At-home sleep testing could be on its way

Sunday, September 16, 2007

WASHINGTON -- While the sleep industry remains split on the issue of at-home sleep testing, CMS appears to be leaning in favor of it, industry leaders say.

In March, the American Academy of Otolarynology-Head and Neck Surgery, asked CMS to review its coverage policy for at-home testing.

Last Thursday, CMS held a Medicare Evidence Development and Coverage Advisory Committee (MedCAC) meeting to weigh evidence in support of different methods of diagnosing OSA, including at-home tests.
The committee consisted of a vice-chairman, nine voting members and four non-voting members. The average vote with regard to at-home testing was 3.6 (on a scale of 1 to 5 with 1 indicating "no confidence" and 5 indicating "very confident.")

Several groups spoke at the meeting, mostly in favor of the proposal, said Tom Pontzius, president of The VGM Group's Nationwide Respiratory, who attended the meeting.

"The challenge that was put before CMS was, 'How are you going to monitor this?'" he said. "What are the rules to play by?"

Some of the concerns raised included how the tests would be conducted, i.e. whether a qualified physician would need to interpret results; and if patients with certain co-morbidities, like diabetes or cardiovascular disease, would qualify or would still be referred to a sleep lab, said Pontzius.

"There was also a question of whether facility-based testing is the gold standard," said Pontizus. "That hasn't been proven."

Among providers themselves, the feeling has been mixed (See HME News, Sept. 2007). While most agree that at-home testing could open up potential new revenues, they are afraid of alienating referring sleep labs, said Mickey Letson, of Decatur, Ala.-based Letco Companies.

"The sleep labs are going to feel like you are competing against them," he said. "If you are new to the sleep industry, and if you really feel that you haven't been getting the referrals out of those sleep labs, those are the people that are likely to go full force with it."

CMS is scheduled to make a final decision on at-home sleep tests March 14, 2008.