Mixed emotions dominate sleep debate

WASHINGTON - While stakeholders on both sides of the debate over whether CMS should pay for at-home sleep testing continue to press their case, sleep providers remain split on the issue. In March, the American Academy of Otolarynology-Head and Neck Surgery, asked CMS to review its coverage policy for at-home testing. CMS, which does not pay for home testing, will hold a public meeting of its Medicare Evidence Development and Coverage Advisory Committee Sept. 12 to consider the request. While most providers don't dispute the potential benefits to patients, they worry how a decision in favor of the tests would fit into current business models. "I have mixed emotions," said Alan Kirk, vice president and general manager of Total Home Health in Elgin, Ill. "We've built a huge referral base with sleep labs and it's growing rapidly. I'm concerned that it's going to upset the apple cart and could disrupt our flow of referrals." Other sleep providers see an opportunity to increase business. "We're talking to one or two providers of home sleep testing," said Cary Nail, president of Independent Med Services in Cullman, Ala. "It would probably bring in quite a bit of business for us. I'm not so sure we would make any money on the actual test, but it would put us in a great position for CPAP." Total Sleep Therapies does full sleep studies and is a provider of CPAP. Fernando DaSilva, sales and marketing northeast, for the Woburn, Mass.-based company, voiced concern about the potential for fraud. "There's no oversight," said DaSilva. "There's no ability to qualify or quantify the process, or maintain certain standards like the labs have." DaSilva thinks the test could serve as a prescreening tool to identify patients needing a full sleep study. "I think they probably will cover it, with some hoops as far as who will qualify for it," said Dr. Robert Hoover, chief medical officer for Sunrise Medical. "There has been a growing recognition of the importance of untreated OSA, so if home testing and allows more patients to get into the system for treatment, they are the big winners." A final decision is expected March 13, 2008.