DME Companies Left Out of Home Testing

It appears that Durable Medical Equipment companies have been left out of home testing by most of the regional Medicare carriers.
Here is part of the Local Coverage Determination for Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (L11518) for Cigna Government Services:

No aspect of an HST, including but not limited to delivery and/or pickup of the device, may be performed by a DME supplier. This prohibition does not extend to the results of studies conducted by hospitals certified to do such tests.

The LCD also states:

The test must be ordered by the beneficiary’s treating physician and conducted by an entity that qualifies as a Medicare provider of sleep tests and is in compliance with all applicable state regulatory requirements.

I interpret this section is not allowing individual doctors to perform home testing in the area covered by Cigna Government Services. It seems that home testing must be performed by a sleep center/sleep lab.

Near Death Experiences Linked to REM Intrusion

According to a new study, many persons with a Near Death Experience (NDE) have symptoms of REM sleep intruding into wakefulness:
For 60 percent of those who had been through an NDE, the rapid-eye movement (REM) state of sleep intrudes into their regular consciousness while awake, the study found. Both before and after their traumatic event, these people had experiences that include waking up and not being able to move, sudden muscle weakness in their legs, and hearing sounds that no one else hears upon waking or falling asleep.
Persons with narcolepsy commonly have symptoms of REM sleep intruding into wakefulness, including sleep paralysis (waking up and not being able to move), cataplexy (sudden bilateral muscle weakness/limpness in response to strong emotion) and hypnagogic/hypnopompic hallucinations (hallucinations, usually visual, as one is falling asleep or waking up).
These symptoms occur when features of REM sleep (muscle paralysis, dreams) occur during wakefulness.
I wonder Near Death Experiences are more common in narcoleptics??

Home Testing Reimbursement Announced

The AASM reports that Trailblazer, the Medicare carrier for Texas and surrounding states (not Mississippi) has decided reimbursement rates for home testing for OSA:

G0399: Home Sleep Testing, Type III portable monitor; minimum 4 channels - $125.00 - $85 is recognized for the Professional Component - $35 is recognized for the Technical Component

With a low reimbursement like this, home testing is not going to quickly become widespread.

Somnus Sleep Clinic is trying out its Type III home testing device tonight. I should be able to let you know next week how it worked out.

Patient Problems at Sleep Labs

A reader commented:
"The problems of sleep labs are not just compliance with regulations. Sleep lab operators need to run good facilities which are tolerable for patients. It took me a long time to recover from the emotional torment of lousy techs who answer every question "you would have to ask your doctor." Insurance companies pay through the nose for the testing, but there is never a doctor available to help the hapless patient. When I couldn't fall asleep during titration and asked for sleeping pills, the tech said he would ask a supervisor, the supervisor hummed and hawed "What kind of meds did you bring with you?" "None, " I said, "never needed any." "Then I will call the doctor, maybe we can get some presecribed for you for tonight." When the doctor did not call back, she said "He hasn't called, but actually you were sleeping beautifully for nearly 3 hours you just woke up a few minutes agao and began calling out for help, which is why I came in!"

Thanks for reading. Actually, the problem is with government regulation. From your description I am assuming that sleep center you went to was an Independent Diagnostic and Testing Facility (IDTF)- a slight majority of sleep centers are IDTF's as opposed to hospital-associated sleep centers or sleep centers that are an extension of a physician practice.
Somnus sleep clinic, which I am a minority owner of, is an IDTF. Because of anti-kickback rules, only a minority of patients can see me prior to the sleep study. Government regulations require a majority of patients to be referred by an outside physician directly for a sleep study.
As medical director, I am available to the technicians for patient emergencies. However, if the techs call me in the middle of the night for a directly referred patient who can't sleep, it puts me in a legally awkward situation of giving a medication to someone who is not my patient. And where is the sleeping pill supposed to come from? Should I call in a prescription to an all-night pharmacy and have the patient drive to go get it (with all the electrodes pasted in their hair)? I guess I could give them one of the samples from my private practice- however new CMS (Medicare) regulations that take effect Jan 1 2009 put new restrictions on the interactions between physicians and IDTF's.
If all of this seems confusing to you, I would encourage you to look through the archives and look at my posts on management of a sleep lab and ownership of a sleep lab.
And technicians are supposed to tell you to ask your doctor about any medical inquiries.

If any sleep physicians out there who practice in IDTF's or hospital-associated sleep labs have a solution for patient requests for hypnotics, I'd be interested in hearing them.

Type 3 Home Testing Device

At Somnus Sleep Clinic, we finally obtained a type 3 home testing device, the SleepTrek 3:

SleepTrek3, a 6-channel Home Sleep Screener, is a small lightweight physiological data recorder specifically designed to assist the clinician in the diagnosis of sleep-disordered breathing. SleepTrek3, Type III Sleep Screener, uses sensors to record oxygen saturation, pulse rate, airflow, snoring, respiratory effort and body position. The screener is designed to be used in a supervised (hospital/institutional) or unsupervised (home) environment. It is capable of recording 12+ hours of patient data using a single 3.6-volt Lithium battery and a CompactFlashCard.

The SleepTrek 3 has been available for several months. Our holdup in getting it was that we were waiting for the software that would allow it to be fully integrated with the Grass Twin PSG system.
We plan to test it over the next week, I'll let you know how it turns out.