Are docs trying to creep into CPAP biz?

Friday, September 28, 2012

DARIEN, Ill. – The American Academy of Sleep Medicine (AASM) thinks sleep physicians should be able to provide CPAP devices and other sleep therapy to Medicare beneficiaries.

The association, which wants to create a "safe harbor" that will allow board-certified sleep medicine physicians to perform and interpret sleep tests, provide CPAP devices and track outcomes, recently sent a letter to its members seeking donations to its political action committee. The money will be used to support lawmakers who support AASM's proposal.

"The care is fragmented and we want to integrate it better," said Dr. Sam Fleishman, AASM president. "One way to do that is to allow physicians to provide other sleep care, evaluation and treatment, and all the things that go along with that."

The AASM took one of its first steps toward expanding the role of physicians in sleep therapy in 2011, when it submitted a proposal to the Center for Medicare and Medicaid Innovation to create a pilot program for an "integrated sleep management delivery model." The proposal wasn’t accepted.

HME industry stakeholders don’t like the implied message that the current model is not integrated and not good for patient care.

"Where do they point to prove that the model many of them have been practicing under for years yields significantly different results related to patient outcomes?" said Kelly Riley, an industry veteran.

Stakeholders say providers provide far better patient care in the fast-evolving sleep field than the physicians ever could.

"The doctors do not know their equipment and there's new stuff coming out all the time," said Helen Kent, president of Progressive Medical in Carlsbad, Calif. "We are going to be out there with the latest item to help them treat their patients and educate them. Who's going to do all of that stuff?”

The AASM’s plans put providers in the awkward spot of advising their referring physicians about the equipment and service side of the sleep business.

"I've had a couple reach out and propose either a joint situation or just kind of inquire with us how about how our business is run," said Ryan McDevitt, general manager of Sleep Solutions Home Medical in Troy, Mich. "It's a very, very fine line. These same physicians are clients of ours."

Most stakeholders doubt physicians would even want to offer CPAP, anyway.

"Normally, the docs don't want anything to do with the DME," said Sam Jarczynski, president of RxStat in St. Petersburg, Fla. "They'd have to deal with the (manufacturers) and carry inventory."

It's not a model that will work for everyone, acknowledges Fleishman.

"Overall, we want better integrated care and there's different ways of getting there," he said. "We want to work hand in hand with DME companies—that's one model and we are open to that model. But we also think this is another viable model and we need to consider this."



This has less to do with patient outcomes and more to do with increasing their cash flow. Some physicians look at providing CPAP and supplies as a new revenue source. It also makes it more appealing when you can bill the insurance for an office visit in addition to supplies. There are a few sleep labs that I know of which provide their own DME and it ends up costing the patients more with less service. In these situations, patients still only see trained technicians (not an R) and they don't usually see the physician even when they have been billed for a visit. Sleep labs currently have the choice to refer patient to a variety of CPAP providers. If a company doesn't take care of your patient than don't refer them there. If it is an issue of quality providers not being available let me know where I can open my next office.