Sleep
Keeping Up with Changes in the Sleep Market
In recent months, Americans have been exposed to the concept of change in a number of different ways.
Change was the central theme for the presidential campaign of 2008, and most Americans got a healthy dose of political news and campaign advertising highlighting this theme. Given the recent performance of the financial markets, many Americans are collecting their change to help stretch their budgets and dollars further.
However, no Americans are likely to be hit harder by change than HME suppliers and sleep labs involved in the provision of home sleep testing and treatments for obstructive sleep apnea.
However, no Americans are likely to be hit harder by change than HME suppliers and sleep labs involved in the provision of home sleep testing and treatments for obstructive sleep apnea.
The HME industry is one that endures and absorbs a significant amount of change on a routine basis. However, 2008 has been a landmark year for sleep providers for several reasons. Not only has home testing caused a significant ripple in the market, but the implementation of home testing guidelines has also made fundamental changes to the reimbursement rules for CPAP and traditional polysomnography.
In order to understand these changes, it is important that each supplier know what sources of new information exist and spend time reading the guidelines to understand what the impact on its operation will be.
Local Coverage Determination
The Local Coverage Determination for PAP therapy provides that a CPAP device is covered for the treatment of obstructive sleep apnea if three criteria are met, including:
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The patient has a face-to-face clinical evaluation by the treating physician prior to the sleep test to assess the patient for obstructive sleep apnea;
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The patient has a Medicare-covered sleep test that meets the clinical criteria set forth in the policy; and
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The patient and/or their caregiver have received instructions from the supplier of the CPAP device and accessories and the proper care and use of the equipment.
The clinical evaluation by the treating physician must be documented in a detailed narrative in the patient's chart and contain, at a minimum, the following elements:
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Signs and symptoms of sleep disordered breathing, including snoring, daytime sleepiness, observed apnea, such as choking or gasping during sleep and morning headaches;
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The duration of such symptoms; and
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Validated sleep hygiene inventory such as the Epworth Sleepiness Scale.
