AN IMPORTANT STEP FORWARD
As physicians, it is our duty to provide patients with the most complete, effective
care available. Using existing data and current research, it is also our obligation
to suggest ways to federal health officials to improve current practices and expand
access to care wherever possible. With this in mind, the American Academy of
Otolaryngology - Head and Neck Surgery (AAO-HNS) applauds the recent decision by the
Centers for Medicare – Medicaid Services (CMS) to revise their national
coverage determination for patients suffering from sleep apnea by including home
sleep testing via Types II, III, and IV tests.
The medical community at large is just beginning to understand what sleep specialists
have known for years: disturbed sleep has wide-spread and harmful outcomes for a
person's overall health. This CMS proposal represents a step towards a more
comprehensive patient-centered approach in widening access to treatment for such
potentially devastating conditions. The CMS review was independent, thorough,
objective, and evidence-based, and provides a solid foundation for moving forward in
adopting their recommendations.
The AAO-HNS's motivation in requesting this change last year was singular:
to improve and ensure quality patient care. Access allowed by these changes can
bring forth a host of new patients who might otherwise be unable or unwilling to
participate in a sleep lab study. These patients can now seek diagnosis in the
comfort of their homes, where they sleep in a natural state. No longer would
patients need to travel long distances to participate in sleep lab activities,
forcing them to choose between their health and lost time at work and home.
Through this CMS decision, we have in front of us the opportunity to increase a
patient's chances for receiving a life-altering diagnosis and treatment of
sleep apnea. We are serious about diagnosing and treating people in the United
States who have undiagnosed OSA and are suffering each day the medical consequences
and costs of not being treated. Portable home testing is one essential tool in this
endeavor.
Bearing in mind the many positives of the new policy, the AAO-HNS will continue to
monitor this area of diagnosis and treatment regarding the impact of the new policy
and new developments in the field of sleep medicine.
Ensuring that diagnosis and treatment of sleep disorders in any setting is primarily
performed by knowledgeable physicians is critical for patients suffering from
sleep-related disorders. Recognizing that home testing is appropriate for a selected
group of patients with a high predictive probability of OSA, further evaluation
outside of the home testing will remain necessary for evaluating many patients.
Additionally, it is important to note that failure of CPAP is not an indicator of
lack of disease and the additional testing is critical to discovering the nature of
a patient's symptoms.
Using this crucial policy change as a stepping stone, the AAO-HNS and its members
will continue to advocate for improved patient care through new research and
collaboration with our physician colleagues.
