home sleep study not a medically necessary

jnk · Post by **jnk** » Tue Jan 31, 2012 8:51 am

ChicagoGranny wrote:
jnk wrote:

But why should I use one sentence to say it when I can type a whole page? Weeeeeeeeeeee! I like the sound of my own keyboard clicks! Eeeeeeeee-HAH!!! Clickity, clickity, clickity, clickity . . .
I thought I recognized you. You are that annoying pig on the zip line.

For the filming of those commercials, they used a stunt pig to stand in for me. But, yeah, you nailed it. That's me. Although I'm actually MUCH more annoying off-screen.

archangle · Post by **archangle** » Tue Jan 31, 2012 11:45 am

chunkyfrog wrote:All that has been said; what if the definition of medical necessity is simply a compromise between the insurance companie's actuaries and its lawyers?

Don't forget corrupt politicians and regulators balancing off competing bribes from pharmaceutical companies, insurance companies, and the doctor's union.

chunkyfrog · Post by **chunkyfrog** » Tue Jan 31, 2012 3:00 pm

Make that co-ordinated bribes--like co-op advertising.
The committee comes up with an amount, everybody pitches in and the pol get a new yacht.

jnk · Post by **jnk** » Wed Feb 01, 2012 8:37 am

A consideration of the history of, and the pros and cons of, HST and AASM and CMS views of it was published in an evidence-review article in RESPIRATORY CARE • JANUARY 2010 VOL 55 NO 1 ( http://www.sleep-wake.com/resources/IsH ... hehome.pdf ). My favorite statement there, in the "con" section, naturally, and apparently made by someone as bad at math as I am, was this:

"Proponents have indicated that portable polysomnography is a more cost-effective way to diagnosis [sic] sleep apnea. Close examination refutes that claim."

Kitatonic · Post by **Kitatonic** » Wed Feb 01, 2012 9:41 am

Due to my severe snoring and gasping wake-ups noted by my husband, I emailed my doctor for a sleep study. He ordered a home study which was read out as "basically normal, but if you're snoring and gasping, can pursue the PSG if you request". The home test was multi-channel and did reveal desats down to 82. These desats were explained away as "possibly latent pulmonary disease, not OSA". In the lab, I had a split study due to desats down in the 60s.
I really think that the home study would have been sufficient had the reading doctor (retired pulmonary, not a sleep-trained) not discounted the evidence. The sleep specialist doctor defended the home study as not as accurate as he didn't have the EEG data like the lab. This EEG data did not contribute to my diagnosis, it was the severe oxygen desats that were even present in the home study. So I would fully support home studies unless the study is read out by incompetent moonlighters.

jnk · Post by **jnk** » Wed Feb 01, 2012 9:55 am

Your experience may be a testimony to the truthfulness of these words from the same article that I quoted above:

"CMS refers to home polysomnography as “home sleep testing,” but none of the typically used portable polysomnographs actually measure sleep. The various professional organizations related to sleep medicine have rightly termed this “portable polysomnography,” but even that is inadequate, as the monitoring is not all-inclusive, certainly when compared to a traditional sleep-laboratory polysomnography attended by a trained sleep technologist. . . . The increase in the diagnosis of sleep apnea is a result of the patient being identified by a physician knowledgeable in sleep disorders, not because there are new technical ways of identifying sleep apnea. It is the expertise in sleep medicine and the associated clinical skills that benefit the patient, before, during, and after the diagnosis, and after a treatment plan is put into place by this knowledgeable physician and sleep technologist—not the technology. There seems to be misguided enthusiasm for more sleep tests, without regard to understanding that, more importantly, we need more sleep physicians. The portable sleep test is only a tool that a skilled physician needs to understand, to know how to interpret, and to use on the patient’s behalf."

Personally, I think we'd all be a lot better off if every primary-care physician was up-to-date enough to be able to be of help to patients in this matter.

archangle · Post by **archangle** » Wed Feb 01, 2012 2:15 pm

Kitatonic wrote:retired pulmonary, not a sleep-trained

Geez, if the only tool you own is a hammer, everything looks like a nail.

home sleep study not a medically necessary

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