Currently there are a few major financial barriers to the use of Auto-CPAP:
Medicare and most insurance companies reimburse the DME companies for Auto-CPAP at the same rate as a regular CPAP machine. Auto-CPAP machines are more expensive (for the DME company) than regular CPAP machines. Unless a DME company is able to negiotiate a discount with the manufacturer, DME companies typically lose money on Auto-CPAP machines.
As far as using Auto-CPAP for an "at home titration study" (number 3 on my previous post)- that titration period (typically 3 nights) currently is unreimbursed and I am not aware of any plans for reimbursement for this.
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When portable testing is approved, I think that some primary care physicians will try to evaluate and treat osa without the involvement of sleep specialists by ordering portable testing and then treating the patient with an auto-CPAP machine (number 2 on my previous post). The auto-CPAP manufacturers have been known to negotiate discounts with large DME companies so this may be financially possible in certain areas. I think that we will see more auto-CPAP use by primary care doctors over the next several years, along with a temporary increase in profits by the Auto-CPAP manufacturers. However, results will be poorer than the current standard of having a patient undergo an in-lab titration before prescribing cpap. A lot of auto-cpap machines will end up sitting in closets and the auto-cpap trend will end by 2012.
Showing posts with label Stocks. Show all posts
Showing posts with label Stocks. Show all posts
Saturday, November 17, 2007
Auto-CPAP in the new portable testing world
To paraphrase a reader question, what role will auto-CPAP play in the future?
Auto-CPAP is basically CPAP that is self-adjusting based on the patient's pressure needs (various manufacturers have different alogorithms to monitor airlow). There are 3 main ways to use auto-CPAP:
1. Some patients who undergoe an in-lab regular CPAP titration are found to have large pressure difference needs between different body positions or sleep stages. In these cases, the patient can be prescribed auto-CPAP within a preset pressure range. For example, if someone needs a pressure of 6 during stage 2 sleep and 10 during REM, he might be prescribed an auto-CPAP machine that was set to automatically adjust between 6 and 10.
2. A patient could just skip the in-lab titration and be sent home with an auto-cpap machine for permanent use. The pressure range might initially be set at 4-20 and then gradually narrowed based on the data generated by the auto-cpap machine.
3. Instead of an in-lab titration, a patient could be loaned an auto-cpap machine for a few days to use at home. Based on the data generated by the machine, the patient could be prescribed a regular fixed pressure cpap machine.
Most sleep specialists, including myself, do option 1 at times. Some sleep specialists will do options 2 and 3 occasionally, but this requires close patient follow up and in my opinion is not appropriate for widespread use, nor for use by non-specialists. If options 2 and 3 become more widespread it would reduce the number of titration studies done by sleep labs and have a negative financial impact on the sleep testing industry.
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Edit (11/21)
A reader asked about reimbursement for options 2 and 3:
I am not directly involved in the DME business, so I don't know exactly what the profit margin is on cpap and auto-cpap machines. For option #2, the physician would collect standard office visit fees and the DME company would sell the patient an auto-cpap machine. Currently, most insurance companies reimburse auto cpap machines (for permanent home use) at the same amount as a standard cpap machine. I have been told by DME companies that they lose money every time they do this.
For option #3, usually the patient (at least in my area) is not charged for borrowing the auto-cpap machine (from the DME company) for a few days for an at-home auto-cpap titration. The DME makes its money by then selling the patient a regular cpap machine. The physician charges standard office visit codes.
Auto-CPAP is basically CPAP that is self-adjusting based on the patient's pressure needs (various manufacturers have different alogorithms to monitor airlow). There are 3 main ways to use auto-CPAP:
1. Some patients who undergoe an in-lab regular CPAP titration are found to have large pressure difference needs between different body positions or sleep stages. In these cases, the patient can be prescribed auto-CPAP within a preset pressure range. For example, if someone needs a pressure of 6 during stage 2 sleep and 10 during REM, he might be prescribed an auto-CPAP machine that was set to automatically adjust between 6 and 10.
2. A patient could just skip the in-lab titration and be sent home with an auto-cpap machine for permanent use. The pressure range might initially be set at 4-20 and then gradually narrowed based on the data generated by the auto-cpap machine.
3. Instead of an in-lab titration, a patient could be loaned an auto-cpap machine for a few days to use at home. Based on the data generated by the machine, the patient could be prescribed a regular fixed pressure cpap machine.
Most sleep specialists, including myself, do option 1 at times. Some sleep specialists will do options 2 and 3 occasionally, but this requires close patient follow up and in my opinion is not appropriate for widespread use, nor for use by non-specialists. If options 2 and 3 become more widespread it would reduce the number of titration studies done by sleep labs and have a negative financial impact on the sleep testing industry.
-------------------------------------------------
Edit (11/21)
A reader asked about reimbursement for options 2 and 3:
I am not directly involved in the DME business, so I don't know exactly what the profit margin is on cpap and auto-cpap machines. For option #2, the physician would collect standard office visit fees and the DME company would sell the patient an auto-cpap machine. Currently, most insurance companies reimburse auto cpap machines (for permanent home use) at the same amount as a standard cpap machine. I have been told by DME companies that they lose money every time they do this.
For option #3, usually the patient (at least in my area) is not charged for borrowing the auto-cpap machine (from the DME company) for a few days for an at-home auto-cpap titration. The DME makes its money by then selling the patient a regular cpap machine. The physician charges standard office visit codes.
Quick Sleep Stock Pick
Respironic's products are superior to Resmed's, especially when it comes to the new servoventilation technology. Respironics is coming out with a new "PAP" machine which combines all the different PAP modalities (BiPAP, BiPAP ST, CPAP, SV) into one easily useable machine for sleep lab use- less work for the sleep lab technicians in switching from one treatment to the other. I remain bullish on Respironics and anticipate their stock reaching 55 within 6 months.
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