Home Sweet Home?

One of the hottest and most controversial topics today in sleep medicine is the issue of home sleep testing and how far CMS will go in approving coverage. While there are a variety of opinions on the merits of home sleep testing (see our Guest Editorial on page 12), it is paramount that sleep medicine specialists become involved in the decision-making process.

No one can argue the fact that the best way to ensure the accuracy and quality of a sleep study is to conduct it in a facility-based setting. The availability of on-staff physicians and sleep technicians, access to the highest quality sleep diagnostics systems, and a controlled environment will in most cases provide an accurate sleep diagnosis; however, as with a number of different areas of health care, such as physical therapy and rehabilitation, respiratory care, and orthopedics, home-based diagnosis and care have proven to be a complement to traditional facility-based testing.

There is no mistaking the fact that there are cost savings associated with care in the home; however, saving dollars should never be the only deciding factor when it comes to deciding quality patient care. It will be up to CMS to decide if and when portable home-based testing equipment passes the test to deliver and ensure an accurate diagnosis. During this rather tenuous period of discussion, it is in your best interest, whether you are hospital-based or working within a freestanding sleep center, to participate in the discussion in an open and honest manner. If indeed home-based sleep testing reimbursement becomes a reality, we will want sleep medicine physicians and specialists to be at the forefront of any changes that take place.

As the publishers of 16 medical/health care publications, this is not the first time that we have seen the issue of home care testing and services come into play. In most instances, home care testing and services have not replaced diagnostic services in hospital-based and freestanding settings, and in many cases they have led to an even greater acceptance of the field itself.

Shari Newman’s Guest Editorial in this issue points out many of the reasons why our industry needs to be proactively involved in the discussion on home-based sleep testing. While there are certainly “turf issues” that will come into play, this growing and exciting field will, in our opinion, be able to come together and arrive at a destination that will ensure quality patient care overall. With just a portion of the OSA population having been diagnosed, CMS approval of home-based sleep testing will still be appropriate only for a certain segment of the population, with the majority of testing remaining within hospital-based and freestanding centers.

Tony Ramos,
Paige Smith,