Hyperbaric oxygen therapy (HBOT) can open new and nontraditional revenue doors while boosting orders for complementary products.

Wound care and hyperbaric medicine represent a significant opportunity for increased revenues and employment for respiratory therapists (RTs). Hyperbaric oxygen therapy (HBOT) is a means of providing additional oxygen to the tissues. This increased oxygen delivery furthers the body's ability to heal wounds.

HBOT can be used in addition to medical and surgical therapy associated with the treatment of people with chronic nonhealing wounds, and is typically utilized as an adjunct treatment for radiation tissue damage (soft tissue and osteoradionecrosis); clostridial myonecrosis (gas gangrene); compromised skin grafts and flaps from failed surgical procedures; necrotizing soft tissue (subcutaneous, muscle, fascia) infections; osteomyelitis or severe bone disease (refractory); and, of course, problematic nonhealing wounds related to diabetic complications.

It is estimated that roughly 4 to 10 million people suffer from chronic nonhealing wounds, which results in an increased burden on the economy with millions of dollars expended for treatment that often can last for months or even years. In fact, it is estimated that the financial impact to the United States exceeds $20 billion annually, and the amount continues to increase as failed treatments from lower extremity wounds result in amputations due to diabetic foot ulcers. Addressing this need presents a tremendous opportunity.

The vast majority of people who suffer from conditions associated with chronic nonhealing wounds are in their homes or long-term care facilities. The incidence of obesity, and the resultant diabetic-related complications, contributes to the increasing numbers of people who develop chronic nonhealing wounds. As the Baby Boomers age, the issues of wound care treatment and management become an even greater concern to the medical community.

HBOT: THE HEALING PROCESS FOR WOUND CARE

HBOT is administered in an air-filled multiplace or monoplace chamber in which patients breathe 100% oxygen at greater than one atmosphere of pressure, while encapsulated in the oxygen-rich environment. This increases the level of oxygen delivered to the tissues and augments wound healing and repair.

The multiplace chambers are typically located in acute care settings and serve as an adjunct for wound care, in addition to decompression sickness and carbon monoxide poisoning. The monoplace chambers can be located in a section of acute care facilities or in a stand-alone location in outpatient settings.

Monoplace chambers treat one patient at a time. Patients typically must lie flat or slightly elevated in one position during the treatment. The chamber is pressurized with 100% oxygen, which the patient breathes directly.

Multiplace chambers can accommodate two or more patients at the same time. Patients sit in seats or lie on a stretcher if necessary. They are even free to stand. The chamber is pressurized with compressed air, and patients breathe oxygen through specially designed hoods, face masks, or endotracheal tubes (for patients with tracheotomies), which is not possible in some instances with monoplace chambers.

The strength of hyperbaric medicine stems from the power of 100% oxygen (the normal air we breathe is only 21% oxygen) delivered in a pressurized chamber to "supersaturate" the blood's plasma. Injury, poisoning, disease, and chronic necrotic tissues that lack blood flow or perfusion can disrupt oxygen delivery, depriving tissues and cells of some or all of their required oxygen, thereby impeding healing.

HBOT is widely recognized by the medical community as a highly effective therapy, and more importantly, it is covered by Medicare and major insurance plans. The treatment is delivered through sessions known as "dives" in which the patient is placed in the chamber.

The hyperbaric chambers (multiplace or monoplace) safely create a pressurized environment (equivalent to two to three times the pressure of air at sea level) for the patient. The "dives" last up to 2 hours in which patients pass the time reading, listening to CDs, or watching videos on the chamber's entertainment system—mounted flat-panel televisions that are either cable ready or equipped with DVD players.

ABANDON THE STATUS QUO

The incidence of chronic nonhealing wounds in most metropolitan areas exceeds 2% of the general population, thus HBOT represents a significant business opportunity. Home care providers and RTs who are innovative and willing to abandon the status quo have a "real time" opportunity to mitigate the reimbursement issues for equipment, and the lack of reimbursement for RTs. In fact, many well-planned HBOT centers can realize a small profit margin in the first year of operation, and a significant margin over the first 3 years.

The pull-through for home care/HME providers also results in orders for diabetic-related supplies, nutritional supplementation, HME equipment and supplies, supplemental oxygen, pharmaceutical services/supplies, and additional referrals from physicians. Home care/HME RTs who pursue this new and exciting opportunity not only are poised to respond to the increasing demand for wound care treatment, but also can capitalize on the revenue potential as wound care management and HBOT use rapidly grow and become more profitable.

HBOT: THE CASE FOR RTS

Vernon R. Pertelle

RTs who have been trained in the specifics of pulmonary gas laws and oxygen therapy can receive additional training of 50 hours of education, followed by 200 hours of comprehensive supervised clinical care of patients using HBOT, and then obtain certification as a certified hyperbaric technician. In the Southern California area, RTs currently perform this treatment in facilities such as Loma Linda (Loma Linda, Calif) Medical Center; University of California San Diego Medical Center; and soon at Tri-City Medical Center (Oceanside, Calif).

Although this may sound like unconventional thinking, it certainly is refreshing to consider the potential if respiratory therapists would simply "think out of the box" and ponder the potential upside to adding another feather in their professional caps. There is a growing incidence of RTs working in the field of wound care and hyperbaric medicine—as well as a growing need to increase the numbers of RTs in this relatively new field.

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It is my desire to secure the medical mainstream acceptance of the RT in home care as a significant component in the continuum of care. I believe that adding hyperbaric therapy to the profession can help achieve this objective. For home care/HME providers who are willing to invest time and resources in hyperbaric oxygen treatment, it can lessen the industry's many reimbursement woes.

Vernon R. Pertelle, MBA, RRT, is senior director/assistant vice president for Tri-City Healthcare District (Home Care, DME, Hospice, Occupational Health & Wellness, Rehabilitation Services, and Center for Wound Care & Hyperbaric Medicine), San Diego. He can be reached via e-mail: .