Primum Non Nocere and the 5 Rights

Area of Science:

• Hyperbaric Medicine
• Healthcare Policy

Background:

• Overutilization of hyperbaric oxygen therapy (HBOT) is prevalent, particularly in outpatient wound care.
• Despite a high number of hospitals offering HBOT, 24/7 emergency inpatient access is critically low in many regions.
• Healthcare purchasers, like CMS, are concerned about HBOT utilization and access.

Purpose of the Study:

• To counter concerns that prior authorization for elective HBOT delays medically necessary care.
• To examine the historical factors contributing to the widespread and unchecked overutilization of HBOT.
• To address the national crisis of emergency access to HBOT.

Main Methods:

• Historical analysis of HBOT practice evolution.
• Review of healthcare policy strategies concerning HBOT utilization.
• Commentary on the impact of prior authorization on patient access.

Main Results:

• HBOT overutilization has become widespread and largely unchecked.
• Significant geographic areas lack 24/7 emergency inpatient HBOT availability.
• Prior authorization is proposed as a strategy to manage utilization.

Conclusions:

• Prior authorization for elective HBOT indications may not adversely delay medically necessary care.
• Addressing HBOT overutilization is crucial for ensuring emergency inpatient access.
• The historical context reveals how the current access crisis developed.