LETTER RE: Sleep medicine practice adaptations

I read with interest Raphaelson and Brown's article on sleep medicine practice adaptations.¹ As a neurologist with subspecialty certification in sleep medicine, I see patients in my hospital's sleep center 2 half-days a week. Recent payment policy changes by Medicare and commercial medical insurance companies have made it increasingly difficult to get an in-laboratory (attended) sleep study approved for the sleep apnea patient who has no other cardiovascular comorbidities. Even if I strongly suspect moderate to severe grade of sleep-disordered breathing in that patient, I have stopped requesting peer-to-peer review since I know that my peer on the other end of the line has his or her hands bound. The answer is going to be "no and request denied" even though he or she may acknowledge (off the record) that I have a valid case. So it is not uncommon for me to order a home sleep study only to find it substandard. Then I am forced to either treat my patient on the basis of that or to request an in-laboratory study and hope to get it approved this time around. Fraudulent practices in the past by some should not result in radical policy changes that apply to all physicians and are detrimental to our patients. The pendulum has swung from in- laboratory sleep study for any and every indication to in-laboratory study only for the patient with documented cardiovascular comorbidities. I hope somewhere between these 2 extremes there is a middle ground where common sense prevails.

Disclosures: N. Sethi serves as Associate Editor for The Eastern Journal of Medicine.

Reference

1. Raphaelson M, Brown DB. Sleep medicine practice adaptations. Neurol Clin Pract 2014;4:63-70.