The Centers for Medicare and Medicaid Services has proposed a revision to their National Coverage Determination concerning the prescription of CPAP for the treatment of OSA.
Currently, the prescription for CPAP would only be reimbursed if the diagnosis was made on the basis of a sleep study done in a sleep lab or sleep center.
The proposed decision could significantly change the landscape for the diagnosis and treatment of OSA. It would allow for the prescription to be reimbursed on the basis of an HST.
HST will be a good thing for the thousands/millions of people who have sleep apnea and are prevented getting treatment due to cost of testing or ability to access an existing sleep testing facility. But, the decision removes necessary participation of the sleep specialist from the treatment pathway and places great reliance on the primary care physician, who may or may not be able properly care the patient with a sleep disorder.
A dear colleague and friend says that the custodian in the office of her sleep lab is capable of diagnosing cases of sleep apnea. But what about the cases that generate a false positive or worse a false negative. What happens with those cases?
CMS will need the wisdom of Solomon to work this out. Whatever their decision, the ASAA will continue to be the comprehensive resource for those seek information about diagnosis and treatment and the home of A.W.A.K.E. and the Apnea Support Forum
2008 promises to be an interesting year... check back often for new entries.
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