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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 RockRpsgt on September 23, 2009 at 10:26am: I had forgotten all about this post. I would think that the AASM would want to control the PAP part of the DMEs. At least the tech that work for them.

Comment by D. W. Conn on September 23, 2009 at 10:23am: Rock
DME certification compliance of state and federal laws fall under different categories than say a sleep clinic.

Comment by RockRpsgt on August 20, 2009 at 9:14am: What about the DMEs. Those certifications are only for the labs right?

Comment by wallace j smith jr on August 4, 2009 at 9:03am: they definetly need to police themselves dme providers especially i stopped by one day to get replacement pillows and was told i had to sign a piece of paper saying they had permission to "treat" me when all i was doing was picking up "parts".. and come on $50 for the two of them????

Comment by D. W. Conn on August 4, 2009 at 7:23am: I should mention there are three ways of accreditation AASM, Joint Commission or ACHC. ACHC at this time is not approved in state of Texas at this time for sleep labs. If you have questions about ACHC for you state contact them at http://achc.org/

Comment by D. W. Conn on August 4, 2009 at 7:14am: It is a sad day. I have to agree. Free standing facilities and some Hospital labs have simply opened for the money that can be generated. DME companies are also guilty at billing and no follow up.
There are however mechanisms in place that should alleviate some of the fly by night Facilities and DME companies.
By January 2010 just a few months away, Free Standing facilities must be certified by either the AASM or JACHO. The failure to certify will result in closure of these facilities.

Comment by RockRpsgt on April 1, 2009 at 10:31am: WOW! That is all I have to say on this subject. WOW!

Comment by Judy on February 3, 2009 at 12:09pm: You know tho, when we slam the DME suppliers for the prices they charge, the money they are paid and what we can buy online for we do have to take into consideration that they are providing an expensive device up front and receiving payments doled out over several months, up to 13 months. That's a lot of upfront money for a lengthy payback. Surely they deserve SOME "interest" type of compensation for that up front investment and long term payback. At least the online suppliers get their monies upfront when they sell their product. THAT can reduce costs A LOT. And anyone who thinks that dealing w/multiple insurances for collection is easy .... hasn't had to deal directly w/their insurance company for reimbursement!! So I TRY to remember to cut the local DME suppliers some slack when I'm slamming them. But then I experience or read of the "less than truths", "half-truths", ignorant comments from them and .....

The medical profession has NEVER been good at policing itself. A good deal of the malpractice problems in this country the medical profession brought on itself by refusing the police their own, by tolerating incompetents in the field and even covering for them. AND by being so secretive. Denying patients information and access to their medical records, etc. is ripe for breeding distrust. Years ago I saw one of their "trade journals" strongly recommending overbooking appointments because patients wouldn't be impressed by or feel comfortable w/a doctor who wasn't busy. Snort!

Comment by Judy on December 9, 2008 at 8:39pm: I'm afraid I tend to agree w/you, Mike. The sleep profession seems not at all inclined to clean up their act.

Comment by Mike on December 9, 2008 at 5:55pm: Judy, my biggest fear is that the whole notion that CPAP helps solve a real problem becomes suspect because so few people are getting the proper care/attention. It's not that sleep apnea doesn't exist and that CPAP doesn't treat it effectively; it's that we don't have people in the industry stepping up to not be lazy and give folks a fair shake at getting it right. But try arguing that to the OIG in a couple of years if we continue like this...

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

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