CMS To Review Sleep Apnea Treatment Coverage Policy at Request of AAO-HNS
Article ID: 528154
Released: 16-Mar-2007 4:30 PM EDT
Source Newsroom: American Academy of Otolaryngology - Head and Neck Surgery
Newswise — The Centers for Medicare & Medicaid Services (CMS), acting on a direct request from the American Academy of Otolaryngology " Head and Neck Surgery (AAO-HNS), has opened up for review and public comment their current national coverage determination regarding the diagnosis and treatment of obstructive sleep apnea (OSA).
The decision now opens a 30-day public comment period for physicians and others to voice their support for the use of multi-channel home sleep testing devices as an alternative to sleep laboratory-based sleep studies (such as polysomnography).
Currently, CMS does not cover the use of home sleep testing devices, a decision that directly impacts coverage decisions by other third-party payers. The Academy supports changing this policy in an effort to ensure the delivery of high quality healthcare to Americans.
Obstructive sleep apnea is a pervasive, profoundly dangerous, debilitating, and largely under-diagnosed disease. In the United States alone, it is estimated that many as 24 percent of men and 9 percent of women suffer from the disorder, increasing their risk of auto accidents, stroke, heart failure, and death, while resulting in a lower quality of life and less productive workplace experience. Furthermore, it is estimated that 75 to 80 percent of all cases of OSA that could benefit from treatment remain undiagnosed.
Under the current system, patient diagnosis and care is hindered by a system that limits coverage to facility-based polysomnography in a sleep laboratory. The current system creates access problems for patients due to a high level of demand, a lack of sleep laboratories in some areas, and discomfort among patients uncomfortable with testing in a lab.
Home sleep testing has been demonstrated in several studies to have diagnostic accuracy similar to polysomnography. Allowing coverage of home sleep studies would improve access, lower costs to the Medicare program, and eliminate treatment delays thereby providing Medicare beneficiaries with high quality care that is safe, effective, efficient, equitable, timely, and patient-centered.
The Academy made their initial request in the form of a 21-page letter to Steve Phurrough, MD, Director of Coverage and Analysis Group for CMS.
About the AAO-HNSThe American Academy of Otolaryngology " Head and Neck Surgery (www.entnet.org), one of the oldest medical associations in the nation, represents more than 12,000 physicians and allied health professionals who specialize in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck. The Academy serves its members by facilitating the advancement of the science and art of medicine related to otolaryngology and by representing the specialty in governmental and socioeconomic issues. The organization's mission: "Working for the Best Ear, Nose, and Throat Care."