There has been recent discussion on the hbo-list about Medicare reimbursement issues for Hyperbaric Oxygen Therapy. As Dr. Wilmeth pointed out, a recent accounting showed Medicare believes that roughly 60% of reimbursements should not have been made.
Yesterday I spoke with an official at HCFA, Kate Tillman [410/786-9252] who confirmed that Medicare is reviewing reimbursement decisions for Hyperbaric Oxygen Therapy. One of the things she referenced was a paper prepared by the national office of Blue Cross/Blue Shield for Kaiser in which they discovered that there there is only valid scientific evidence to support only four of the 13 approved indications, and so there is some thought [because of the 60% of questionable reimbursements] to limit the reimbursements to only those four indications that have the science to substantiate the use of HBOT.
This lack of science was pointed out in a lecture to the UHMS by Dr. Paul Harch in April, 1999. During this same lecture, Dr. Harch detailed the physiology of HBOT on the body tissue for the 13 approved indications--then he explained the physiology of HBOT on neurological tissue.
It's the same physiology.
Ironically, the Undersea and Hyperbaric Medical Society tried to have the medical licenses of both Dr. Neubauer and Dr. Harch revoked for treating brain-injured children with Hyperbaric Oxygen Therapy.
The good news. Even though it appears that there is a risk that 9 of 13 UHMS approved indications will lose Medicare reimbursement, Ms. Tillman said there is a new policy in place [as of April, 1999] that will allow private citizens to present information/data so as to get other indications approved, i.e., Hyperbaric Oxygen Therapy for cp and other brain injuries.
The procedure for determining covereage of a new medical procedure under medicare can be found here.
Ms. Tillman also said they've always relied on the Undersea and Hyperbaric Medical Society in the past because they don't know who else to turn to, but they would rather have more sources of information than just the UHMS. Not only that, HCFA doesn't require double-blind controlled studies.
Guess what moms and dads. Here's another reason why your kids have gotten SPECT-scans. Let's get our collective heads together on this and figure out how to send all this to HCFA. We've got more scientific data to support the use of Hyperbaric Oxygen Therapy for cp kids than 9 of the 13 UHMS indications.
There's a very real possibility that our children just might save Hyperbaric Medicine.
-Recived from David Freels via C-Palsy List Serve 11/04/00