Sleep coalition seeks to keep sleep studies in check

Wednesday, April 7, 2010

YARMOUTH, Maine - When CMS approved home sleep studies in 2008, it may have opened the gates a little too wide, says a group of sleep providers.

"We are seeing a lot of patients getting these studies who aren't appropriate for it," said Jack Miladin, executive committee member of the Coalition for Effective Sleep Medicine and president of Mount Laurel, N.J.-based SleepCare. "We're in support of home studies if they are done properly."

The coalition, which formed last year and is comprised of about 20 members, wants to create strict protocols to establish which patients should be eligible for home testing and how they should be cared for based on an "integrated care model," said Miladin.

"If the patient isn't getting the continuum of care, compliance falls and the patient falls off the charts," he said. "In some cases, you have family doctors doing this who don't have the right background. We want to help them understand what they could be doing (to help patients)."

Additionally, existing CMS guidelines for home testing could be stronger, and they could be applied to private payers, as well, said Miladin.

CMS itself has suggested it would like to see some form of accreditation for sleep providers or outcome measures to support integrating services for sleep disorders, said Nancy Taylor, an attorney with Greenberg Traurig in Washington, D.C., who is working with the coalition.

"CMS is interested in understanding how to more effectively evaluate the reimbursement and growth of services," she said. "Healthcare reform has a focus on bundling services. How do we modify provider behavior to reward for value, not volume? The bundling of services is consistent with what Congress is asking CMS to start focusing on."