Insurer boosts profile of APAP devices

Tuesday, September 6, 2011

United Healthcare hasn’t just changed its clinical policies for sleep therapy, it has also changed its preferred device for treatment. The health insurer notified physicians recently that auto-adjusting positive airway pressure (APAP) devices are good alternatives to CPAP devices. Maura Weis, director, sleep marketing, Philips Respironics, spoke with HME News about APAP devices, the more sophisticated cousin of CPAP devices.

HME News: Give us a primer on APAP devices.

Maura Weis: From a functional standpoint, it’s monitoring every breath of a patient and making very subtle adjustments, so that breath by breath, the patient is getting the level of pressure that’s needed.

HME: Does the level of pressure needed by a patient frequently change?

Weis: Over the short term, if a patient moves from their back to their side, or if they have a couple of glasses of wine, that can change the needed pressure slightly. Over the long term, there’s variability based on weight gain or loss, or changes in medication.

HME: So what happens when these changes happen and a patient is using a CPAP device?

Weis: When a patient is put on fixed pressure, which is the more traditional model, that pressure is maintained until the patient is seen again, which could be a year or longer. If any of those changes exist, the pressure may need adjusting and that’s not identified.

HME: APAP devices sound like the way to go. What’s holding them back?

Weis: When you think of simple CPAP models and advanced auto-adjusting models of therapies, there is a price difference. Auto therapy does have advanced functionality, but it comes with a higher price tag. So while the reimbursement is the same to the provider, the cost is a little different.

HME: Will an endorsement, like this one from United Healthcare, change that?

Weis: What’s happening in the market, as home sleep testing is taking off and as home titration is taking off and as patients are getting more complex with co-morbidities, auto therapy is being more accepted, more endorsed and more recommended. Of course, you have this other dynamic of payers decreasing reimbursement levels, like with competitive bidding, and providers saying, “This is hurting us. We want to provide the top level of care, but it’s challenging to do it in an economical way.”

HME: As a manufacturer of APAP and CPAP devices, what’s your response to that?

Weis: We’ve come out with Remstar Pro with AutoIQ, which is kind of like a hybrid. It allows you to provide CPAP—it’s not an APAP device and it’s not priced like an APAP device—but it also allows you to provide long-term monitoring and adjustment based on a patient’s needs.