AASM shifts sleep strategy

DARIEN, Ill. - A proposal that would allow sleep centers to provide CPAP equipment to Medicare beneficiaries could threaten the role of HME providers in the market.

The American Academy of Sleep Medicine (AASM) on Sept. 16 released a final draft of its proposal to create a pilot program with an "integrated sleep management delivery model." The pilot would be tested in partnership with the Center for Medicare and Medicaid Innovation.

"The idea is to move sleep medicine from being just diagnostic to more management and outcomes-based," said Dr. Nancy Collop, AASM president. "It hopefully improves patient care and puts the sleep physician at the controls in getting the patient through the process."

Under the AASM plan, participating sleep centers would need to receive AASM accreditation for sleep centers, DME programs and out-of-center sleep testing; partner with a dental sleep medicine professional experienced in oral appliance therapy; partner with a surgeon experienced in upper airway surgery to treat OSA; have a tracking mechanism to record patient follow-up and outcomes; and have a compliance program to prevent fraud and abuse.

Many commercial insurers already allow sleep labs to bill for both the sleep test and the CPAP equipment--something Medicare rules prohibit. To date, that's been an advantage for HME providers who currently tread a thin line between competing with labs and getting referrals from them.

"There's been this one segment isolated from the lab being a total competitor and that's Medicare," said one provider. "This would be a decrease in the number of referrals to us."

The proposal is the latest effort by the AASM to keep up with a changing industry. In 2010, it began offering a DME accreditation program; earlier this year, it launched an accreditation program for out-of-center sleep testing. Collop emphasized that the proposal is still in its early stages and said there may be room in the future for partnerships with HME providers.

"The focus right now is on the fragmentation of care," she said. "Lots of times patients get lost in the system and our goal is to try and improve communication, not necessarily to exclude people."

If HME providers don't want to find themselves shut out of the CPAP business, they need to do a better job--as an industry--of proving their value to other healthcare providers, says Lisa Feierstein.

"We understand the complexity and the special needs around patient care in the continuum," said Feierstein, founder of Raleigh, N.C.-based Active Healthcare. "The better DME providers understand that it's more than a piece of equipment. There's a whole process around compliance."