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."