Delphia Langford is normally not one for cramped spaces.
However, Langford, 61, and a diabetic for 33 years, is willing to spend up to two hours at a time in a hyperbaric oxygen chamber at Wake Forest University Baptist Medical Center to possibly avoid the amputation of her left foot.
"I'm hoping this effort will let me continue to walk and take care of myself," said Langford, one of the first patients at the hospital's Wound Care and Hyperbaric Center, which officially opened last week.
"I just don't know if I have the strength to use an artificial limb."
Hyperbaric therapy works by providing 100 percent oxygen to a patient inside a pressurized, clear chamber that is 32.5 inches in diameter and 90 inches long. It's the equivalent of being a diver about 33 feet below the ocean's surface.
The therapy is becoming increasingly available in North Carolina for reducing swelling, fighting infection, building new blood vessels and producing healthy tissue for people with chronic, hard-to-heal wounds.
Treating those wounds, particularly for diabetics, has become a focus of Forsyth and Wake Forest University Baptist medical centers in recent months.
It also has the potential to intensify market competition between the health-care rivals.
Each has opened a treatment center for chronic wound care in recent months that they believe will attract patients beyond the Triad. The bulk of wound-care patients are more than 60 years old, according to the Centers for Medicare and Medicaid Services.
Wake Forest Baptist's center is a 3,800-square-foot facility that eventually will have four hyperbaric chambers and six treatment rooms. The center is being operated in partnership with Diversified Clinical Services, the world's largest wound-care management company.
Forsyth's limb-preservation center is aimed at reducing the number of limb amputations in patients with complications from diabetes, peripheral artery disease and injury. It has 10 treatment rooms. Forsyth does not provide the hyperbaric therapy but offers referrals.
Both hospitals declined to provide the cost of establishing their specialty centers, but hyperbaric chambers can cost about $25,000 each.
The hospitals expect that internal referrals from their physician groups or affiliated community hospitals will provide most of the wound-care patients.
The centers opened at a time when most hospitals are pursuing new revenue streams, particularly from outpatient procedures that are becoming a more prevalent source of care than inpatient medical admissions.
The centers also are handling an increase in charitable care related to treating patients with no or limited insurance, such as COBRA.
With 9.3 percent of North Carolinians, or about 643,000 residents, diagnosed as diabetic, there is no shortage of patients requiring wound-care therapy, said Dr. Stephen Motew, the director of Forsyth's vascular program and an organizer of its limb-preservation center that opened in May.
"The local market should absolutely be able to support multiple, appropriate centers, but there may be more competition for particular services," Motew said.
Rex Healthcare, which serves the Triangle, has two wound-care centers and a combined five hyperbaric chambers.
"Demand has been pretty significant, with the center serving new patients every week," said Dr. David Eddleman, the co-medical director for the Rex wound-care center. "Most primary physicians can manage, but not help completely heal, these types of wounds."
Coordinated services
The goal of wound-care centers is offering specialized treatments and services to help speed the process of healing sores and injuries lasting more than 30 days.
Besides diabetic ulcers, the centers treat such conditions as foot and ankle deformities, radiation and physical injury, compromised skin grafts, and vascular and limb deterioration.
The hospitals say that what makes their centers stand out is that they offer coordinated wound-care services, including for vascular, foot and ankle, infectious diseases, nutrition, physical therapy, self-treatment education and pain management.
Patients typically get about 30 treatments in the hyperbaric chamber. Most qualify after going through 30 days of conventional wound-care therapy.
"The goal is treating the underlining issues of wound care and helping the wounds heal quicker and more efficiently," said Dr. Joseph Molnar, the medical director of the wound-care center for Wake Forest Baptist, which also is affiliated through the Triad Health Alliance with Lexington Memorial Hospital and Moses Cone Hospital of Greensboro.
"When healing is satisfactory, patients are returned to the care of their primary physicians," said Molnar, who also serves as an associate professor of plastic and reconstructive surgery at Wake Forest Baptist.
More patients at risk
The main reason why more N.C. hospitals, small and large, are offering wound-care services is the increasing rate of Type 2 diabetes and obesity in the state. The rate of diabetes for blacks is nearly twice that of whites.
"With conditions such as diabetes and obesity on the rise, more patients are at risk for foot and leg diseases that can result in a need for amputation if the condition is not properly cared for," said Dr. Bradley Thomason III, the medical director of Forsyth.
Nearly 40 percent of North Carolinians with diabetes make less than $35,000 a year, and many lack health insurance or depend on Medicare and Medicaid.
According to N.C. Diabetes Prevention and Control, a nonprofit group, about 52 percent of adults with diabetes were obese in 2008.
The group reported that 2,608 lower-limb amputations were done in the state in 2007 among people with diabetes. Nationally, diabetics represent more than 60 percent of lower-limb amputations not caused by a trauma injury.
National studies have shown that if a wound reaches the point where lower-extremity amputation is required, the initial cost is about $65,000, said Jule Crider, the executive director for the American Association of WoundCare Management.
"But the lifetime cost of caring for the patient with this condition can exceed $500,000," Crider said. "The average cost for using hyperbaric oxygen therapy to heal a diabetic wound is estimated to be less than $20,000."
Langford, from East Spencer, has dealt with diabetic ulcers on her feet for 10 years.
"My problems started with a little toe getting infected," Langford said. "It eventually needed to be amputated, but the problems have persisted and I'm dependent on a cane."
Langford had surgery in August for infected and exposed bone joints, Molnar said. She is a candidate for the hyperbaric chamber in terms of severity of her ulcers.
"By treating her with tools such as artificial skin over the bone, we're hopeful of being able to save the foot," Molnar said.
'Not a magic bullet'
Medicare recently began covering the cost of hyperbaric oxygen therapy for 15 kinds of wounds.
That has led, Motew said, to some health-care providers — not Wake Forest Baptist, he said — jumping on the wound care and hyperbaric chamber "bandwagon as a money maker, something to order without taking a comprehensive look at the patient's need."
Eddleman, the Rex Healthcare official, said about 12 percent of the patients at its center are candidates for its hyperbaric oxygen therapy.
"What the public needs to look out for are private companies — not affiliated with a health-care system — that offer hyperbaric treatment for just about anything, like someone dealing with memory loss," Eddleman said.
Motew cautioned that hyperbaric chambers "are not a magic bullet but just one tool" for treating chronic wounds.
"We're trying to spread the word that preventive care, as well as these centers, can help improve the quality of life for those dealing with chronic wounds," Molnar said.
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