that these clinics be shut down. Instead it is the opposite.

People are spending what it takes to get their children and loved ones treated

and clamouring for more. Look what you did trying to get them to treat your

wife after her stroke.

So, to add a bit of rationality to the world out there, the IHMA is moving

forward, organizing the evidence that exists, and sponsoring research projects

where more evidence is needed, while helping other physicians, government and

insurance companies better understand the true science behind the miracle of

oxygen saturation technology. The result is that all of the community will

benefit, and the government will save billions of dollars. Every year of delay

is more billions wasted and more lives destroyed because of the stupidity of a

few smart people.

One of the keys is health care practitioners need to learn how to do this

treatment, which is why the IHMA Foundation is sponsoring the first ever courses

in neurlogical treatment with hyperbaric medicine next year. These courses will

be available to anyone with sufficient medical education to take them.

Enjoy Dr Bill Duncan, inside the government and truly here to help. :-)