Home Sleep Tests & Reimbursements

[Goldcsx]

As of this year, home sleep tests and auto CPAP titrations for OSA (with some exceptions) are now mandated by some major carriers as of 2012, like Aetna & United Health, drastically reducing physician and sleep lab/ctr compensations. More insurance companies are likely to follow....How is this affecting sleep physicians' patient care, practice, and reimbursements? Who thinks this will bring seismic change to the landscape of sleep medicine and industry? Will many sleep centers/labs close up because of this in favor of large corporations that do high volume at low cost like dialysis centers? Relevant thoughts, facts, and educated guesses will be appreciated...

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[neurolddoc]

I think it will have a large impact. In fact I think that we have already started to see a shift towards outpatient studies, often initiated b the primary physician. This, combined with the over proliferation of sleep labs and specialists, will have very bad consequences for those who want to practice strictly sleep medicine.

 

[Faebinder]

Basically, if you are a sleep apnea mill then you are in trouble. You need to be interested in what else is making the patient not sleep well.

 

[michaelrack]

Basically, if you are a sleep apnea mill then you are in trouble. You need to be interested in what else is making the patient not sleep well.

Some of the sleep apnea mills will continue to do well, in my opinion. It's those who take time to talk to the patient and treat all sleep problems who will be in trouble (due to tightening margins)

 

[Shikima]

I think the one caveat to all of this would be the VA system. Or am I over generalizing?

 

[michaelrack]

I think the one caveat to all of this would be the VA system. Or am I over generalizing?

It's been a while since I interacted with the VA sleep system. My wife is a psychiatrist at the VA.

The VA is different from everything else.

As far as being a doc in the VA- you go in, do your work, and go home.

 

[Faebinder]

Some of the sleep apnea mills will continue to do well, in my opinion. It's those who take time to talk to the patient and treat all sleep problems who will be in trouble (due to tightening margins)

The apnea mills will get in trouble because their sleep studies wont be approved because they didn't take the time and find a reason to do the sleep study as opposed to the standard r/o OSA.

Yes some mills will survive I am sure. I am curious as to what will happen to the half-hospital half-outpatient pulms out there. MM..

 

[michaelrack]

The apnea mills will get in trouble because their sleep studies wont be approved because they didn't take the time and find a reason to do the sleep study as opposed to the standard r/o OSA.

..

Maybe.... if the AASM enacts their new proposed accreditation criteria (which requires patients to be seen by a sleep doc prior to the study), that will hurt the apnea mills.

 

[Faebinder]

Maybe.... if the AASM enacts their new proposed accreditation criteria (which requires patients to be seen by a sleep doc prior to the study), that will hurt the apnea mills.

MMmmm... well if the mill becomes unaccredit by the AASM, will it lose that many customers? What you are saying really changes the game if the insurances wont reimburse for non-accredited labs. You think they will do this soon or is this just talk? any links?

 

[michaelrack]

MMmmm... well if the mill becomes unaccredit by the AASM, will it lose that many customers? What you are saying really changes the game if the insurances wont reimburse for non-accredited labs. You think they will do this soon or is this just talk? any links?

The proposed revised accreditation criteria were available on the AASM website, to members only.

Many insurances already won't reimburse for non-accredited labs, although their are several options for accreditation, including the Joint Commission for hospital labs.

 

[Faebinder]

The proposed revised accreditation criteria were available on the AASM website, to members only.

Many insurances already won't reimburse for non-accredited labs, although their are several options for accreditation, including the Joint Commission for hospital labs.

So JACHO pretty much bypasses the AASM. Funny. Thanks for the heads up. I'll look for that part on the website.

 

[michaelrack]

So JACHO pretty much bypasses the AASM. Funny. Thanks for the heads up. I'll look for that part on the website.

There's another accrediting organization, specific for sleep labs, although I can't remember its name right now.

Check your local insurance contracts/companies for what sleep lab accrediting organization they will accept.