American Academy of Sleep Medicine | ICDMPPO

Obstructive sleep apnea (OSA) is a disorder with significant prevalence in the Medicare community. OSA is linked to several co-morbidities, including myocardial infarction, stroke, hypertension and type-2 diabetes, which add significant burden to the health care system. The diagnostic algorithm and treatment model for OSA is fragmented and flawed in its present state. Currently, physicians untrained in sleep medicine infer a diagnosis of OSA based on a computer-generated simplistic report provided by a commercial home sleep testing company. Further, treatment is not provided or managed by a physician but rather a DME company that emphasizes equipment sales. This model is the present standard because Stark law prevents the board certified sleep medicine physician that diagnoses OSA from providing treatment to patients. These realities prompted the development of the Innovation Care Delivery and Management Program for Patients with OSA (ICDMPPO). This program creates a new model of patient management with an emphasis on the following goals: Improved care coordination ; increased adherence to PAP therapy; reduced co-morbidities; strengthened patient satisfaction; and realized, significant cost savings for CMS. There are two fundamental concepts that formulate the ICDMPPO: More patients will undergo Out of Center Sleep Testing (OCST) and treatment adherence will increase by 20 percent. A minimum of 50 and a maximum of 75 sleep centers will be recruited for the program. Each participating site will be required to annually enroll a total of 100 Medicare beneficiaries for a total participant base of 22,500. The program will change the current standard of all patients tested in-center to a testing algorithm of 20 percent in-center, 20 percent split-night in-center, 40 percent OCST and 20 percent OCST and in-center retest. Improved adherence will be realized on account of all care coordinated by the board certified sleep medicine physician, and greater patient education and support provided by the sleep center facilitator. To achieve the program's objectives, there is a need for a waiver of Stark Law, allowing the board certified sleep medicine physician to diagnose and treat patient with OSA by providing PAP therapy and monitor the patient's progress during the demonstration project and long-term. The proposed budget of the ICDMPPO is $8,733,481.52. Funds will be used to support the creation and implementation of the new care model and will be spent on activities including but not limited to accreditation, education, training and a database that tracks outcome measures. According to the CPT Claims Database, …