by Caroline Fife, M.D. | May 20, 2015 | Cassandra Chronicles: Regulatory and Coverage Policy, Don't Miss This, Pressure Cooker: Rethinking Pressure Ulcers, US Wound Registry
This is the photo of a 30-year-old white male with a one-year history of a small non-healing ulcer on the dorsal aspect of his right great toe. He was followed for a year at another wound center in my city, using a variety of topical products. I follow the “wounds...
by Caroline Fife, M.D. | May 14, 2015 | Cassandra Chronicles: Regulatory and Coverage Policy, Miscellaneous Musings, Pressure Cooker: Rethinking Pressure Ulcers, US Wound Registry
Today I had to write a letter to a NPWT company in order to prevent that therapy from being discontinued. The patient is a quadriplegic with an ischial pressure ulcer. I’ve been seeing him for the past 4 months and have managed to keep him out of the hospital,...
by Caroline Fife, M.D. | May 13, 2015 | Cassandra Chronicles: Regulatory and Coverage Policy, Miscellaneous Musings, Pressure Cooker: Rethinking Pressure Ulcers, US Wound Registry
Last week I told you about the case of a 55 year old man with rest pain and a TCOM of 35mmHg on his anterior leg. Because he had been sleeping in a chair due to rest pain, he had some edema of his leg. In order to know whether a low oximetry value is due to ischemia...
by Caroline Fife, M.D. | May 6, 2015 | Cassandra Chronicles: Regulatory and Coverage Policy, Don't Miss This, Pressure Cooker: Rethinking Pressure Ulcers, US Wound Registry
I thought I’d spend the month of April thinking about vascular screening. Last week I saw a 55-year-old man who suffered a minor scratch on his left shin 6 months earlier. He is a heavy smoker. Before the injury his walking was limited by claudication. After the...
by Caroline Fife, M.D. | May 5, 2015 | Cassandra Chronicles: Regulatory and Coverage Policy
Is anyone else out there noticing that they have to call for a “peer-to-peer” every time they want to get an advanced therapeutic approved for patients with Medicare HMOs? I try to be very judicious in my use of advanced therapeutics like cellular products and...
by Caroline Fife, M.D. | Apr 16, 2015 | Cassandra Chronicles: Regulatory and Coverage Policy
By now you have heard about Medicare rescinding coverage for most of the honey based dressings. I had good success with them for a variety of applications. However, the sad fact is that a lot of the research we need to do about dressings and the benefits of the...
by Caroline Fife, M.D. | Apr 6, 2015 | Cassandra Chronicles: Regulatory and Coverage Policy, Do the Right Thing: Thoughts on Quality, Fight the Good Fight
I just got back from the National Quality Forum meeting in Washington, DC. I’ll spend Mondays in April telling you what I learned about the conference, the theme of which was “Tackling Costs: The Quality Solution.” The Kaiser Foundation estimates that the average...
by Caroline Fife, M.D. | Mar 31, 2015 | Cassandra Chronicles: Regulatory and Coverage Policy
The field of hyperbaric medicine is under threat from so many different directions that it’s hard to decide which one is the BIGGEST. Helen Gelly and I will talk about this at the upcoming SAWC (Saturday May 2nd, 4:45 PM-5:45). We will have a big Prozac salt lick in...
by Caroline Fife, M.D. | Mar 24, 2015 | Cassandra Chronicles: Regulatory and Coverage Policy
Unless you are in one of the 3 states affected by the “preauthorization” requirement for hyperbaric oxygen therapy, you may not have been following this issue so let me fill you in. Medicare is rolling out a pilot project in which they are requiring non-emergency...
by Caroline Fife, M.D. | Feb 24, 2015 | Cassandra Chronicles: Regulatory and Coverage Policy
Package pricing is only the beginning of the changes to outpatient payment. There are new global periods going into effect, and there will be other changes that take us toward some sort of outpatient “DRGs” (diagnosis related groups) or capitation—or reimbursement...
