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Nonacute indications:
•
select problem wounds
•
delayed effects of radiation therapy
•
chronic osteomyelitis
HOW CHAMBERS GET FUNDING
HBOT facilities most often treat nonacute indications.
Because these indications are not as time-sensitive as
the acute indications, patients can be scheduled and
insurance coverage issues addressed in advance. These
indications pay the bills of the hyperbaric centers, and
payment for services is more predictable from these
patients. Other factors beyond finances, however, affect
a facility’s ability to be available 24/7.
As recently as 10 years ago the majority of hyperbaric
centers were located in or attached to a hospital, which
meant that most patients requiring HBOT were treated
at the hospital. Income generated by treating the
scheduled patients provided enough financial support
to allow the hospital to offer after-hours emergency
hyperbaric care. This also facilitated comprehensive
treatment of emergency patients who required access
to ancillary services such as critical care, vascular
surgery, neurology and other specialties.
Reimbursement of chamber facilities’ costs by
insurance companies and especially Medicare is the
same whether the facility is available for emergencies
or not. The costs of having staff on call 24/7/365 can
be substantial. Accepting emergency and critical-care
patients increases the potential liability risk to the
facility and thus may increase liability insurance costs
for the physician group and the hospital.
In recent years nonhospital-based clinics have
dramatically increased, primarily due to an increase
in the number of patients who can benefit from
nonemergency HBOT. Patients in stable condition
who require multiple scheduled treatments are likely
to use facilities that are most convenient to them. This
migration away from hospital-based chambers has
reduced those chambers’ ability to absorb the additional
costs incurred by accepting emergency patients.
Several years ago one hospital-based hyperbaric
facility announced publicly that it was planning to end
its emergency HBOT services. In an average year it
treated 10-15 acute patients. Compensation for these
treatments came nowhere close to offsetting the costs
incurred by being available 24/7/365. This is a reality
that many facilities face. In this case, local divers
organized themselves and were able to persuade the
hospital to continue emergency services.
DAN AND UHMS
DAN continues to work with health-care professionals,
including prehospital-care providers, to educate them about
dive injuries and treatment. DAN also works continuously
to stay up to date on each chamber’s operational status
and willingness and ability to provide emergency care. The
UHMS, which promotes dive and hyperbaric medicine,
is trying to find a solution to the current state of affairs.
Some in the field are working with the appropriate
government agencies to address potential reimbursement
incentives and remove obstacles to encourage more
emergency facilities. One proposal currently under
consideration is having similarly capable facilities in a
given area provide emergency care on a rotating basis to
avoid placing undue strain on a single facility.
WHAT DIVERS CAN DO
The dive community can influence the availability of
chamber facilities for dive emergencies. First, divers
should make certain they have insurance that covers
HBOT, whether through their primary medical
insurance or with specific coverage such as a DAN
dive accident insurance policy. A community of insured
divers means that facilities providing care are more
likely to be paid (an important consideration for hospital
administrators as they work to keep their hospital
solvent) and thus less reticent to treat injured divers.
Divers can also use social and news media to
bring attention to the situation. We should, as a
community, emphasize that the need for emergency
HBOT is not only for divers but also for the other
potential acute/urgent indications for HBOT as well.
Acknowledgement of the serious financial challenges
facilities face should help foster productive dialogue
among care providers and local communities of divers,
and cooperation among interested parties offers the
best opportunity for a solution.
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Less than 10 percent of the
hyperbaric chambers in the
U.S. will treat injured divers.
Because of the costs of being
available for emergencies on
a 24/7 basis, every year fewer
chambers are available for
dive injuries.
JOE CLARK
MATÍAS NOCHETTO