New policies signal 'paradigm shift' in sleep testing

CORAL SPRINGS, Fla. - VirtuOx, an IDTF for home sleep testing, stands to benefit significantly when UnitedHealthcare changes its clinical policies for treating patients with obstructive sleep apnea Oct. 1, 2011.

On that date, UnitedHealthcare will begin performing clinical reviews to determine not only whether prescribed sleep tests are medically necessary but also whether they should be performed in the home instead of a lab. In a bulletin, UnitedHealthcare stated home sleep testing is "more convenient and cost-effective."

"From what I've seen from other insurance companies, there's been a dabbling in home sleep testing," said Felix Krupcyzynski, COO of VirtuOx, which in January, was contracted by UnitedHealthcare to perform home sleep tests nationwide. "I think United is leading the way in a movement toward home sleep testing and we expect to see an increase in business, absolutely."

Initially, UnitedHealthcare is rolling out the new policies in a handful of areas, but the goal is to expand them nationwide.

The big questions for HME providers upon hearing of UnitedHealthcare's new policies and its contract with VirtuOx: Who will interpret the results of the home sleep study and who will make the referrals for therapy?

Krupcyznski says VirtuOx will mail home sleep tests to patients; will facilitate the process of patients taking the tests; will score and interpret the tests once patients have returned them; and will send the results to the physicians.

"It doesn't affect (providers)," he said. "The physician drives the therapy."

Still, as home sleep testing becomes more prevalent, providers say they will ramp up education efforts with physicians, including the role they play in therapy and compliance.

"It may be a boon for us," said Eric Parkhill, vice president of clinical operations/corporate compliance for Home Medical Professionals in Gainesville, Ga. "If we don't have to go to a sleep lab and we can go to a primary care physician, who we already have a relationship with, there are advantages."

UnitedHealthcare's new policies won't mean the end of lab testing by any means, but for certain patients, they will tip the scale in home testing's favor, Krupcyznski said.

"I think there's a paradigm shift occurring, and it will continue to occur in the next 12 to 24 months," he said.