Vol. 21 • Issue 25 • Page 7
Home care
Home diagnostics for sleep apnea has been available for years. However, until recently it was reimbursed only by private managed health plans, integrated health plans and local medical groups which paid the bills for patients suspected of having obstructive sleep apnea (OSA).
The Centers for Medicare & Medicaid Services (CMS) has now embraced the approach as well because home sleep testing (HST) costs only a fraction of the “gold-standard”-a fully attended polysomnography performed in a sleep lab.
Technology for HST has existed for years and has been used by organizations like Graybill Medical Group of Escondido, Calif., and Kaiser Permanente of Oakland, Calif. My personal experience with Kaiser and Graybill home diagnostic technology was fulfilling, and we effectively saved significant dollars while improving the quality of care and compliance for patients diagnosed with OSA.
HST will definitely cut the overall Medicare expenses for diagnosing sleep problems. Some “purists” believe home diagnostics will result in poor health outcomes; however, that was not our experience when we developed a system to meet the needs of 6 million privately insured members.
We found patients were diagnosed and treated earlier, and this resulted in significant reductions in wait times for diagnosis at traditional sleep facilities. The key to the overall success of HST is using board-certified physicians with a specialty in sleep diagnostics and skilled allied health practitioners.
During my time at Kaiser Permanente, we developed diagnostic algorithms in which patients who presented with high Epworth Sleepiness Scale scores and symptoms suggestive of OSA were diagnosed with HST; those more difficult to evaluate were routed to sleep labs.
This approach allowed us to quickly diagnose patients and follow up with continuous positive airway pressure (CPAP) treatment if needed. The most important benefit of using home diagnostics is patients are treated sooner, and this circumvents some of the backlogs at accredited sleep labs.
There is significant evidence available supportive of home diagnostics, and the technology continues to advance at a rapid pace to support the trend of the provision of health care outside of traditional methods.
Time for Technology
The availability of new, emerging technology creates an opportunity for home care/HME providers to partner with accredited sleep centers to provide valuable services. Most sleep centers already have the technology available for HST; however, they lack the staff for follow-ups in the home. As such, home care/HME providers can thrive by meeting a need to evaluate and troubleshoot patients in the home.
Sleep-related health care diagnostic and treatment costs are increasing at an annual rate of approximately 25 percent overall, compared with the overall GDP for health care of 15 percent to 18 percent.
We must focus on using technology that will allow us to meet the needs of patients at significantly lower costs while ensuring quality care and compliance with therapy.
At Kaiser Permanente, we established clinics to provide group education and instruction on the operation of HST equipment for unattended studies, and we partnered with home care providers to set up CPAP and auto-CPAP to establish the appropriate pressures.
Equipment used at Kaiser Permanente ranged from oximetry with auto-CPAP to Type II, III and IV devices. Expanded coverage called for a combination of a clinical assessment followed by unattended HST using Type II, III or IV devices in addition to required monitoring for 12 weeks, ideally starting at seven days following set-up on CPAP and then at 14 days, 30 days and 90 days.
Some New Codes
Recently, CMS outlined new “G” codes-G0398, G0399 and G0400-identifying the types of devices used for unattended tests. CMS regulations now cover various portable monitoring technologies deemed appropriate, safe and effective for assessing OSA.
Manufacturers of home study devices are familiar to therapists and sleep techs. The list includes companies like Phillips Respironics, ResMed, Embletta, Itamar Medical, Cardinal Health and Mallinckrodt.
As home care/HME providers look for mainstream acceptance as an essential component in the continuum of care, it is important that they take full advantage of the opportunity to participate in home diagnostics for OSA. n
Vernon R. Pertelle is senior director/assistant vice president for Tri-City Healthcare District, Home Care, Care Management and Social Services, Hospice, Occupational Health and Wellness, Rehabilitation Services, Center for Wound Care and Hyperbaric Medicine and Orthopedic Service Line Administrator. He can be reached at [email protected].
