“The future is uncertain … but this uncertainty is at the very heart of human creativity.”—Ilya Prigogine.
If you are concerned about CMS’ home monitoring decision regarding reimbursement for CPAP for the diagnosis of OSA, you should take heart from the quote above. While there is great uncertainty as to what CMS will decide about home testing reimbursement, such uncertainty can lead to creative business approaches.
Now is a good time to begin thinking about how CMS’ verdict on home testing will affect your business. CMS’ final ruling is scheduled to be released March 13, 2008. “The decision one way or another is going to have a big impact on every sleep lab,” says Delmer Henninger, MD, FCCP, FAASM, owner and director of Complete Sleep Solutions. “If CMS says home testing is not ready for prime time, then it gives sleep labs a nice little break. But you can see the writing on the wall—eventually home testing is going to be used more extensively. You have to be ready to get your share of the market.”
To corner your share, you will have to be smart, confident, and creative. “There are lots of aggressive groups and companies that will try to come out and corner the market,” says Henninger. If you are considering creating a home testing approach to business, make sure you:
- Know your patients. Home testing is not for every patient. “It is really only cost-effective, in my opinion, in the high- to moderate-probability sleep apnea patients,” says Henninger. “If they have another comorbid problem—central apnea or some sleep disorder other than straightforward sleep apnea—then don’t even think about using it for those patients.” The key is to be able to effectively screen and identify high-probability sleep apnea patients.
- Know your equipment. Patients have to be able to effectively use home testing equipment, and labs need thorough results. Henninger says equipment should be accurate and clinically validated, provide full disclosure of all the raw data, and have some measure of airflow, respiratory effort, pulse oximetry, snoring, and body position.
- Know your treatment pathway. The patient tests positive for sleep apnea, now what? You can bring them into the lab or you can treat them at home with automatic titrating CPAP. “If you are going to do the diagnostic, you have to be prepared to be able to do the treatment for those patients who want to go on CPAP,” Henninger says. “You need to have the equipment and technician available to do in-home, automatic titrating CPAP for these patients.”
- Know your payors. This is critical. Question all of your payors, HMOs, and PPOs to see if they cover home testing. Ask how much they reimburse. “You still have to run the numbers even if you have a system you want to run and all of the right equipment,” Henninger says. “If you are not getting paid enough to make it worthwhile, then the whole thing goes down the drain.”
Also know that Sleep Review has tools to help you succeed. Be sure to take advantage of Sleep Report, Sleep Review’s weekly e-newsletter, featuring all of the breaking news and analysis surrounding home testing. You can subscribe at www.sleepreviewmag.com. Experts are also available at our Web site to answer your clinical and business questions. All you have to do is ask.
—Franklin A. Holman