Yesterday I posted some of the reasons for denial of HBOT under prior authorization. I thought I’d point out something that should be obvious but might not be. It appears that HBOT is being denied for DFUs unless—at a bare minimum: Hemoglobin A1C is being checked and recorded, vascular screening is performed (more than checking pulses) and followed up if abnormal, and there is documentation of off-loading at every visit. This is a perfect description of the “appropriate use of HBOT in DFU” quality measure available through the US Wound Registry.
If I was a hospital wanting to implement a quality plan for my outpatient centers that would help ensure reimbursement, or if I was a payer looking at quality performance, or if I was a management company with any financial “skin in the game” with centers or providers, then I’d be getting my clinicians to report this measure as a way to evaluate how they might perform when prior authorization of HBOT comes to a MAC jurisdiction near you. Because, I can virtually guarantee that prior authorization of HBOT will eventually be required everywhere.
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
The opinions, comments, and content expressed or implied in my statements are solely my own and do not necessarily reflect the position or views of Intellicure or any of the boards on which I serve.
