New York City

NYS bill would require Medicaid to pay for oxygen wound treatment

Parker, Ortiz: Treatment crucial to Brooklyn residents

March 19, 2015 By Mary Frost Brooklyn Daily Eagle
Sen. Ruben Diaz, Sen. Kevin Parker, Assistant Assembly Speaker Felix Ortiz, patients and doctors at Wednesday’s press conference in Albany. Photo courtesy of Sen. Parker’s office
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Photos of the injuries are stomach-churning: gaping wounds on the bottom of diabetic patients’ feet, amputations that never close, skin ulcers that fail to heal.

On Wednesday, state officials announced legislation that would require the state to continue paying for a medical treatment currently used to treat severe, non-healing wounds of the type common in diabetes.

Known as topical oxygen wound therapy (TOWT), the treatment is used only when standard treatments have failed for at least 30 days.

Medicaid has covered its use since 2008, but in December 2013, the New York State Department of Health (DOH) announced that coverage would be discontinued.

State Sen. Kevin Parker (D-Park Slope, East Flatbush) and Assistant Assembly Speaker Felix Ortiz (D-Red Hook, Sunset Park) introduced the bills. They were joined at Wednesday’s press conference by Sen. Rev. Ruben Diaz Sr. of the Bronx, patients and doctors.

The officials said the treatment is crucial for Brooklyn and Bronx residents, who suffer disproportionately from conditions like diabetes and venous disease. The largest proportion of patients receiving the treatment — 42 percent — reside in Brooklyn.

“Access to this kind of essential treatment should not be denied to our neediest residents, the 1.3 million adults in New York with diabetes, and the many who have tried other treatments and have nowhere else to turn,” Parker said in a statement.

Senator Parker’s bill was unanimously approved by the Senate Health Committee and sent to the Senate Finance Committee for consideration.

Dr. Amit Shah, chief of Vascular Surgery and co-director of Endovascular Services at Jacobi Medical Center in the Bronx, said in a statement, “As a doctor, I cannot see why the state would deny sick people access to this treatment.”

Dr. James DeMeo, director of foot and ankle surgery at Interfaith Medical Center in Bedford-Stuyvesant, told the Brooklyn Eagle on Wednesday that he was mystified at DOH’s announcement.

“It’s the most advanced therapy we have. When all else fails, this is what we go to — and if all else fails, we go to amputation,” he said.

DeMeo said the treatment ultimately saves the state money. The treatment “is relatively inexpensive, and can be done at the patient’s home, so it requires no transportation, no physician’s supervision and no visiting nurse.”

“At Interfaith Medical Center we see patients with social and economic issues,” he said. “Paying out of pocket is not an option.”

Roughly 40 percent of De Meo’s patients use the therapy; no adverse effects have been reported. TOWT is approved for use in federal Veterans Administration facilities and in 19 states.

Device Maker Obtains TRO

During TOWT, a device delivers 100 percent oxygen directly to the wound, at a pressure slightly higher than atmospheric pressure.

Device maker GWR Medical says the treatment is cheap compared to the alternatives, costing about $2,000 a month for three or four months. They say TOWT heals about 45 percent of chronic wounds unresponsive to standard treatment, and dramatically reduces other wounds.

The state informed GWR in December 2013 that its advisory committee recommended against continuing coverage. GWR maintains that the state didn’t explain why they want to take the Medicaid benefit off the schedule, and that DOH did not follow their own Medicaid benefit review process in making the decision.

The company obtained a temporary restraining order in Brooklyn last November, issued by State Supreme Court Justice Arthur M. Schack and extended by Supreme Court Justice Genine D. Edwards.

GWR is awaiting Justice Edwards’ decision on the substance of the case. In the meantime, the TRO remains in effect.

In February 2015, Ronald Bass, a director in the Office of Health Insurance Programs for DOH, filed an affidavit with the court saying coverage was being discontinued because “There is a lack of consistent, authoritative and persuasive evidence that it is an efficacious treatment, and because alternative, proven types of wound therapy are available under Medicaid.”

Bass wrote that this recommendation had been made by experts at Oregon Health and Science University’s (OHSU) Center for Evidence-Based Policy, which judged that supporting scientific literature was weak, scientific evidence was conflicting and that randomized controlled trials were not carried out.

(A source noted that one of the papers called weak was written by OHSU’s own researcher Dr. Daniel Ladizinsky, and published in Wounds Journal in December 2010. It stated that “there appears to be a significant advantage to delivering oxygen topically.”)

Dr. De Meo told the Eagle that DOH has asked for a “double blind study.” Such a study would involve giving a placebo to a percentage of the patients seeking treatment — something he called “morally irresponsible.”

“Knowing that someone could potentially lose their leg, it’s unethical. It’s a strange request,” he said.

DOH told the Eagle that the agency does not comment on pending litigation.



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