Why CPAP Therapy is Failing
There is a huge failure rate for CPAP therapy; some would even say it is as high as 50 percent. That number is being used by insurance companies, home sleep testing companies, and people who do not believe in sleep apnea to prove that we are testing too many people and spending too much money. But we're not. The failure rate results from our failure to educate and assist people who have started therapy.
Follow up in many cases does not happen because no one will pay for it. Decreased reimbursement and capitated contracts have caused many providers to drop off a CPAP machine and never follow up with the patient. But what those companies and the Medicare competitive bidding program have not taken into account is that trained personnel are essential to raising the success rate. These professionals listen to the patient, examine their issues, and come up with the creative solutions to help them become compliant with therapy. The trained sleep personnel understand how to properly craft a desensitization plan for a patient. They understand the value of proper mask fitting and why different masks work on different faces.
Sleep centers should have the autonomy to change interfaces without a medical prescription. If a patient trials several masks on the night of a titration study, they do not know whether that mask will work long term. The sleep tech does not know if the patient may have issues with skin breakdown or leaking because their pillow is different than the one at the sleep lab. And if a patient loses weight while on therapy and his mask no longer fits, there's no guarantee that he will see his primary care physician and receive a script to refit the mask. A mask change should just be able to happen with a proper fitting at a lab or DME company.
And although many patients are being followed by a sleep specialist, more are being followed by their primary care doctor. Reimbursement amounts do not cover referrals for follow-up by the sleep labs (although many centers do call patients, have newsletters, and host support groups) or for DME companies that set up the patients.
In order to change the issues, we need to make it clear that CPAP failure is truly about failure to interact, and interactions must be reimbursed. We cannot save money on trained personnel in the short term without taking into account the long-term effect on therapy success rates. We, as a community, need to make it clear to patients, the medical communities, and the insurance companies that with proper reimbursement enabling proper care of patients, this therapy can be successful.