Questions surround proposal

While CMS appears to be leaning toward covering at-home sleep testing, the devil is in the details, industry leaders say. Who can perform the tests and what type of patient qualifies are just two of the many unanswered questions. "What types of equipment will be required, how many channels are needed?" said Joe Lewarski, vice president of Invacare's respiratory products group. "Who can do the prescribing, who can do the testing? Those details will have to be worked out." One model CMS could follow: independent diagnostic testing facilities (IDTF) for oxygen testing. "It's a proven model," said Mickey Letson, president of Decatur, Ala.-based Letco Companies. "The provider delivers the test, sets it up. The data can be downloaded to a qualified IDTF that assembles the data and sends reports to the physician, who interprets it." While CMS has typically frowned on recognizing HMEs as clinical entities, the technology is there to support at-home testing, and in fact, some HMEs have performed the tests for other payers, said Lewarski. Alan Kirk, vice president and general manager of Total Home Health in Elgin, Ill., said his company did unattended studies for payers like Blue Cross before full-scale polysomnography testing became the norm. "It was a great business for us," said Kirk, who still performs a few for hospitals and people willing to pay out of pocket. While he said he's built a huge referral base from local sleep labs and wouldn't want to risk that business, he would love the chance to do more independent sleep studies.