Problems with the Push Toward HST
I've been mulling over the articles I've been reading about the coming changes in reimbursements for sleep testing. I feel like just throwing my hands up and running in circles, screaming, "The sky is falling! The sky is falling!"
If I understand correctly all diagnostic sleep testing must be considered as home testing unless the patient meets a specific criteria and then autopap is the alternative to in-lab titrations.
First of all, let's not even discuss the impact this is going to have on the thousands of techs currently gainfully employed who may not be next year at this time. I know there have been some studies that suggest there is no
significant therapeutic difference in the studies done at home and with autopap versus traditional in lab testing. But I have to disagree with that data simply because that has not been true in my experience. I know the universe is a lot bigger than my little corner of the world, but I have to go with what I know.
Maybe other labs have a significantly different patient population than mine has. Maybe other labs are able to get at least one working phone number from a patient. And maybe after a quick instructional video other labs are able to get their patients' to return demonstrations and put their CPAP mask on with no problem the first time every time. And in that case I am sure standby phone support will work out just fine. (United Health Care has contracted with a company nationally to deliver HST to the patient and have standby phone support available.)
I've heard stories from DMEs who have given equipment out only to never see it again or who have to pay fines in order to reclaim equipment that has been confiscated when a user moves and leaves it behind. I have doubts that the HST will actually make it back to the supplier.
I don't anticipate a lot of success with this program based on my experience. What about people who are sleep deprived and oxygen starved with memory problems? And what about the CPAP titration? For years all we've heard is how important the technologist's role is in a successful titration, getting the patient comfortable with the equipment and having them on board with the process, acclimated and able to sleep. This is not achieved in 15 minutes over the phone! And I don't know of any DMEs that will have be able to have staff stay for extended time to get the patient through even the first hour of CPAP.
I know on the face of it, sleep testing and CPAP titration may sound simple, so some are thinking, "Why not self-service it?" But truly, that is just not the reality. I've even had doctors who have problems acclimating
and managing the equipment, and they are professionals.
I think it is unwise and unfair to impose this policy on people who need and deserve a quality sleep test and results and CPAP therapy to minimize ill effects of sleep apnea, diabetes, heart disease, stroke, hypertension, atrial fibrillation, migraines, depression, fibromyalgia, asthma, neuromuscular diseases. Need I go on?