Dealers Discuss

Providers Weigh In on Home Sleep Testing

• Mar 01, 2008

In Respiratory Management's exclusive survey, providers had the following to say about home sleep testing:

Benefits

• "We are in a rural area in Iowa and don't have a sleep lab in our hospital. The closest one is approximately 20 miles away. Some elderly patients are unable to get transportation to and from out-of-town sleep labs. Therefore, I think at-home sleep testing would be great for these patients."
• "It will be successful for HME companies (and) patients, and reduce overall costs to CMS only if reimbursement is fair to providers."
• "I feel like we won't have to rely on the sleep labs as much as we do now."
• "I'm hoping this will help offset some of the losses we have come by. We have to try. 2009 will tell the story by how many of us are still left in the business."
• "I think this is a great opportunity for DMEs and home care respiratory therapists since the government has done so many reimbursement cuts. It is a positive for the industry."
• "I believe there are many patients that will benefit from in-home sleep testing and will be more compliant for the ease of getting the test done in-home and quicker."
• "Increasing access and reducing costs is a positive step toward reaching a significant number of people with undiagnosed sleep-disordered breathing."
• "Obviously the home test isn't for everyone. However, there is a definite portion of our patients who are quite capable of performing the testing."
• "Most of the complaints I get from our patients are that they can't sleep at all at a sleep lab. Could you? I have a really hard time sleeping anywhere but my own bed."

Drawbacks

• "If home testing is not done properly, it could be a black eye for the HME industry."
• "I don't think that it (home sleep testing) will be as good as a lab. I think for diagnostic purposes, it will be fine, but I think that titration should still be done in a lab."
• "I think this is a wrong-headed solution to a non-existent problem and is setting up a fraud and scandal opportunity that will dwarf the recent power wheelchair problem."
• "I'm not sure how effective it (home sleep testing) will be. I would prefer a sleep doctor to stay in charge of patient care due to their experience with sleep."
• "I think this will be a fad that will be short-lived, but not until a lot of manufacturers make their money off of it. It will go the same way that in-home X-rays did."
• "The only concern I have is that the sleep labs are employing trained certified professionals to do these test. I do not feel that I am qualified to perform the testing — otherwise there would not be additional schooling offered for sleep testing."
• "I feel that accredited sleep centers provide gold standard testing and that in-home testing in our area is unnecessary and will produce poor quality results that will harm patient care."
• "I do not feel like patients would be able to conduct sleep studies well in their own homes without someone there to assist with this procedure. I am hospital-based and our outpatient department sends an overnight SAT monitor home with patients often. Usually patients have to take the monitor home two nights because they do not understand what they are supposed to do."
• "I don't know if we will be able to get an accurate sleep study from a patient. It's hard enough for them to understand how to do an overnight oximetry."

Points to Consider

• "As another way of curbing health care costs, I believe it's (home sleep testing) worth perfecting, but it will be a slow process getting physicians to make the change."
• "Information, so far is really too scanty to determine (the) potential scope of use and conditions. Reimbursement is undefined, and while home sleep testing is needed, this proposal allows too much leeway and opportunity for sub-standard testing, equipment and results. CMS is setting themselves up for fraud and patient problems, which they are likely to blame on our industry instead of lack of requirements for proper conditions, specifications and training."
• "We happen to be in an area with no backlog/waiting period. On one hand, we are concerned that the sleep center business will decrease, leading to possible layoffs. On the other hand, with good promotion, perhaps we will tap into a population that will be more accepting of completing a study at home due to the out-of-pocket cost savings."
• "Venturing into this market must be a resource to the sleep labs, not a competition."
• "We are working on this for the last three years and signed a contract with local Blues. Did a few testing and private payment. Blue now requires us to have a sleep doc on staff. This is preventing us from continuing to do the testing."
• "Though this (home sleep testing) may sound great to help cut costs, cut waits at sleep labs and make the patient more comfortable, this is not the way to go. There could be other underlying factors not picked up by the unattended study; whereas, an attended study would be able to pick these up. I could see it as a possible screening tool, but not a complete fix."
• "A registered respiratory therapist should be a minimum standard if this gets implemented."
  
  

This article originally appeared in the Respiratory Management March 2008 issue of HME Business.