1. Masturzo, Arti MD

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I am writing in response to the recently published Commentary titled "Primum Non Nocere and the 5 Rights" by Dr Popp et al.1 Popp et al1 call attention to the important and complex challenges impacting the practice of hyperbaric oxygen therapy (HBOT). Healogics agrees with and is committed to providing "safe, efficient, medically efficacious, and cost-effective care to those patients with evidence-based indications for HBOT."1 Further, Healogics uses 2 evidence-based, proprietary clinical processes, the 9 steps of healing and the Medical Surveillance Review, to ensure the delivery of medically appropriate chronic wound treatment.


Clinical evidence supporting HBOT in the treatment of chronic wounds suggests a positive effect for appropriately indicated patients. However, clinical research focused on advanced therapies used to treat chronic wounds, such as HBOT, is challenged by the heterogeneity of the patient population and limited research end points. Studying an adjunctive therapy is further complicated by the difficulties of controlling for the variety of other medical therapies a patient may receive in the course of their treatment. Despite these barriers, Healogics is committed to growing the evidence base and improving patient outcomes through the collection, analysis, and sharing of clinical use data on advanced wound therapies, including HBOT. It is in this spirit that we announced the Healogics Wound Science Initiative earlier this year and continue to share insights with the Centers for Medicare & Medicaid Services. In addition, with the development and application of standardized federal and state documentation processes, we are supportive of prior authorization.


Let us remember, in the broader context of medicine, chronic wound care as a specialty is relatively new; we are a young field. The industry has a shared responsibility to work collaboratively to advance the science of wound care.


With all of this in mind, Healogics cautions against suggestions that (1) the outpatient wound care industry segment alone is responsible for the complex challenges associated with the utilization of HBOT to treat patients in immediate need, and (2) outpatient wound care centers do not currently employ highly trained and experienced professionals who understand the "evidence-based indications for HBOT and are motivated by the desire to provide excellent, ethical, cost-effective, and evidence-based treatments for their patients."1 These statements are not only inaccurate and subjective, they are counterproductive to our efforts to maintain patient access to advanced wound therapies, including HBOT. For example, in addition to learning and following the evidence-based, proprietary clinical processes mentioned above, Healogics-employed physicians and nurses stay informed with ongoing education on advanced wound care and the clinically appropriate use of HBOT.


Given the challenges facing the wound care industry and the potential risk our patients may face by not having access to a life or limb-saving treatment, we must unify to produce productive dialogue. A standardized method to measure and report healing rates could be this unifier, creating a shared purpose toward wound care that matters. After all, our patients are counting on us.




Arti Masturzo, MD


Executive Vice President of Clinical


Innovation, Healogics


Jacksonville, Florida




1. Popp G, Clarke D, Rothstein S. Primum non nocere and the 5 rights. Adv Skin Wound Care 2017;30(10):473-8. [Context Link]