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As early as 2004, the American College of Hyperbaric Medicine (ACHM) began to receive numerous notifications from its membership that several national insurance carriers had determined that hyperbaric oxygen therapy (HBOT) for radiation necrosis would be categorized as experimental/investigational and subsequently resulted in denial of submitted claims. The results of these determinations, if left unchallenged, would have eliminated the use of HBOT for patients with radiation injuries. Thanks to the ACHM and funding from the Kindwall Foundation which allowed ACHM to create radiation registry. We are at same crossroads at the present time as insurance companies look at resource utilization and value-based care. It is imperative for societies like ours to encourage its members to do research not only to look at the value of HBOT for existing indications and to find out if there is evidence to support its use in other widespread conditions where HBOT might be useful.
The ACHM board is passionate about supporting research to develop more evidence on existing indications and to look at other potential new indications where there is a lot of global anecdotal evidence but not enough data to support its routine use. For example, use of HBO therapy for Ulcerative Colitis or Crohn’s disease. There was a recent abstract presented by Dulai PS et al, which clearly shows that HBOT can be useful and is a cost-effective therapy for the patients with ulcerative colitis but rightly concluded that further studies were needed. Traditional treatment for patients with ulcerative colitis is biological therapy. We want to know if patients with ulcerative colitis will benefit from HBOT as an adjunct to biological therapy, as biological therapy is a extremely costly treatment. We also want to know if we can start HBOT before starting biological therapy which again needs more research.
Many hyperbaric medicine physicians have seen the beneficial effect of HBOT in patients with pyoderma gangrenosum, but these patients are not able to get HBOT because of lack of evidence and most insurance carriers consider HBOT in such cases to be experimental and therefore are non-reimbursable. TBI studies are going on right now and there are several studies already published on this subject with considerable interest. Stroke is another indication where HBOT might be useful but we need to work together to develop evidence. As HBOT is not funded by pharmaceutical companies, it will be our duty to support the research foundation which would focus completely on HBO therapy research.
Our board members are committed to work for HBO therapy and to develop its science. I encourage each one of you to donate generously for this cause.
Dr. Jayesh Shah, President