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Steven B. Ronsen updated their profile
Sep 15, 2018

Fed to Audit Sleep Industry; DMEs, Industry Insiders Wet Pants

It didn't have to be this way. When the Office of Inspector General (OIG) recently unveiled its plans to audit the Sleep Industry as part of its Work Plan for fiscal year 2009, it sent a shudder of fear through the sleep community, with doctors, sleep labs and DMEs scrambling to put their best foot forward. With an economic crisis afoot and President-elect Obama gearing up to bring healthcare to every American, it's no wonder that the government would want to take a closer look at an industry where Medicare payments for polysomnography increased from $62 million in 2001 to $215 million in 2005, a 246% increase. Add to that the OIG observation that “previous OIG work revealed cases in which Medicare paid for CPAP devices that were not used by or delivered to beneficiaries," and we have something of a perfect storm facing our beloved Sleep Industry: the same or fewer number of dollars to be allocated over a greater number of government subsidized beneficiaries, an enormous spike in the dollars being spent on Sleep disorders and mounting evidence that the beneficiaries of these disorders are using their CPAPs as door stops, if they even know how to find the machine they were prescribed.

Of course, it is doubtful the OIG will dig far enough to recognize and appreciate the countless lives saved and emergency room visits foregone thanks to the increasing number of CPAP patients who actually do use the machines, and use them properly. We can count on them turning a blind eye to this because, unlike the door stops, it's hard to quantify.

We at SleepGuide believe that Sleep Apnea deserves better. We're dealing with a serious disorder which at worst is life threatening, and at best is a cause of diminished quality of life. The problem, we believe, is with the behavior of the current cast of characters who are the stewards of the disorder. If the DMEs, sleep labs and doctors don't police themselves better, then the government will have no choice but to step in and do it for them. And that can get ugly.

Let's be specific: right now, if anyone is even paying attention to patient compliance with PAP therapy, the metrics are duration and frequency of usage. If that blower is going for 4 hours or more most nights, you're "compliant." Rarely are the other indicia of success with CPAP therapy analyzed: AHI, leak, pressure, for starters. But these are the metrics that actually make the difference between compliance and non-compliance. What good is using the device 100% of the time if it's not actually doing the job it is intended to do, which is preventing the airway from collapsing, or partially collapsing? What good is using the device 100% of the time if all the air is leaking out because the mask is improperly fitted?

Industry insiders must do better. Sure it will be more costly, but don't you think it will be less costly in the long run than letting the government decide how to slash costs? The doorstop model of CPAP treatment is a goner. The question is what to do about it?

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Comment by Judy on December 9, 2008 at 5:37pm
What to do about it? Lets have doctors who elect to take on sleep medicine as a sub-specialty do so w/the intention of providing GOOD medical care to their sleep disorder patients. In-person consultations, clear explanations, encourage the patients to take an active part in their therapy.

Local DME suppliers' RTs who actually take the time to READ the Clinician's Manuals and to understand the devices they sell and the various treatment and comfort options the device are capable of. Encourage patients to take an active part in their therapy. Provide TRUTHFUL advice, not afraid to say "I don't know" and make it a point to find the answer or to help the patient find the answer. Advocate for the patient when the sleep doctor turns a deaf ear. HELP the patient find THE RIGHT mask for comfortable, effective therapy. Explain the data, go over the data w/the patient, answer the patient's data questions. Local DME's are receiving $2800 for a $1600 device over a 13 month period. EARN IT! Provide the service, education and support you claim the extra money for.

Personally, I think it would be very cost effective to provide a full data capable APAP to every OSA patient who expresses an interest in taking an active part in their therapy for the sleep doctor, sleep lab and/or local DME supplier to provide a "technician", an RT/RPSGT, who is experienced and familiar w/xPAP titration and xPAP therapy to work w/those patients. Pattern CPAP therapy on the order of that provided to diabetics: education, training, support, advice, guidance and oversight.

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