TWC-OCT2015Please remember to check out my November/December 2015 editorial in Today’s Wound Clinic. I reviewed the sad history of the two years I spent as President of the Undersea and Hyperbaric Medical Society from 1998 to 2000, during which CMS attempted to reduce facility payments for HBOT by 75%, reduce physician payments for chamber supervision to $0.00 (by zeroing out the work component of the RVU), eliminated coverage for hypoxic wounds, and launched an OIG investigation into HBOT services. Those 2 years were the most difficult of my professional life and at the end of it, I wrote an article in the UHMS membership magazine to warn hyperbaric physicians that we had gained only a reprieve. CMS officials told the late Robert Warriner and me personally that they would be watching us.
There was a window of opportunity in which we could have turned the tide for HBOT, but we missed it. We could have implemented better standards of practice for clinicians, created a culture of carefully protocolized patient selection, and analyzed registry data to prove the clinical effectiveness of HBOT in the real world. We could have established the value hypothesis of HBOT for limb salvage and amputation prevention, and completed the research necessary to make the transition from volume to value based reimbursement. But that’s not what happened. CMS is going to stop the runaway train of hyperbaric utilization. Unfortunately it only has Draconian methods to do that. Patients will suffer.
The HBOT prior authorization demonstration project going on in 3 states is not the biggest challenge the hyperbaric community is facing. There is a much bigger challenge and I will tell you about it next week. If you are an HBOT provider, you need to get ready.

Caroline Fife, MD
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