Home Sleep Testing Vs. In-Lab Sleep Studies
HST has been used in Canada, Australia, and Europe successfully for over twenty years. For many years, US based insurers considered it to be inferior to an in-lab polysomnography (PSG). Why has this changed and what evidence is there to support it? The following is an excerpt from a letter from the American Academy of Otolaryngology—Head and Neck Surgery regarding obstructive sleep apnea.
“Home sleep testing is a validated alternative and an important step in improving recognition and control of OSA. The current paradigm of high reimbursement for PSG and low reimbursement for treatment is not only a waste of precious resources, but also discourages more appropriate focus on rapid diagnosis and effective treatment for OSA.”
The argument for in-lab sleep studies was weakened because of the night to night variability in patients sleep patterns which results in a change in diagnosis in more that 40% of borderline obstructive sleep apea (OSA) patients. Another concern was the limited recorded sleep time prior to the initiation of treatment of patients participating in split night sleep studies.
It was determined by CMS (Centers for Medicare and Medicaid Services) that HST testing is no worse than the more expensive alternative. They determined that it was more important to link long term payments for PAP therapy to documented compliance to address the issue of patients not using their CPAP. This action would motivate HME’s to better track patients usage remotely and to create a comprehensive approach to ensure better results for newly diagnosed sleep apnea patients.
Our Home Sleep Testing device uses the exact same electrodes that are used in sleep labs. The difference is that we are honing in on respiratory problems instead of doing a full diagnostic study. With a quick front end screening with simple questions like: Do you snore? Do you wake up with dry mouth? Do you ever wake up gasping for breath? With these questions, you can determine whether or not a patient really needs to go to a lab or if they can be easily diagnosed with an HST. The biggest difference between HST and Labs is felt by the patient.
FAST FACT Did you know that over 40 million Americans are affected by sleep Apnea, 90% of which go undiagnosed and untreated?
The Benefits of Home Sleep Delivered
HST is greatly preferred by patients over the traditional sleep lab studies.
Most Comfort- Most people are more comfortable sleeping in their own beds with no one observing them from another room.
Lowest Cost- Cost is a huge consideration as well with HST. A home sleep test is a fraction of the cost of an in-lab study. Because of this overwhelming cost factor, Medicare and most insurance companies are now covering HST. Interpretation of the HST results is performed by a board certified sleep doctor.
Most Convenient- Patients are usually diagnosed, treated, and on therapy in less than a week with the Austin Sleep Solutions process as compared to possible months later in traditional in-lab sleep studies. With Austin Sleep Solutions, the device is dispensed right out of your office, complete with knowledgeable instructions given by a trained professional. The next day, the patient returns the device to your office, the study is then uploaded and read by a board-certified sleep physician, and a follow up visit to review results is scheduled.
Frequently Asked Questions by Doctors
How will HST benefit my practice?
-For starters, you will notice reduced paperwork and less interaction with insurance companies. Most insurers don’t require prior approval for HST if the order is from the primary care physician (PCP). Your staff can save a bit of time by not having to obtain approvals for a specialist referral or in-lab sleep study. They will not have to waste time going back and forth with the insurance companies to justify the test, providing documentation, clinical notes, CMN’s, etc.
-HST allows faster results and interpretation by a boarded sleep doctor. Results are usually available in 3 – 5 days after the patient has completed their HST and the boarded sleep physicians review each study making treatment recommendations or suggestions on how to proceed. Patients are usually tested and receiving treatment within a week compared to a several month delay with many in-lab sleep studies. This allows for patient retention within your practice, along with simple follow up if necessary under the guidance of a boarded sleep physician.
-Most important of all, HST makes for happier patients. People like being able to sleep in their own bed and in an environment in which they are accustomed. Not to mention, nobody wants someone watching over them while they sleep. Patients with high deductibles and co-pays appreciate the low cost this option provides in these harsh economic conditions. Older patients appreciate not having to drive in the dark and go to some unfamiliar place to sleep.
How reliable is home sleep testing technology?
The technology for home sleep testing has been available for over twenty years. It has been effectively utilized in Europe, Canada, and Australia to substantially lower healthcare costs. Technological improvements in the last several years have made it even more reliable including simpler set up procedures for the patient and faster sampling rates on the oximetry channels. For more information on home sleep technology please refer to Amercian Academy of Sleep Medicine.
How do I perform the Clinical assessment?
OSA risk can be determined in one of three ways:
Patient can complete the Thornton Snoring Scale
Patient can complete the Sleep Epworth Exam
Ask the patient the five OSA screening questions:
Do you snore?
Do you have hypertension?
Are you excessively tired during the day?
Have you been told that you stop breathing during sleep?
Is your neck size greater than 17 inches (Male) or 16 inches (Female)?
If the patient answers “Yes” to at least two questions then they are candidates for HST. The physician should perform a cardiopulmonary assessment to rule out disorders such as CHF and COPD, examine the airway for enlarged tonsils, obvious asymmetries or blockage of the nasal passages and document your results in the patient’s chart.
Does Insurance pay for the Test?
CMS approved coverage in 2008. Most insurance companies have already followed suit, but there are a few stragglers that are trying to catch up. We have been in talks with the few that do not cover HST and most of them have it on their agenda, but are still trying to adjust to some of the other changes in the healthcare system and it hasn’t quite made it to the top of the list.