Thursday, September 20, 2007

Home Testing for Obstructive Sleep Apnea

As reported in Sleep Review, last week Medicare (actually the Medicare Evidence Development and Coverage Advisory Committee) met to decide the future of sleep medicine:
On September 12, industry leaders with varying positions about adopting home testing for the diagnosis of OSA gathered to present their opinions to a Medicare Evidence Development & Coverage Advisory Committee (MedCAC) panel. Based on the content of the meeting, the panel will make a recommendation to CMS about the future of home testing.
Earlier this year, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) submitted a formal request to CMS to revisit its national coverage determination (NCD) to not reimburse patients for positive airway pressure therapy if their sleep apnea was diagnosed with any form of testing other than in-laboratory polysomnography (PSG).
The AAO-HNS letter triggered the home testing debate...

rest of sleep review quote deleted at their request.

The MedCAC panel recommendation is expected to be out December 14, 2007, when the proposed decision memo is due.

Currently a polysomnogram (sleep study) performed in a sleep lab is required by CMS (medicare) to cover the purchase of a CPAP machine, the most common treatment for obstructive sleep apnea. Usually another sleep study, a CPAP titration (in which the CPAP settings are adjusted), is performed before CPAP is prescribed.
If CMS approves home testing for the diagnosis of sleep apnea, it will be disastorous for sleep labs that are currently in operation. Most private insurance companies follow CMS guidelines, and there will be a drastic drop in the number of sleep studies performed. Many sleep labs will close. It takes a lot of money to keep a sleep lab going, the typical yearly overhead (technician costs, equipment, rent) for a sleep lab is approximately $100,000 per bed, and much of this expensed is fixed.
Home testing, in my opinion, will be bad for patients. Sleep apnea will be less accurately diagnosed. CPAP will be titrated inadequately, and patients will get poorer results with CPAP.

I don't think that CMS is going to make the change, though. The final decision is expected March 14, 2008

7 comments:

Naomip said...

I am currently working on an article about the new advances in sleep medicine and mattress selection titled "Your best night ever". I would love to interview you about what you know in the field and if you have any expertise on what mattresses/pillows/exercise/foods halp you sleep or nap better, that would be fantastic. Also, if you know someone that might be better suited for the job, I would love to be pointed in the right direction. Thanks so much.
Naomi

Michael Rack, MD said...

Naomip:
please email me at MichaelRack@msn.com.

I need to warn you, though, that sleep physicians have no expertise in mattresses/pillows.

rogsam said...

do you know if home testing will be approved by the CMS next week? If yes, what is going to be the extent of approval (i.e full, only those with mile to severe OSA, etc)?
thanks

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