The Hyperbaric oxygen therapy prior authorization project has been in effect a little more than a year and CMS is in the process of reviewing its impact to prepare an interim report. As the Medicare coffers dwindle, we have to ask ourselves how we can best utilize resources like HBOT. For patients with serious diabetic foot ulcers, CMS uses TIME as the way to identify patients who are not likely to heal with conservative care. HBOT is limited to Wagner Grade 3 or higher DFUs that have not improved over 30 days of appropriate care. Is this the best way to identify patients who will not heal spontaneously? After 30 days, any Wagner 3 or higher DFU that has not improved can then undergo HBOT. Are there better ways to determine which patients will actually benefit from HBOT and which ones will not?
I’ve suggested a method that might be more accurate to predict which DFUs need HBOT and which ones can benefit from it in the September issue of Plastic and Reconstructive Surgery. Let me know what you think.
The article CAN be accessed without going through the supplement. Here is a direct link to the work: http://journals.lww.com/plasreconsurg/Fulltext/2016/09001/An_Update_on_the_Appropriate_Role_for_Hyperbaric.15.aspx

Caroline Fife, MD
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