Straight Talk Tuesday

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 the middle of the room. I’ll provide a brief overview of the threats.

Many private insurance companies are mandating that physicians be subspecialty Board certified in Undersea and Hyperbaric Medicine (UHM) to be paid for hyperbaric chamber supervision, while some Medicare Administrative Carriers (MACs) are also creating credentialing requirements including certificates of added qualification (CAQ). That’s a fixable problem because CAQs are obtainable from the UHMS and the American College of Hyperbaric Medicine so if you don’t have one, head’s up. What may not be fixable is the way private payers have classified many HBOT indications as “experimental” based on private technology assessments to which it is nearly impossible to respond. You may think you can survive without Blue Cross or Aetna patients, but a recent report from the Kaiser Foundation showed the predicted growth rate of “Medicare Advantage” plans in the USA. Right now on average about 30% of Medicare patients are enrolled in one of these replacement plans but in some areas of the country it’s more than 60%.

During the 2 years I was president of the UHMS, I made 7 trips to Baltimore to talk to the CMS Coverage Policy group about changes in Medicare’s coverage policy but at least in the end, we were able to obtain coverage for the diabetic foot ulcer. At the time I thought the process was traumatic (particularly since during that brief time there was 4 new Directors of Coverage policy and we had to start the explanation over anew with each one) but now I realize how fortunate we were to have individuals who were accountable (however indirectly) to tax payers as well as a process that at least was somewhat transparent. It doesn’t work that way with private insurance companies. They can do whatever they want. There are a lot of other things going on with the revaluing of the “work component” of the procedure code for hyperbaric chamber supervision. Helen Gelly and I created a 13 page “threat report” to the UHMS. We will talk about all these issues at our SAWC session.

However, there is an issue that could change everything about HBOT and that is the issue of “site neutral payment”. If you want to understand what that might mean to the field of hyperbaric medicine, come to our session at the SAWC.

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