Medicare gives thumbs up to home sleep testing

Sunday, March 16, 2008

WASHINGTON - After studying the issue for many months and reviewing loads of public comments, CMS approved at-home sleep tests Thursday--minus a few nuts and bolts.

"The only thing we know is, it's approved," said Tom Pontzius, president of The VGM Group's Nationwide Respiratory. "We're waiting for the local coverage determinations to come out with the meat of what we are looking for."

Overall, the final decision echoes December's proposed coverage memo, which many industry leaders say is a step in the right direction

"It gives the physicians options for their patients," said Jill Spellman, president of Sleep Apnea Solutions in Waukesha, Wis., which offers home-based sleep testing. "A person with moderate to severe obstructive sleep apnea with no co-morbidities can be studied at home."

With the final approval comes numerous questions: What CMS will reimburse for the tests? Who can perform the tests? And what documentation is needed after a required 12-week trial period to allow patients to continue treatment?

One surprise: Type IV devices are still included, provided they have at least three channels. Many had believed the devices would be excluded from the final decision.

"I was betting the farm (they would drop that)," said Pontzius. "But it's included with three channels. Are there any mandated channels?"

Industry leaders will rest easier once it becomes clear what qualifications are needed to perform home sleep tests. For example, will a facility need to be accredited by the American Academy of Sleep Medicine and will a sleep medicine specialist oversee treatment?

Under current Medicare guidelines, the prescribing physician must consult with a sleep doctor, said Ed Grandi, executive director of the American Association for Sleep Apnea. Grandi wants to know how the relationships between potential new players to the market will flesh themselves out.

"For me, the challenge is going to be with the primary care physician and with DMEs," said Grandi. "This could put a lot of pressure on them to have to bone up on sleep real fast."

However this shakes out, expect a possible sea change in the industry, said Mike Kuller, president of Concord, Calif.-based Allstar Oxygen Services.

"I'm sure the majority of testing will shift to the home," he said. "The question is, who will do it?"