Following the results of a recent study, the Office of Inspector General (OIG) has urged the US Department of Health and Human Services Centers for Medicare & Medicaid Services (CMS) to review and revise the CPAP supply replacement schedule in a report published today.
The study, prompted by a 2012 finding that CMS beneficiaries may have received more CPAP supplies than medically necessary, was conducted to assess waste within health care services.
The OIG reviewed CPAP replacement supply schedules in effect as of January 1, 2012 from 50 fee-for-service State Medicaid programs and from four fee-for-service Federal Employees Health Benefits plans. They compared the replacement schedules for 15 types of CPAP supplies with Medicare’s schedules against recommended replacement schedules from five sleep disorder clinicians and four manufacturers.
The OIG concluded that 39% of frequencies were less than those under Medicare, 51% equaled those under Medicare, and 10% of frequencies exceeded those under Medicare.
Sleep medicine clinicians stress the importance of proper mask fit, but research suggests that once fit is established, necessary replacement of masks is less frequent than Medicare allows, according to the report. Also, manufacturers recommended specific replacement frequencies for only a few types of supplies on an as-needed basis and potentially less frequently than under Medicare’s replacement schedule.
CMS did not concur with the OIG’s suggestion to review CPAP supply replacement schedules and make efforts to revise the national and local coverage determination, stating that “failure to consider noncompliance or the potential impact of supplier fraud or abuse may bias the estimate of a clinically appropriate refill rate.”