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 Compliance monitoring technology has become a vital tool in the industry. The Centers for Medicare & Medicaid Services requires proof of patients' continuous positive airway pressure therapy use between 31 to 90 days to allow continued payment after that time.
"Patients often don't realize how poorly compliant they are," said Carole Marcus, MBBCh, director of the Sleep Center at the Children's Hospital of Philadelphia. "In their minds, they went to the bathroom at 4 a.m. and only left it off for a couple of hours, but really they went to the bathroom at 1 a.m. and left it off most of the night.
"So it can be a teaching tool, but, at the same time, if someone isn't using it at all, it's a waste of money for insurance companies to be paying for these expensive pieces of equipment to be sitting in the bottom of a closet."
Noncompliance rates among sleep apnea patients who start CPAP but terminate treatment by end of the first year are estimated to be more than 50 percent.1 One New York-based insurance provider has shown that identifying non-adherent patients with compliance monitoring saved them more than $62,000 in 2004.2
CPAP compliance monitoring used to imply bringing the entire unit to a provider to collect data or having a patient submit it over the phone. However, smart cards, memory sticks, modems, and wireless internet now allow for more convenient and sophisticated documentation. At the minimum, machines will monitor run time. Advanced models can show how long the machine actually was used and even report an estimated apnea/hypopnea index. Physicians can check patient data anytime with this technology.
Some patients may see this as a "Big Brother" approach, but according to Peter Gay, MD, professor of medicine, pulmonary critical care, and sleep medicine at the Mayo Clinic in Rochester, Minn., CMS is not aiming to take treatment away from anyone who is trying to use it. Although ideal use is approximately seven hours, CMS has maintained the modest definition of compliance - four hours a night at least 70 percent of the time for more than 30 consecutive days.
Nevertheless, some doctors fear the mandate will result in a loss of coverage for patients who are motivated to use their equipment but are doing so incorrectly. "I would hate to see somebody discover on the 11th week that he's not using his CPAP well enough for a correctable reason, and then be told on the 12th week that he can't have the CPAP anymore while he tries to adjust it," said David Rapoport, MD, an associate professor of medicine at the New York University School of Medicine.
Compliance monitoring is especially helpful during the first week of treatment, when the pattern of adherence is being established. "It enables you to know very quickly whether or not the patient is going to use their treatment as prescribed, or if there's going to be difficulty and more intervention will become necessary," said Terri E. Weaver, PhD, RN, FAAN, professor, school of nursing and school of medicine in the division of sleep medicine at the University of Pennsylvania, Philadelphia.
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