Letter to Members from AASM President Esther Online
Mary Susan Esther, MD, the president of the American Academy of Sleep Medicine (AASM), has written a letter to members that provides updates on several on-going projects and new initiatives acted on by the Board of Directors at its meeting in October. Download a copy of the letter from the AASM Web site: www.aasmnet.org/Members/SleepNews.aspx.
Call from Nominating Committee: Applications for AASM Board of Directors Now Being Accepted
For more than 30 years the American Academy of Sleep Medicine (AASM) has been at the forefront of sleep medicine: upholding quality care through standards for accreditation, advocating for the field through legislative and lobbying efforts, and fostering research through the American Sleep Medicine Foundation. Success as a field is a direct result of the volunteer efforts of our members.
One of the most important volunteer roles within the AASM is service on the Board of Directors.
The 12 members of the Board of Directors meet five times each year to address issues that affect clinical practice and research, set policies for the field, work with committees on new initiatives, and develop strategies to foster the continued growth of sleep medicine. The make-up of the board is representative of the diversity of our membership, and the board also is comprised of members who have extensive knowledge of the AASM through involvement with the organization, and maintaining this balance is important.
In January, the Nominating Committee will consider candidates to fill vacancies on the Board of Directors, and President Mary Susan Esther, MD, invites interested members to submit application materials for consideration. As standard, the Nominating Committee requests each candidate submit a letter of intent as well as an abbreviated CV adapted from NIH format, which can be downloaded from www.aasmnet.org/resources. All materials are due by December 15, 2008. Please submit your application materials to Jordana Money either via e-mail at jmoney@aasmnet.org or via facsimile to (708) 492-0943.
There are several other means to be active within the AASM, and a call for committee members and chairs will be communicated to members in early 2009.
Recognize Sleep Medicine Colleagues with AASM Awards
Each year at the SLEEP Annual Meeting, the American Academy of Sleep Medicine (AASM) recognizes members of the field who have made indelible professional contributions to sleep medicine.
This year, members are invited to nominate colleagues who have shaped our field through their service and achievement in the areas of academics, public policy and education for the Nathaniel Kleitman Distinguished Service Award, William C. Dement Academic Achievement Award, Mark O. Hatfield Public Policy Award, and AASM Excellence in Education Award; members may also self-nominate. Below is a description for each award.
All nominations will be considered by the Nominating Committee in January, and members are encouraged to submit nominations and supporting materials for consideration before the December 15, 2008, deadline. For each candidate you submit to the nominating committee, please indicate the award for which you are nominating them, and include a one-page letter of recommendation as well as an abbreviated CV adapted from NIH format for the candidate; a template of the CV can be downloaded from www.aasmnet.org. Please submit your nomination materials to Jordana Money either via e-mail at jmoney@ aasmnet.org or via facsimile to (708) 492-0943.
Nathaniel Kleitman Distinguished Service Award
Establishedi n 1981, the Nathaniel Kleitman Distinguished Service Award honors individuals dedicated to the sleep field who have made significant contributions in the areas of administration, public relations and government affairs.
The research of Nathaniel Kleitman, one of the world’s eminent sleep scientists, formed the foundation for many areas of current sleep medicine, including REM sleep, circadian rhythms, and the effect of drugs on sleep. Through his inventiveness and achievement, Dr. Kleitman has left a vast impression on the sleep medicine field.
William C. Dement Academic Achievement Award
The William C. Dement Academic Achievement Award, established in 1994, recognizes members of the sleep field who have displayed exceptional initiative and progress in the areas of sleep education and academic research.
The award’s namesake, William C. Dement, MD, PhD, is one of the nation’s leading sleep researchers. His extensive publication of research, work with REM sleep and development of the Multiple Sleep Latency Test greatly advanced the sleep medicine field. The William C. Dement Academic Achievement Award embodies the pursuit of knowledge, a commitment to teaching and an unceasing quest to disseminate truth.
Mark O. Hatfield Public Policy Award
The Mark O. Hatfield Public Policy Award, established in 1996, acknowledges an individual who has developed public policy that positively affects the healthy sleep of all Americans. This contribution is unique, yet vital to the advancement of the field.
Retired United States Senator Mark O. Hatfield (R-Ore.) has continually supported sleep medicine initiatives and policy. His work on behalf of the field has been instrumental in increasing NIH funding for sleep, increasing public awareness of sudden infant death syndrome, establishing the National Center on Sleep Disorders Research, and supporting nationally-recognized sleep disorders research at Oregon Health Science University. Sen. Hatfield also chaired the transportation appropriations subcommittee, where he introduced the driver fatigue initiative, which passed in 1995.
AASM Excellence in Education Award
The Excellence in Education Award is presented to those individuals who have made outstanding contributions in the teaching of sleep medicine. The award serves to recognize and honor dedicated individuals who have skillfully taught and enhanced the knowledge of professional and lay people in the areas of sleep and sleep medicine.
