Home sleep study positive, do patients really need two sleep lab studies?

[pastafan]

I am asking the experts for advice. In my practice I screen for sleep apnea and use the Watermark home sleep testing equipment. If positive, and over 90% are, I send the patients to a boarded sleep physician for treatment.
The results that I see with the HST correlate closely to the lab studies.

What I don't understand is that if a patient has moderate or sever OSA on a home study why do they need a sleep lab study and then a second CPAP titration study. Why can't the cPAP titration be step two? Is this HST and then 2 sleep lab studies truly medically indicated or just a revenue generator for the sleep doc? I recently had a patient that I referred report that the sleep doc completely dismissed the validity of the home sleep test although the AHI and RDI were within 1-2 of the overnight study.

---

Members don't see this ad.

 

[michaelrack]

I am asking the experts for advice. In my practice I screen for sleep apnea and use the Watermark home sleep testing equipment. If positive, and over 90% are, I send the patients to a boarded sleep physician for treatment.
The results that I see with the HST correlate closely to the lab studies.

What I don't understand is that if a patient has moderate or sever OSA on a home study why do they need a sleep lab study and then a second CPAP titration study. Why can't the cPAP titration be step two? Is this HST and then 2 sleep lab studies truly medically indicated or just a revenue generator for the sleep doc? I recently had a patient that I referred report that the sleep doc completely dismissed the validity of the home sleep test although the AHI and RDI were within 1-2 of the overnight study.

Sometimes patients question the validity of the HST. Another issue that comes up is that some insurers (medicare) require that the doctor prescribing CPAP see them prior to their qualifying diagnostic sleep study. So if you (pastafan) saw the patient prior to the HST and then send them to me for CPAP, Medicare won't cover my CPAP prescription unless I order a PSG or split night (Medicare would, however, cover pastafan's cpap prescription)

 

[pastafan]

Sometimes patients question the validity of the HST. Another issue that comes up is that some insurers (medicare) require that the doctor prescribing CPAP see them prior to their qualifying diagnostic sleep study. So if you (pastafan) saw the patient prior to the HST and then send them to me for CPAP, Medicare won't cover my CPAP prescription unless I order a PSG or split night (Medicare would, however, cover pastafan's cpap prescription)

Definitely not patient questioning validity in this instance.

Would it be covered if I write a prescription for CPAP to be titrated and then send them to sleep doc and their lab for one overnight titration study? I just don't see why what I have been told is 3-5k needs to be spent on an additional night's study. I just want my patients treated properly in an efficient manner but it appears that the system discourages this. I practice interventional pain medicine and I am constantly amazed by the patients that I see who have never been tested or screened for OSA. There is a reason why their pain, depression, anxiety, HTN, etc. just doesn't seem to be getting better despite the narcotics and benzodiazepines thrown at them.

 

[Shikima]

Perhaps you can work in collaboration with said colleague to help screen for sleep breathing disorders and make arrangements to have a bed kept open for the patients you send over so they can complete a split-night sooner. This way the complete study is done (and likely covering the centrals better than an autopap can do) and you can help follow-up with Epworth screeners and check to ensure they're using the device.

Curiously, where are you practicing? I too am amazed at the amount of people who are walking around with undiagnosed OSA, PLMD/RLS or heavily sedated due to medications..... you get the picture. In general, I struggle with this as a sleep physician to get the necessary parties in line so nothing is left untouched.

 

[michaelrack]

Definitely not patient questioning validity in this instance.

Would it be covered if I write a prescription for CPAP to be titrated and then send them to sleep doc and their lab for one overnight titration study? .

Yes you can write an order for a cPAp study, but what is really critical is that you be willing to write the order for the actual CPAP machine (if you want the patient to qualify for cpap based on the HST you ordered).