Medicare's Home Testing Proposal

Has anybody else read this info?


http://www.sleepdoctor.blogspot.com/

It sounds pretty much like some doc is trying to sacrifice quality in the name of $$$. Am I reading it right?

Dawgguy

Well, we've already got stupid, greedy doctors running the existing entities....so, they might as well dumb-down the whole thing and hand out the PAP machines at Wal-Mart. That's probably where it's going to end up anyway, some day. There's an epidemic of "diseases" in this country (and elsewhere) and sleep deprivation may be one of the root causes.

Who knows......

Den

I understand your concern about home testing, but think there may be a place for them too. I live in an area where there are mostly small towns being served by one large hospital. The test I was given was at a time that was not my normal bedtime, and I only slept an hour max ( the tech was very unhappy with me). I think since I don't usually sleep on my back, and toss and turn a lot due to disc disease and arthritis, my study was probably not all as accurate as it would be with my true sleeping conditions. I think the whole system needs and will get improvements. At least I can hope....

Hiya, Folks.

I hope I'm not treading on any toes, especially of any people who give me such great advice - but I'm going to do it anyway - never let it be said I let sense get in the way of making noises with my mouth (or tapping keys on the keyboard).

In Australia it seems to be quite common for testing to be done at home. At least, I wasn't offered any option - mind you, the service at our sleep clinics seems to be on a par with a good number of yours, judging from some of the comments on this site.

I was quite confident about the setup - but of course I am unaware of any negatives that might be attached to this approach. One great positive from my point of view is that I detest sleeping in beds other than my own (a devil of a problem in my younger years, happily not a problem for 22 wonderfully partnered years). I've been through it twice, and while my sleep was disturbed because of all the wires etc, at least I was comfortable among my family and in my own bed.

Perhaps this is food for thought - although being an old cynic, it seems doubtful anyone would be suggesting this unless there was money in it for someone - probably in the form of savings for your insurance companies. However, I note that a lot of your US citizens and residents do not seem to have insurance, so it may even work out cheaper for them. The whole deal cost me several hundred dollars, with a pittance back from my insurer.

Regards,

GrizzlyBear

I will be going to read the link you posted shortly. I think the main concern is w/just the autoPAP home test where OSA would be the only sleep problem that it could detect. Granted its probably the most common sleep disorder and the easiest to treat but other causes or contributing causes couldn't and wouldn't be detected or addressed by "just" a home autoPAP test.

I'm off now to read the link.

Ha! The referral to Dr Davidson's 2004 letter referring to 692 as the number of sleep labs in the US like to have blown my mind just thinking of the number of sleep labs in Saginaw, MI alone in 2007. REALLY supported my theory of sleep medicine as the latest "cash cow" for the medical profession!!!

Dr Rack's comment that since 2001, the number of sleep laboratories accredited by the AASM has more than doubled to 1,169. And his referral to a 2004 study by Shariq which estimated there were more than 2,500 accredited and non-accredited sleep laboratories in the US, whilst probably more accurate than Dr Davidson's, still supports my contention that sleep apnea is the latest "cash cow" for the medical profession.

it is darn near funny watching Sleep Docs and Labs squirm when a proposal like this comes up, about as popular as the suggestion to make Auto's OTC

how will they ever make their Mercedes lease payment? Some may resort to selling books.

Kinda like the sleep pulmo and sleep neuro "pots" calling the sleep ENT "kettles" black isn't it?

I am all for it. Why not sell the machines without prescriptions. I suspect thousands of people who suspect they might have sleep apnea would try a machine if they didn't have to spend thousands of dollars at a sleep lab. The thought of the stress involved in a sleep lab is enough to keep many from going not to mention the thousands of dollars involved for those whose insurance doesn't kick in until they have spent 5 thousand dollars or so.

Anonymous wrote:I am all for it. Why not sell the machines without prescriptions. I suspect thousands of people who suspect they might have sleep apnea would try a machine if they didn't have to spend thousands of dollars at a sleep lab. The thought of the stress involved in a sleep lab is enough to keep many from going not to mention the thousands of dollars involved for those whose insurance doesn't kick in until they have spent 5 thousand dollars or so.

There's a "double-edged sword" in all of these arguments. On one hand, it's pretty expensive to get through the "process" to the point of using it. If it gets too cheap, and with the insurance providers paying the bulk of the expenses, people don't seem to take the therapy SERIOUSLY. That could be one of the reasons that so many of these machines get stashed in the closets.....somebody else paid for it. If it hurts you in the checkbook enough, you tend to want to make the most of your investment.

