Yes or No to Home Sleep Testing? Maybe Some of Each, Experts Say

ATLANTA–As the industry awaits CMS’ decision on coverage of
CPAP therapy based on home testing, DeVilbiss Healthcare’s Robert
D. Hoover, Jr., MD, MPH, FACP, is optimistic about the outcome. “I
believe CMS probably will provide some level of coverage for home
studies,” said Hoover, chief medical officer for the Somerset,
Pa.-based manufacturer.

“The question is going to be how deep down in the technology it
will go in terms of the type of study it will allow and what kind
of hoops patients or physicians will have to jump through in order
to qualify for a home study,” Hoover said.

For example, he sees CMS allowing a home-based study if the
patient has five out of eight subjective and objective criteria,
such as a large neck circumference, a high body mass index,
confirmed snoring and daytime hypersomnolence.

“Home-based testing would not be used for screening the general
population, but in patients that are more likely to have
obstructive sleep apnea, these tests are … more likely to be
approved,” he explained.

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 a request from the American
Academy of Otolaryngology-Head and Neck Surgery asking the agency
to accept in-home testing prompted CMS to open its policy for
review earlier this year. (See
HomeCare Monday, July 9.)

At a meeting of the Medicare Evidence Development and Coverage
Advisory Committee Sept. 12, all aspects of the National Coverage
Determination on diagnosing OSA were open for review. After its
meeting, MedCAC voting results appeared favorable to home testing.
But the panel’s findings are not binding on CMS, so the outcome
depends on the agency’s final decision, due in March of 2008, with
a proposed decision memo expected Dec. 14 this year.

According to Don Spence, president of Murrysville, Pa.-based
Respironics’ sleep and respiratory group, the allowance of
home-based testing could increase OSA diagnosis.

“There is a large population of patients that has not been
diagnosed and treated, and it’s likely that if home testing is
approved, it will allow some of those patients that may feel
uncomfortable coming into a lab setting to consider having testing
in their home,” Spence said.

However, he does not see home testing as a replacement for sleep
lab testing.

“I don’t think this in any way says that testing in a lab won’t
continue,” Spence said. “There is probably going to be a place for
home testing under the correct clinical supervision but,
ultimately, it is up for clinicians to decide what is the best way
to diagnose these patients.”

No matter how the decision turns out, Bob Messenger, RRT, sleep
product manager for Invacare, Elyria, Ohio, advised HME providers
to get ready–now.

“If I was a provider today, I would want to strengthen my
personal relationships with referring labs and be prepared to offer
a service they are not accustomed to–that of delivering service in
the home,” he said.