Atlanta
The possibility that CMS might expand its sleep-testing policy to include in-home sleep studies has generated talk of enticing opportunities for HME providers, but experts cautioned 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 in mid-March. 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.”
But both Riley and Pontzius said that, while in-home studies might allow more people to gain access to diagnosis and treatment, not everyone is a candidate.
“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 relaxes its policy to include in-home studies, it also would need to define who would be eligible for an in-home test. Those with complex OSA would be better diagnosed by a polysomnography study in a sleep lab, she said, noting that improper treatment could put such patients at risk of dying.
According to Riley, “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.”
If CMS does allow in-home sleep studies, Pontzius believes a number of providers would be interested in expanding their sleep businesses. “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.”
