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More advanced systems can improve patient care with the ability to store massive amounts of data, which results in what is practically a continuous, full-disclosure, one-channel sleep study. For example, Dr. Rapoport indicated that if a patient complains of snoring, you can check up on your suspicion of low pressure by simply looking at the data. "If you capture that, you can say, 'Well, this is clearly not high enough,' and without bringing the patient back in, you can raise the pressure by one or two centimeters, and even check the progress later," he said.
Although Dr. Rapoport indicated improvements in automated analysis and data reduction schemes will need to be made to exploit the technology fully, improved patient care can lead to huge financial savings for both patients and CMS if it avoids more in-lab studies, which cost from $1,000 to $1,500 per study.
Compliance monitoring has great potential; however, navigating reimbursement issues is a tricky prospect. At NAMDRC's annual conference in March, vendors told Dr. Gay that getting the data for CMS and other payers "has been a nightmare" because most physicians do not understand the rules or keep up with the details.
"Many (payers) are telling ordering physicians, 'Look, I'm not going to take a chance on this. If you're not going to supply me with this data, I'm not going to continue coverage,'" he said. "Some are even making patients sign a liability statement that if they don't supply this information then either they're going to pay for the device or they're going to give it up."
CMS also demands a face-to-face physician or nurse practitioner evaluation of patients so they can be assessed for their CPAP use.
Dr. Gay said this is counterproductive, as it prohibits nurse and respiratory therapist-led evaluations, even though many labs have done it that way for years. "That is certainly a target for many of us to go back to CMS or even consider legislative approaches to try to change that. It takes a huge number of people out of the workforce and the care program that, in fact, are very experienced at this."
References:
- Loube DI, Gay PC, Strohl KP, Pack AI, White DP, Collop NA. Indications for positive airway pressure treatment of adult obstructive sleep apnea patients: a consensus statement. Chest. 1999;115(3):863-6.
- Hoover Jr, RD. Public Comment for Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA) [letter]. 2007 Apr 13. Available from http://www.cms.hhs.gov/mcd/publiccomment_popup.asp?comment_id=12832
Frank Visco is editorial assistant of ADVANCE. He can be reached at fvisco@advanceweb.com.
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