Do doctors need to be ACLS certified for HBO therapy? Is there any research that states hyperbaric oxygen therapy causes cardiac arrhythmias?
Posted: 3/21/2023
Q:
Do doctors need to be ACLS certified for HBO therapy? Is there any research that states hyperbaric oxygen therapy causes cardiac arrhythmias?
A:
Do hyperbaric oxygen treatments cause cardiac arrhythmias?
Hyperbaric oxygen is not known or reported to cause cardiac arrhythmias except for bradycardia which is usually benign. Dr. Bove states in the chapter cited above, "Current evidence indicates that HBOT results in increased vagal tone... These changes are well tolerated in patients with normal cardiovascular function, but can result in clinical deterioration in patients with compromised cardiac function." I include some attachments that provide additional guidance. The most significant issue related to cardiac complications and hyperbaric oxygen are the induction of cardiac congestive failure which can be fulminant and cause flash pulmonary edema. See attached additional information from Dr. Hampson and Dr. Weaver’s small case series of patients. In part, the pathophysiology results from peripheral arterial vasoconstriction with resultant increased afterload.
Is there a requirement for physicians to have ACLS certification to practice hyperbaric medicine?
Several years ago Novitas in their coverage document indicated that hyperbaric physicians should have ACLS certification to qualify for payment. This is no longer a requirement by Novitas. Local credentialing requirements may require specific educational or training requirements to be credentialed at their institution, and this could include ACLS certification.See below Dr. Gelly's discussion of treatment in free standing centers and in hospital treatment centers where a code team is not readily available.
Medicare intermediaries are not credentialing agencies, however private insurance carriers are credentialling agencies, and they can, and do, require Board certification in some instances.
The question is whether or not you are credentailing to the most restrictive, ie commercial plans.
A prime example of this is MVP in upstate New York that required UHMS accreditation for payment, they can set whatever criteria they want.
Cigna has already sent out letters denying physician participation in their plan because they were not Boarded in UHM.
A provider recommends that physicians supervising hyperbaric oxygen therapy should be certified in Undersea and Hyperbaric Medicine by the American Board of Emergency Medicine (ABEM) or the American Board of Preventive Medicine (APBM) or must have completed additional training in hyperbaric medicine, such as the 40-hour training required by the ABPM. Advanced Cardiac Life Support (ACLS) training and certification of supervising physicians (and NPPs) is required in physician offices and off-campus hospital sites; and in on-campus provider-based departments only for which provider-response time of an emergency code team to the chamber can be expected to exceed five minutes.
With only one exception, WPS Medicare has never required board-certification for any Local Coverage Determination. The one exception was a national Medicare requirement. We have never required any physician to complete a specific course, although we have encouraged appropriate training.
A suggestion that ACLS training not be required for supervising physicians until six months after the effective date of this LCD and that such training will not be required for supervising physicians in on-campus facilities, at which code teams always arrive within five minutes was made. The provider further suggested that board certified physicians whose practice routinely involves intensive care not be required to have ACLS training.
WPS Medicare has not put into this policy that the physician must have ACLS or ATLS certification. Such certification is recommended, but is not required.
John Feldmeier, D.O.