Brigham and Women’s Hospital Earns Recognition as an AASM Comprehensive Academic Sleep Program of Distinction
In October 2008, the AASM Board of Directors accepted the application for Brigham and Women’s Hospital to be recognized as an AASM Comprehensive Academic Sleep Program of Distinction. Congratulations are extended to co-chairs, Charles Czeisler, PhD, MD and Atul Malhorta, MD, and the entire program on their clinical service, educational mission and research accomplishments.
The AASM Comprehensive Academic Sleep Programs of Distinction recognizes academic sleep programs that have demonstrated excellence though compliance with rigorous standards in the areas of clinical service, educational mission and research accomplishments.
Programs can compete, on an annual basis, for a one-year grant from the American Sleep Medicine Foundation that supports a fellow for training in sleep medicine research. All recognized programs will receive, on an annual basis, a grant that provides travel assistance to the SLEEP meeting for one fellow.
Please visit www.aasmnet.org/ProgramsDistinction.aspx for more information on the program requirements and to download the application.
CMS 2009 Physician Fee Schedule Published in Federal Register
The 2009 Physician Fee Schedule: Final Rule with Comment Period from the Centers for Medicare and Medicaid Services (CMS) is published in the November 19, 2008, edition of the Federal Register. The rule includes regulatory language relating to billing for the provision of CPAP equipment and the valuing for actigraphy.
Polysomnography and CPAP Billing
CMS makes the following statements in the preamble to the proposal: We believe that Medicare beneficiaries and the Medicare program are vulnerable if the provider of a diagnostic test has a financial interest in the outcome of the test itself. This creates incentive to test more frequently or less frequently than is medically necessary and to interpret a test result with a bias that favors self-interest. In the specific context of this rule, we believe that the provider of a sleep test has self-interest in the result of that test if that provider is affiliated with the supplier of the CPAP device that would be covered by the Medicare program.
We are concerned that the provider of a sleep test will have a bias to interpret an inconclusive sleep test as positive if that provider has a financial interest in the payment for the CPAP device that would be used to treat the beneficiary. We believe that this represents a vulnerability to the Medicare program. We believe that we have sufficient reason to believe that OSA and CPAP are more amenable to fraud and abuse than some other items and services.
Our administrative contractors informed us that they have not historically found these integrated sleep management programs furnishing attended facility-based PSG to be a significant vulnerability. We cannot at this time confidently exclude the possibility that disrupting this model of care might be harmful to some patients.
We agree that an entity that has been accredited by a recognized sleep therapy accrediting body would likely have protections in place that would minimize the potential fraud and abuse concerns we addressed above. We believe that the scope of such accreditation programs should be broad enough to include OSA diagnosis and the supply of CPAP treatment under a unified certificate.
The Regulatory language on polysomnography and CPAP billing reads as follows:
42 CFR Ch. IV 424.57(f) Payment prohibition. No Medicare payment will be made to the supplier of a CPAP device if that supplier, or its affiliate, is directly or indirectly the provider of the sleep test used to diagnose the beneficiary with obstructive sleep apnea. This prohibition does not apply if the sleep test is an attended facility-based polysomnogram.
42 CFR Ch. IV 424.57(a) Attended facility-based polysomnogram means a comprehensive diagnostic sleep test including at least electroencephalography, electro-oculography, electromyography, heart rate or electrocardiography, airflow, breathing effort, and arterial oxygen saturation furnished in a sleep laboratory facility in which a technologist supervises the recording during sleep time and has the ability to intervene if needed.
Actigraphy
CPT code 95803, Actigraphy, testing, recording, analysis, interpretation and report (minimum of 72 hours to 14 consecutive days of recording), requires the patient to wear a home monitor for 24 hours a day for 3 to 14 days. The RUC PE recommendations did not include the typical number of days the home monitor would be in use. They also did not include the necessary equipment used to analyze the data. Therefore, we seek comment on the typical number of days for this service. We will continue to contractor price this service for 2009.
Download the Federal Register online at www.gpoaccess.gov/fr/.
CMS Announces Revision to NCD 240.4 CPAP Therapy for OSA
In mid-October the Centers for Medicare – Medicaid Services (CMS) revised the language in its National Coverage Determination (NCD) for Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA) (240.4). The initial NCD Decision Memo was issued on March 13, 2008, and the implementation date was August 4, 2008. Following is a list of some key points in the revised policy:
Coverage of CPAP is initially limited to a 12-week period for beneficiaries diagnosed with OSA. CPAP is subsequently covered for those beneficiaries diagnosed with OSA whose OSA improves as a result of CPAP during this 12-week period.
CPAP for adults is covered when diagnosed using a clinical evaluation and a positive: Polysomnography (PSG) performed in a sleep laboratory; or Unattended home sleep monitoring device of Type II; or
Unattended home sleep monitoring device of Type III; or
Unattended home sleep monitoring device of Type IV, measuring at least 3 channels
A positive test for OSA is established if either of the following criteria using the Apnea-Hypopnea Index (AHI) or Respiratory Disturbance Index (RDI) is met:
AHI or RDI greater than or equal to 15 events per hour of sleep or continuous monitoring, or
AHI or RDI greater than or equal to 5 and less than or equal to 14 events per hour of sleep or continuous monitoring with documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease, or history of stroke.
