Re: [ACEsthetics] Medicare nails CPAPs

Well, John, some of these in-house studies are nothing except a charge to Medicare and the feds know it.  I have personally gotten the hospital to refund copays to patient and charges to BC/BS and Medicare for sleep studies that got zero results.  All three were the result of the "patient not going to sleep".  It seems that our main man charges you for the bed and not the study and the hospital is still letting him run their sleep center.  That will end soon.  The patients and insurance/Medicare was charged but no results came from the tests because the "patient would not go to sleep.".  His fault not theirs it seems.  I told the doc that, hell, I could have gotten them to go to sleep in my chair...do it all the time.  

See, in the vast majority of these centers only poorly trained personnel do the actual "study" and the doc reads it getting the patient the results three weeks later with a recommendation of where to get their CPAP.  We have FIVE sleep labs in our town of 13k...five of the damned things.  All but the the hospital are owned by physicians and the same doc reads all but one lab.  He was reading Aries studies for a while but it got too busy.  

Possibly they only measure oximetry but when I had mine done in Dallas it told Kent a hell of a lot more than that.  He knew how loud I snored, that I did not snore on my left side (I've found that my airway is more open when I am on the left for some reason).  It told them how many times I essentially stopped breathing and the severity of everything.  That is just about all you get if you go to a sleep lab.  My reports from Aries look very similar to the ones I get from the guy reading all the tests in labs in town...scary similar.  

The feds are very aware of the abusive codes in Medicare and Medicaid and according to the key note speaker at the Georgia Hospital Association meeting these codes will be diligently pursued and penalties severe.  As with any abuse the abusers cause pain and suffering and loss of compensation to the honest nonabusing doctors.  The government can try every abusing physician and dentist so they punish us all...same with insurance.  As compensation drops the temptation to abuse gets higher and higher.  Sort of like not paying your taxes and nothing happening.  My brother in law did that for twenty plus years including five years in the military where he did not file...JAG corps naturally.  It got so good to him he couldn't stop. His punishment was severe even though he turned himself in.  He kept his bar license though.  

This is an area of huge abuse and this is evident by all these sleep labs opening up.  But they'll be like a county just making booze legal.  There'll be twenty five liquor stores and in ten years three.  The sleep docs will not last that long.  Oh, this one is a rep for two CPAP wholesalers...legal?...nah.  Go figure. Just an ignorant old doc, Guy

On Sat, Feb 2, 2013 at 4:54 PM, John Highsmith DDS <schminsk@bellsouth.net> wrote:

Unfortunately the majority of home studies are only oximetry. My understanding is that oximetry only shows severe OSA, the type that can kill you. Nice to know, but there are a myriad of ways OSA can make your life miserable and can exacerbate any co-morbidities the patient has, so these screenings seem totally inadequate. Ironic that a patient will often get better medical care in this regard walking into Kent Smith's office than going to their physician. 

John Highsmith DDS

Clyde, NC

AACD Accredited Dentist

LVI Clinical Instructor

Diplomate, ICOI

Fellow, Misch Implant Institute

DrHighsmith.com

On Feb 2, 2013, at 4:40 PM, Guy Moorman wrote:

Don't know if this hit everyone but got a message from sleep society that Medicare is cutting CPAP reimbursement by 47% for full mask devices.  Nothing was said about MADs.  I worked on the nurse practitioner for the local big shot sleep guy who got me to take Kent's course (thank goodness) and asked her if they were doing any ambulatory sleep studies.  I'd heard that Medicare and the Blues were going to move almost totally to ambulatory over the centers.  She angrily told me that the Blues had just about made them go totally to ambulatory sleep studies because they were essentially as accurate as those being done in docs' offices or centers rather than hospitals.  She said she hated the ambulatory sleep studies because patients did not know how to use them.  We've had not one problem other than one clerical error and a temp loss of one test.  They just hate the lower reimbursement.  

I'm sure all of this is due to abuse of sleep studies and CPAP sales by Home Health Companies.  Kent that 47% I know you've seen but I did not know if the Blues in Texas had moved on the sleep centers like they have here.  If we could come up with a cheaper device than the CPAP we've be doing most of the sleep devices.  This will push the average Home Health fee to about 100 bucks for the lower end CPAPs which is what the government is going to mandate.  I'm betting fewer and fewer people will tolerate that mask and will want to pay for an oral appliance or more expensive CPAP.  Guy

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Guy W. Moorman
The Swamp
Douglas, Georgia

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Guy W. Moorman
The Swamp
Douglas, Georgia

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