Home sleep studies get second look

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Monday, April 30, 2007

WASHINGTON - CMS's recent decision to review its coverage criteria for CPAP, including whether it should pay for home-based sleep studies, could be a boon for both patients and providers, say industry leaders.
"It's going through this time," said Helen Kent, president of Carlsbad, Calif.-based Progressive Medical. "I have no doubts."
CMS initiated the review in mid-March, after the American Academy of Otolaryngology-Head and Neck Surgery requested that Medicare allow portable multi-channel home sleep testing devices as an alternative to facility-based polysomnography.
The industry has changed in the past few years, said Mike Thomas, CEO of Pasadena, Md.-based Sleep Solutions.
"There's been publication of stronger, evidence-based medicine, and some higher-quality validation studies," said Thomas. "And a lot of insurance companies have been passing policy allowing for these kinds of tests."
CMS has also received requests concerning the criteria for determining the apnea-hypopnea index (AHI).
Currently, "the AHI is equal to the average number of episodes of apnea and hypopnea per hour and must be based on a minimum of 2 hours of sleep recorded by polysomnography using actual recorded hours of sleep."
Stakeholders want this changed, to: "the AHI is equal to the average number of episodes of apnea and hypopnea per hour and must be based on a minimum of 2 hours of sleep or less, if the actual number of AHI episodes recorded is 30 or more in less than 2 hours, recorded by polysomnography using actual recorded hours of sleep."
Kent doesn't feel that reducing sleep time is a smart move.
"A lot of people don't get into REM in two hours," said Kent. "You're not even seeing the worst."
With backlogs of up to 12 weeks at sleep labs around the country, expanding diagnosis beyond the confines of a lab would ease the way for treatment by giving providers an opportunity to get more involved in the diagnostic side, said Joe Lewarski, vice president of clinical and government affairs for Inogen.
"It creates an opportunity to move patients through the diagnostic process that much faster," said Lewarski. "If more patients are diagnosed with OSA, then more patients move to therapy faster and that could increase the demand for sleep therapy and related products."

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