Tuesday, February 12, 2008

My Last Comment about Home Testing for OSA

This is my last comment about home testing for OSA, until CMS makes its final decision in March. I have previously extensively discussed the AASM's task force report on home testing, and its role in bringing about home testing for obstructive sleep apnea (click on the Home Testing or Portable Home Testing label below for more details).

Nic Butkov, the RPSGT guru, discusses another development that paved the way to home testing in this month's issue of SLEEP REVIEW:
It has been suggested by some that the new scoring manual is paving the way for portable, limited channel sleep studies and automated scoring. The manual does, in fact, present the respiratory scoring parameters apart from the rest of the polysomnogram, without discussing the relevance of viewing respiratory patterns within the context of the patient's sleep/wake physiology. The only reference to other PSG channels is made by the brief mention of arousal, as a possible scoring criterion for the alternative hypopnea definition and as a criterion for the optional scoring of RERAs. The lack of discussion regarding other PSG parameters creates the impression that respiratory events can be evaluated based solely on respiratory tracings and oximetry, without viewing the polysomnogram as a whole. This is unfortunate because without correlating respiratory patterns with the patient's physiological state, and evaluating their effects upon that state, the interpretation of respiratory events becomes largely a matter of guesswork.
So in addition to the Task Force report, the new American Academy of Sleep Medicine Scoring Manual also played a role in bringing about CMS approval of home testing for qualifying a patient for cpap therapy. Although the AASM claims it is going to work with regional Mediare carriers to limit home testing to board certified sleep specialists (wouldn't it be funny if some carriers excluded diplomates of the American Board of Sleep Medicine but instead required passing the new American Board of Internal Medicine test?), it is my opinion that most Medicare carriers will not limit the specialties that can perform home testing. The AASM has made its bed and now has to lie in it.


Welcome to our World said...

Just out of curiosity, I am trying to understand this situation a little better. I work primarily with Pulm/CCM physicians and they are required these days to do an extra yr of fellowship in SLP in order to become certified and the only recognized board is ABIM. How will this situation impact those physicians who are doing that extra year of SLP? In your opinion, how would you advise someone considering that extra year of fellowship in SLP?

Thank you for your thoughts in advance!

dawgguy said...

Dr. Rack: We have just learned that home testing for OSA will NOT be covered under Medicare for the following areas: American Samoa, California, Connecticut, Delaware, Guam, Hawaii, Kentucky, Illinois, Indiana, Maine, Marina Islands, Massachusetts, Michigan, Nevada New Hampshire, New Jersey, New York (with the exception of Queens County), Ohio, Vermont, Virginia, West Virginia, and Wisconsin.

Steve Gardner
Sleep Wellness Institute
West Allis, Wisconsin

David said...
This comment has been removed by the author.
David said...

From Sleep Well and Alive:

We have just received word from the American Academy of Sleep Medicine that National Government Services, an agent contracted by the Centers for Medicare & Medicaid Services (CMS), has released its Local Coverage Determination (LCD) for polysomnography and sleep studies (L26428). The LCD affects the following primary geographic jurisdictions: American Samoa, California, Connecticut, Delaware, Guam, Hawaii, Kentucky, Illinois, Indiana, Maine, Marina Islands, Massachusetts, Michigan, Nevada New Hampshire, New Jersey, New York (with the exception of Queens County), Ohio, Vermont, Virginia, West Virginia, and Wisconsin.

Effective April 1, 2008: “For a study to be reported as a polysomnogram, sleep must be recorded and staged and must be attended. Sleep studies should be performed in a hospital, sleep laboratory or by an Independent Diagnostic Testing Facility that is supervised by a physician (MD/DO) trained in analyzing and interpreting the recordings and should be attended by a trained technologist. Sleep studies performed in the home are not covered.”

This is outstanding news for those of us who have stated from the beginning that unattended at home sleep studies for Medicare beneficiaries are not in their best interest. It is a clear statement that ensuring quality of care for our Greatest Generation outweighs expediency.

Mark Stoiber, President

Michael Rack, MD said...

thanks for the update on the Local Coverage Determination.
Welcome to our world: I would recommend a sleep fellowship to anyone interested in practicing sleep medicine. While home testing may not be limited to board-certified sleep physicians (in those jurisdictions that cover home testing), reading sleep studies at an AASM-accredited sleep center requires either 1) board certification/elgibility in sleep or 2) that the studies be "over-read" by someone who is board-certified/elgible.

sarah25 said...

A significant increase in the diagnosis and treatment for obstructive sleep apnea (OSA)
over the past several years has led to a surge in the need for sleep studies, and an increase in joint ventures and cooperative arrangements between DME companies, physician offices, and sleep labs. Although DME suppliers are justifiably interested in
cooperating with other entities on matters related to sleep testing, the expansion of sleep testing and OSA treatment has led CMS, the OIG, and the program safeguard
contractors (PSCs) to more closely scrutinize sleep testing and CPAP utilization than they have in the past. This increased scrutiny has resulted in both positive and
negative consequences.

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