It’s hard to believe it’s been 20 years since I was president of the Undersea and Hyperbaric Medical Society (UHMS). I thought my biggest challenge would be trying develop an approach to off-label use of HBOT. As it turned out, only weeks after I took office, physician reimbursement for HBOT was reduced to zero, the facility fee was cut by 75%, and what was then the Healthcare Financing Administration (HCFA), now CMS, re-wrote coverage policy, cutting indications – the trifecta of misery that nearly wiped out HBOT and was a nearly perfect rehearsal for the current HBOT climate.
Since I was kind of consumed trying to save the field of hyperbarics, I didn’t get to do much else. However, I did raise enough grant money to fund an ethics review of off-label HBOT by two professional ethicists. The process was fascinating and the subsequent paper they wrote remains the authoritative guide on the subject. It’s available for free from the UHMS Rubicon foundation. Rubicon is the best kept secret in the field of hyperbaric medicine. Virtually every paper you could ever need is available for free. Here’s a link to the ethics paper.
As it becomes increasingly difficult to provide HBOT for approved uses, and as interest in off-label use increases for many things, physicians need guidance to help them navigate the complex issues surrounding informed consent, cash payments, advertising off-label use, etc. The March issue of Today’s Wound Clinic is focused on Hyperbaric Oxygen Therapy. Here’s a link to my ethics article.
You will also need to review The Math of Hyperbaric Oxygen from my previous blog – because it’s a fascinating reality that people are buying inflatable hyperbaric chambers to provide a lower amount of inspired oxygen than they could with a cylinder of oxygen and a mask.
The issues are fascinating and well worth ongoing discussion.