As the Covid-19 epidemic continues, our wound center partners find themselves navigating an entirely new landscape. Randy Brooker, President of Center Operations, has managed wound care programs for over 15 years. He’s also a certified hyperbaric technologist and a previous educator for various hyperbaric courses. Here, he answers common questions about Covid-19 and hyperbaric oxygen therapy (HBOT).
Q: How can wound centers keep hyperbaric oxygen therapy (HBOT) patients safe when they receive treatment during the current pandemic?
A: It’s important to note that many wound care patients need this essential treatment, even during this challenging time. Our patient population is already at high risk for complications, including amputation. So, we’ve collaborated with our wound care program partners to help them take their already rigorous disinfection policies to the next level with specific cleaners that are 1) safe for hyperbaric oxygen therapy chamber acrylics and 2) effective against the Covid-19 virus. In addition, it’s important to clean and disinfect all high-touch areas within the suite, including the HBOT unit, in between patient visits. Lastly, we suggest patient screening begin one day prior to each appointment. We suggest pre-appointment telephone screenings for any signs or symptoms of active disease. It’s important to screen once again before entry into the waiting room. Many of our wound centers are having patients call from their cars on arrival and wait until the unit is ready so they can be safely escorted to their treatment room. It’s important to reschedule if any risk is detected for the protection of employees and other patients.
Q: If a patient stops coming in for HBOT during the pandemic and returns several weeks or months later, what are the risks? If they simply cannot come in, what is done?
A: If a patient decides not to continue treatments for any reason, they need to be re-evaluated. This would include a new HBO orientation and a medical evaluation to assess if any medical changes would prohibit their resumption of care. Additionally, the patient may have improved to the point where HBO treatments may no longer be necessary. Lastly, if indicated and needed, we will again approach commercial payers for another round of authorizations and verify insurance benefits for the new course of treatment.
Q: Some hospitals are using HBOT as a way to help Covid-19 patients avoid the need for mechanical ventilation. Has it been effective?
A: It’s very early and we need more data. A couple of our HBO units are treating patients in an effort to improve organ hypoxia and prevent eventual patient intubation and mechanical ventilation (assumed to be a limited resource during a worldwide pandemic). There are a few small studies out currently showing some effect in both of these areas and other, larger studies are currently underway. The mechanisms of action associated with hyperbaric oxygen are uniquely able to impact these pre-critical patients’ disease symptoms, hopefully having positive effects on acute disease outcomes. We’ll know more soon, when the larger studies are released.
Q: There are clinical trials taking place now at NYU Winthrop Hospital/NYU Langone Health. What do we know, so far? Will this result in an increase in HBOT for COVID-19 patients?
A: The very early results of these studies indicate there is a positive result on the organ hypoxia and resulting “cytokine storm” that eventually leads to more critical disease. We need more data to determine the long-term role of HBOT in the COVID-19 patient population. The ongoing studies will certainly give us a better understanding of the future role of HBOT for this patient population.
Q: What about insurance coverage for COVID-19 patients and HBOT? Is it reimbursable?
A: At this point, the use of HBOT for these patients is for compassionate use only and no additional reimbursement is anticipated. It’s sometimes just the right thing to do for the patients’ overall well being. Should the study data be proven to have an effect on preventing the progression to a more critical nature including mechanical ventilation, it is possible that CMS, and probable that commercial payers, will begin to allow these treatments to be reimbursable.