The full policy is available for review on the CMS Web site: www.cms.gov.
DME Carriers Publish Revised LCD for CPAP Coverage
In late September the four DME carriers, CIGNA, NGS, NHIC and Noridian, published their revised local coverage determination (LCD) policy for CPAP. According to the revised draft, the policy allows for CPAP compliance to be documented, “through direct download or visual inspection of usage data with documentation provided in a written report format.’’ Additionally, the requirements for educating patients about Home Sleep Tests (HST) have been eased, and the policy now allows either face-to-face instruction or video and/or telephone instruction with 24-hour phone support. Physicians interpreting facility-based sleep tests have until January 1, 2010, to meet the credentialing requirements.
Also, the policy states that to be covered, the HST must be one of the following: Type II device that records a minimum of seven channels, EEG, EOG, EMG, ECG/heart rate, airflow, respiratory movement/effort, and oxygen saturation; a Type III device that records a minimum of four channels, ECG/heart rate, airflow, respiratory movement/effort, and oxygen saturation; or a Type IV device that records a minimum of three channels that allow direct calculation of apnea-hypopnea index (AHI) and respiratory disturbance index (RDI).
The policy also notes: Devices that record channels that do not allow direct calculation of an AHI or RDI may be considered as acceptable alternatives if there is substantive clinical evidence in the published peer-reviewed medical literature that demonstrates that the results accurately and reliably correspond to an AHI or RDI. This determination will be made on a device by device basis. Currently there is no device that indirectly measures AHI or RDI that meets this criterion.
The updated LCD does maintain the following restrictions on HST:
- All sleep tests must be performed by an entity that “qualifies as a Medicare provider of sleep tests’’ and must be interpreted by a physician who holds either:
- Current certification in Sleep Medicine by the American Board of Sleep Medicine (ABSM); or,
- Current subspecialty certification in Sleep Medicine by a member board of the American Board of Medical Specialties (ABMS); or,
- Completed residency or fellowship training by an ABMS member board and has completed all the requirements for subspecialty certification in sleep medicine except the examination itself and only until the time of reporting of the first examination for which the physician is eligible; or, d. Active staff membership of a sleep center or laboratory accredited by the American Academy of Sleep Medicine (AASM) or The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations – JCAHO).
No aspect of an HST, including but not limited to delivery and/or pick-up of the device, may be performed by a DME supplier
To continue to receive payment for CPAP after three months, the patient must be clinically reevaluated and evidence of symptom improvement and CPAP adherence must be documented.
The DME carriers have created a fact sheet with answers to frequently-asked-questions to aid physicians and medical staff: www.aasmnet.org/Resources/PDF/PAPDevicesFAQs.pdf
Fogarty International Clinical Research Scholars Program Seeks Applicants
The Fogarty International Clinical Research Scholars Support Center is seeking graduate-level students in the health professions to apply for its one-year clinical research training program.
The Fogarty International Clinical Research Scholars Program gives graduate students a unique opportunity to experience mentored research training at an advanced research center in the following countries: Bangladesh, Botswana, Brazil, China, Haiti, India, Kenya, Malawi, Mali, Peru, South Africa, Tanzania, Thailand, Uganda and Zambia.
The fellowship begins in July 2009 with an orientation program followed by 10-plus months of intense research training at the foreign site; program applications are due December 5, 2008. To learn more about the Fogarty International Clinical Research Scholars Program, visit www.aamc.org/overseasfellowship.
NIH Supports Research with Programs to Repay Student Loan Debt
The National Institutes of Health (NIH) announced a new program that supports the careers of researchers through student loan debt forgiveness.
NIH is now accepting applications for its extramural Loan Repayment Programs (LRPs), which repay up to $35,000 of educational loan debt annually for individuals who commit to conducting at least two years of qualified biomedical or behavioral research at a nonprofit institution of their choice. There are five extramural LRPs: clinical research, pediatric research, health disparities research, contraception and infertility research, and clinical research for individuals from disadvantaged backgrounds.
The application deadline for all five LRPs is December 1, 2008. Log on to www.lrp.nig.gov for more information and to apply.
House and Senate Approve Mental Health Parity Bills
The House and Senate on Tuesday, September 23, 2008, approved compromise mental health parity legislation, but the chambers have not agreed on a funding mechanism. The House Resolution (HR 6983) would require health insurers to cover mental illnesses at the same level as physical ailments. The measure has received support from both parties, President Bush, business and insurance companies, health care advocates and the medical community, but it is unclear whether a joint agreement can be reached in the few days remaining before Congress recesses. Lawmakers must decide whether the bill should be a stand-alone measure or part of a larger legislative package. As developments occur, the American Academy of Sleep Medicine will keep members abreast of changes to the legislation.