Den (hopefully, investing in a longer "future")

Anything 'over the counter' insurance companies don't pay for at all. They would love to ditch the sleep labs and the cpaps.

Anonymous wrote:Anything 'over the counter' insurance companies don't pay for at all. They would love to ditch the sleep labs and the cpaps.

Probably. This therapy COULD be done less expensively......everything is WAY overpriced. $100 or $200 for a mask that probably costs less tha $5 to make? I'm sure there's a healthy profit margin built into the machines, too.

It's that "medical device" category that's putting dollar signs in everybody's eyes. Until they can figure out how to identify the Central and Mixed apnea categories (along with other "sleep issues") and deal with them properly, this probably isn't going to change real soon.

Den

There's a "double-edged sword" in all of these arguments. On one hand, it's pretty expensive to get through the "process" to the point of using it. If it gets too cheap, and with the insurance providers paying the bulk of the expenses, people don't seem to take the therapy SERIOUSLY. That could be one of the reasons that so many of these machines get stashed in the closets.....somebody else paid for it. If it hurts you in the checkbook enough, you tend to want to make the most of your investment.

so I am supposed to spend 4 thousand dollars..otherwise I won't use cpap. Hell...why not make it 30,000 then and no machines will ever be in the closet .

I thought treatment was about feeling better....getting a better nights sleep...living a more healthy life. If it isn't rewarding in itself no amount of money up front is going to make any difference.

It's a crime that you need a doctors prescription and a multi thousand dollar sleep lab test to blow a little wind down your throat to keep the airways open when you snore. As consumers we should be outraged that these machines are not available over the counter. It doesn't take a rocket scientist to tell when your spouse is snoring loud and is not breathing. Companies are allowed to sell all sorts of bogus sprays and devices to supposedly stop snoring but something that really works is not available without spending mucho bucks to the health industry. It's not like they aren't raping us enough.

Anonymous wrote:

There's a "double-edged sword" in all of these arguments. On one hand, it's pretty expensive to get through the "process" to the point of using it. If it gets too cheap, and with the insurance providers paying the bulk of the expenses, people don't seem to take the therapy SERIOUSLY. That could be one of the reasons that so many of these machines get stashed in the closets.....somebody else paid for it. If it hurts you in the checkbook enough, you tend to want to make the most of your investment.

so I am supposed to spend 4 thousand dollars..otherwise I won't use cpap. Hell...why not make it 30,000 then and no machines will ever be in the closet .

I thought treatment was about feeling better....getting a better nights sleep...living a more healthy life. If it isn't rewarding in itself no amount of money up front is going to make any difference.

It's a crime that you need a doctors prescription and a multi thousand dollar sleep lab test to blow a little wind down your throat to keep the airways open when you snore. As consumers we should be outraged that these machines are not available over the counter. It doesn't take a rocket scientist to tell when your spouse is snoring loud and is not breathing. Companies are allowed to sell all sorts of bogus sprays and devices to supposedly stop snoring but something that really works is not available without spending mucho bucks to the health industry. It's not like they aren't raping us enough.

If there was a way they could figure out how to GET $30,000 out of our insurance providers, they'd do it! But, right now, many are in the $4000 bracket.....or at least that's what they seem to try to inflate their bills to (for the sleep studies and some of the machines) and yet there's probably a 50% compliance rate. To ME, "compliance" doesn't necessarily translate to "successful" or "good" therapy......it just means that you're USING the machine.....even at the WRONG pressure settings.

I totally agree with EVERYTHING you said.

How do they get everybody (that needs one) to USE them???

As we've read or have experienced first-hand, these "doctors" are (in too many cases) clueless when it comes to what information these machines will report. (And often times get terribly offended at having to deal with an "enlightened" user.) The DMEs hand out the cheapest machines to maximize profits. And, the poor, struggling user......is basically in the dark as far as how his therapy is working. He/she MAY feel "better", but that's a relative term and you ask "Better than WHAT?". It's probably been so long that they're wondering what "normal" used to feel like. I know I did.....maybe still do at times.

What we see on these forums is a drop in the bucket to the total number of users.

Den

Current regulations will only reimburse in lab PSG's
current regulations will only reimbuse cpap equipment if the patient has been diagnosed with an in lab PSG

CMS Proposal allows medicare payment for unattneded sleep studies and the cpap equipment prescribed without an in lab PSG

Personally, I think it is a good thing.