CMS decision doesn't snuff sleep debate headline

BALTIMORE -- Despite CMS's announcement this spring that it will continue not to allow in-home screening for sleep apnea, proponents of the tests say this issue has not been laid to rest. "This just means that it has been pushed off a year or two," said Mike Thomas, president and CEO of Sleep Solutions, which provides mail-order in-home sleep screenings. "Everyone will tell you, even the pulmonologists who run their own sleep labs, that this is coming eventually." Medicare issued its final national coverage determination after a year-long review of the subject. Currently, the only CPAP qualifying study sanctioned by the agency is polysomnography conducted in a facility-based sleep lab. Proponents argued that a change was needed to alleviate long waiting lists for diagnostic screenings at sleep centers. Terry Davidson, a sleep doctor at the University of San Diego who is credited with spearheading the initial effort to qualify in-home screening, said he is disappointed with CMS's decision to ignore the mounting evidence in favor of portable sleep tests. He said, however, the industry did not present a united front to CMS, and there was little input from cardiologists, family practitioners, beneficiaries and consumer groups. "There was nothing compelling urging CMS, and CMS took a look at it and said if medical groups can't make a decision why should we," said Davidson. The only group that did make a strong showing, according to Davidson, was the American Academy of Sleep Medicine, which made a staunch argument against in-home sleep tests. The academy points to a study it completed with the American College of Chest Physicians and the American Thoracic Society that determined evidence did not exist to support home monitoring. "This is about evidence. It's not about anything else," said Jerry Barrett, executive director of the academy. Barrett said the three groups that assembled the original report are setting the framework to meet again this summer to examine the issue further. Davidson also said more research and evidence is coming out to support a switch. In the meantime, Thomas said CMS's decision to ignore portable sleep testing would not hurt business because only 10% of the entire sleep apnea market is Medicare. The biggest benefit he sees is in CMS's role as a policy leader. Individual insurance providers are more likely to cover a test if it approved by Medicare. "CMS also stifled competition," he added. "If they had opened it up, then you would have seen a dramatic rush toward the in-home business and competition would have taken over and driven prices down."