With sleep therapy, screening is easy, treatment is hard

Friday, June 20, 2014

WASHINGTON – A new bill that would increase sleep apnea screening requirements for Medicare beneficiaries is a positive step, but it overlooks problems in the program when it comes to therapy, say providers.

“I think it’s great to see so much attention placed on screening,” said Lisa Feierstein, president and co-founder of Raleigh, N.C.-based Active Healthcare.“But the other side of the regulatory framework just sets everyone up for failure by making it difficult for patients to get treated and providers to get paid.”

H.R. 4695, introduced last month by Reps. Michael Burgess, R-Texas, and Bobby Rush, D-Ill., seeks to add a screening questionnaire for obstructive sleep apnea to the initial preventive physical exam for new Medicare beneficiaries.

That could be especially helpful when a longtime CPAP user ages into the Medicare program and, not surprisingly, doesn’t have a copy of the original sleep study, say providers.

“We just had a call for a patient who’s been on CPAP since 2003,” said Debra Drillen, a respiratory therapist with Sleep Well in Brewer, Maine. “We’ve spent a lot time explaining to the doctor what needs to happen.”

Still, the legislation comes at a time when CMS is already looking to put more controls on CPAP therapy. A recent proposal seeking to implement a prior authorization process for “frequently over-utilized” DME includes CPAP. Increased utilization typically means increased audit activity, say providers.

“Would this bill raise utilization?” said Eric Parkhill, vice president of clinical operations/corporate compliance for Home Medical Professionals in Gainesville, Ga.

Overall, more and more health professionals are aware of the dangers of sleep apnea—but not everyone knows how best to treat it, say providers.

“Everybody’s asking about sleep but there’s a lot who are in the dark,” said Helen Kent, president of Progressive Medical in Carlsbad, Calif. “A lot of our doctors don’t really have much of a background in sleep.”