In-Home Sleep Studies Could Boost HME Biz, but There’s a Caution

ATLANTA–The possibility that CMS might expand its sleep-testing
policy to include in-home sleep studies generated talk of enticing
opportunities for HME providers, but industry experts cautioned
last week that stringent rules must be in place in order to
safeguard the health of patients.

“There probably are patients who absolutely will not get tested
if they need to go to a sleep lab … [This] provides huge
opportunities for HME providers because the floodgates are going to
open more. But it comes with huge responsibility,” said Kelly
Riley, director of The MED Group’s Respiratory Network.

Prompted by a request from the American Academy of
Otolaryngology-Head and Neck Surgery, CMS opened for review its
coverage policy on patients with obstructive sleep apnea (the
30-day comment period began March 14). Current policy dictates that
OSA patients needing CPAP treatment be diagnosed through a sleep
lab test in order for Medicare to cover the cost of treatment.

But the academy requested that CMS consider including
“multi-channel home sleep testing devices” as an option, saying
that the current system “creates access problems for patients due
to a high level of demand, a lack of sleep laboratories in some
areas, and discomfort among patients uncomfortable with testing in
a lab.”

“There is a strong possibility that it will be initiated,” said
Tom Pontzius, president of VGM’s Nationwide Respiratory division.
“It would provide the opportunity for HME providers to diversify
their businesses and become full-service providers for sleep
apnea.”

HME providers could supply the in-home testing devices and be
reimbursed. But experts noted that, while in-home studies might
allow many more people to gain access to diagnosis and treatment,
not everyone is a candidate for an in-home or unattended sleep
study.

“The population that could probably benefit the most is the
person who has just been diagnosed with [OSA],” said Pontzius.
“Others would be better diagnosed in a sleep lab.”

Riley said if CMS were to relax its policy to include in-home
studies, it also would need to define who would be eligible to have
an in-home test. Those with complex OSA would be better diagnosed
by a polysomnography study done in a sleep lab, she said, noting
that improper treatment could put such patients at risk of
dying.

“I would go so far as to ask, ‘Who absolutely cannot go to the
lab?’” Riley said. “There needs to be an algorithm that is
developed by the specialists in this field. The pulmonologists, the
sleep doctors–they need to be the people who weigh in on this, and
weigh in on it pretty quickly.”

Questions also abound about the specifics of testing.

“There have to be some type of rules and some type of policy
that mandates who does the test, who does the scoring,” Pontzius
said.

“I think they need to back up the boat and define what is a home
study, how many channels are necessary, how many hours of recorded
sleep [there must be] and what is the definition of quality and a
credible study,” said Riley.

While there could be an influx of patients seeking in-home
studies were CMS to reimburse for them, both Riley and Pontzius
said there would always be room for sleep labs. “We encourage our
providers to work with the sleep labs to provide the best
diagnostic and therapy,” said Pontzius. “There is still a role for
the facility-based sleep lab.”

If CMS does allow in-home sleep studies, Pontzius believes a
number of providers will be interested in expanding their sleep
businesses. Nationwide Respiratory has started a home sleep-testing
program to train HME providers on the devices, which type of
patient is best suited to such tests and how to run the program, he
said.

“This is an opportunity,” he said, adding that this is one
instance for beleaguered providers where “there is light at the end
of the tunnel and it’s not a train.”