Frequently Asked Questions by Physicians
Who can order a Home Sleep Test?
According to Medicare: (Rev. 1506; Issued: 05-16-08; Effective/Implementation Date: 06-16-08)
20 - Ordering of Test
All procedures performed by the IDTF must be specifically ordered in writing by the physician or practitioner who is treating the beneficiary, that is, the physician who is furnishing a consultation or treating a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary's specific medical problem. (Nonphysician practitioners may order tests as set forth in CFR 410.32(a)(3).)
Keep in mind that ordering practitioners must have an NPI number. Also, Alabama state law requires the person ordering the test be a licensed physician.
From the Federal Register regarding Non-physician Practitioners that can order tests:
(3) Application to nonphysician practitioners.
Non-physician Practitioners: (that is, clinical nurse specialists, clinical psychologists, clinical social workers, nurse-midwives, nurse practitioners, and physician assistance) who furnish services that would be physician services if furnished by a physician, and who are operating within the scope of their authority under State Law and within the scope of their Medicare statutory benefit, may be treated the same as physicians treating beneficiaries for the purpose of this paragraph.
How will Home Sleep Testing help my practice?
Healthier patients, better acceptance: Home Sleep Testing (HST) is typically preferred by patients over in-lab studies. They appreciate being able to sleep in their own bed with no one watching them. Patients also appreciate the convenience of an HST. There are no long drives to a sleep lab, and no waiting for an opening to make an appointment. Cost is also a very big concern for patients, particularly those with high co-pays and deductibles. The full cost of an IDS HST is typically less than the co-pay of a lab visit. See the patient section of this website for more benefits to patients.
More revenue and better relationships per patient: Medicare requires at least two office visits for all Obstructive Sleep Apnea (OSA) patients now: one prior to testing (HST or PSG in a lab) to confirm the patient is a candidate; and a second follow-up between the 31st and 91st day of PAP treatment to determine if the patient is showing clinical improvement. In a sleep lab situation, these visits are typically handled by the sleep physician; while primary care physicians (PCP) prefer to keep their patients in their office. Therefore, IDS provides the PCP with easy-to-read test reports and simpler treatment and titration when utilizing today's auto-titrating PAP equipment with their built-in compliance and efficacy reporting. There may even be additional CPAP initiation codes that can be billed depending on the situation (speak with your CPAP supplier for more information) and insurer. These extra office visits are great opportunities for the PCP to learn more about their patient and strengthen their doctor-patient relationship.
Test results interpreted by a board certified sleep physician: Our panel of board certified sleep physicians reviews and interprets each study and makes treatment recommendations.
Faster results: Many hospital-based and independent sleep labs require a consult with the sleep physician prior to testing. They also have a limited number of beds, making appointment scheduling a long, drawn-out process. IDS not only allows PCPs to refer directly, but provides results in as few as 5 days, and typically less than 10, from the date the PCP orders the test. Patients will likely be treated, on therapy, and getting relief in a week, rather than months later as in many sleep lab programs.
Less hassle: The IDS HST referral form and process is extremely simple. IDS handles insurance verification when needed, allowing the PCP's staff to save time by not having to get approval for a specialist referral.
How reliable is HST technology?
HST technology has been around for more than two decades. It has effectively lowered healthcare costs in Australia, Europe and Canada. Within the past five years, improvements to the technology have made it even more reliable. HST devices now include faster sampling rates on the oximetry channels (better correlation between channels) and simpler setup procedures for patient self-application.
It's difficult to do direct comparisons between the sleep lab and the home because of individual differences from night to night. However, HST is probably slightly less reliable for patients with a borderline Apnea Hypopnea Index (AHI) because sleep time is not measured. That is why Medicare and other insurers have said that it cannot be used as a screener; HST should only be used to confirm sleep apnea in patients with clinical symptoms.
For peer-reviewed articles supporting HST and the historical perspective, refer to the section titled Clinical Evidence.
Who is a candidate for HST?
HST is intended for patients who exhibit clinical symptoms of Obstructive Sleep Apnea (OSA). Patients with other sleep disorders (i.e. Restless Leg Syndrome (RLS), narcolepsy, REM-behavior disorder), co-morbid conditions (which may impact the diagnostic relevance of the SaO2 data such as COPD or CHF), and patients in whom you only mildly suspect sleep apnea ARE NOT candidates for HST. Patients with hypertension or diabetes ARE candidates, as are those that exhibit symptoms of insomnia. In fact, middle-aged women with OSA may present as sleep maintenance insomniacs—their OSA could be made worse with hypnotics (Reference: Shepertycky et al.). Signs to watch for include:
- Loud snoring
- Witnessed apnea events
- Excessive daytime sleepiness
- Morning headaches
- History of high blood pressure
- Memory problems or poor judgment
- Gastroesophageal reflux
- Difficulty concentrating
- Personality changes or irritability
How do I perform the clinical assessment?
First, you will uncover patients at risk for OSA in one of two ways. They are: