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Special Report from the QUARC Committee


In a recent paper published in “Plastic and Reconstructive Surgery,” Dr. Caroline Fife discussed the value of hyperbaric oxygen (HBO2) therapy’s “unique ability . . . to induce neovascularization,” noting that this “accounts for its persistence in the clinical armamentarium of chronic wound treatments, despite ongoing controversy regarding its cost effectiveness.” Dr. Fife is co-chair of the UHMS committee on Quality, Utilization, Authorization and Reimbursement.

The paper goes on to discuss the way in which predictive models can be used to help select patients for HBO2 treatment and suggests that such an approach could be more appropriate as a mechanism for selecting hyperbaric patients than current Medicare policy. For example, the current Medicare policy for diabetic foot ulcers requires that all patients with Wagner 3 (or higher) ulcers wait 30 days, after which HBO2 therapy is offered only to patients “with no visible signs of healing,” a criteria that is not evidence-based. However, Medicare uses such criteria in hopes of ensuring that only patients who cannot heal spontaneously receive treatment with HBO2. Unfortunately, this delays treatment for everyone, and then allows treatment only for an overly restrictive group, among which are some patients not likely to benefit from HBO2.

Says Dr. Fife: “HBO2 could be utilized more cost effectively if we could reliably identify the patients who cannot heal spontaneously and provide them with HBO2 therapy sooner, but limit treatment only to those patients who are predicted to benefit from it. This is the sort of thing we will need to do under ‘bundled payments.’ ”

It is published open source so UHMS members can get a copy by clicking on this link:
Fife CE, Eckert KA, Carter MJ. An update on the appropriate role for hyperbaric oxygen: indications and evidence. Plast Reconstr Surg. 2016;138(3 Suppl): 107S-116S.

— Based on reports by CAROLINE E. FIFE MD, FUHM  •  E:

Caroline Fife is co-chair of the UHMS committee on Quality, Utilization, Authorization and Reimbursement, with Helen Gelly MD, FUHM, and and Marc Robins DO, FUHM.