Tuesday, November 06, 2007

Stabbed in the Back

I previously posted regarding the controversy about portable home testing for obstructive sleep apnea. This Sept 20 post gives some background information about the issue. Briefly, CMS (Medicare) is considering allowing portable home testing for the diagnosis of OSA, prompted by a request by the ENT physicians. A little more info is provided in my 9/21/07 post. Initially, The American Academy of Sleep Medicine (AASM) opposed home testing for OSA.

Now, The bureacrats at the AASM have joined the ENT docs in stabbing the field of sleep medicine in the back. If you look at this link, you'll notice under recent announcements "AASM Approves Portable Monitoring in Adult Patients". Basically, an AASM task force report is coming out in December recommending portable testing for OSA.

It’s all over. With the AASM caving in and publishing a task force report recommending portable testing, it’s a done deal. CMS (Medicare) will approve home testing for OSA. Within 3 years, the financial foundation of sleep medicine will crumble. Much of the evaluation and tx of OSA (the bread and butter of sleep medicine) will now be done by Primary care docs, who will diagnose with portable testing and treat with auto-CPAP machines. This will lead to worse outcomes for patients and many sleep labs going out of business.

Buy Respironics (at under 49). Begin to liquidate your Sleep Holdings positions (or if you are a speculator like me, buy and sell the volatility). Disclaimer- my stock picking ability isn't perfect, I recently tried to get a bargain with Washington Mutual and ended up catching a falling knife.

I will post more about this issue later. I need to get ready for a trip to inspect a sleep lab for the AASM, as well as complete some committee work (for the AASM Behavioral Sleep Medicine Committee).
Edit (11/8) Thank you to Kevin, MD for linking to this post. Also, I regret using the phrase "bureaucrats at the AASM". I should have used the phrase "academics at the AASM". The leadership of the AASM, like that of most of organized medicine, is out of touch with the needs of physicians out in the community.

Michael Rack, MD

1 comment:

Chad said...

Certainly some sleep labs will remain active. There are pediatrics and very sick patients that will need all night testing. I work as an RPSGT at a lab that is highly regarded and has a good reputation. What can I expect for the future? How will doctors discriminate between those patients that can use portable units at home and those that need in lab testing?