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SLEEP APNEA Continued from page 17
Q: How do insurers view the increasing interest in sleep apnea? A patient may also be advised by a physician in some instances to pursue surgery and the American Association of Oral and Maxillofacial Surgeons web site www.aaoms.org provides an excellent reference about the surgeries that may be recommended. One such procedure, maxillomandibular advancement surgery (MMA), is highly therapeutic as a treatment of OSA because it pulls forward the pharyngeal soft tissues suspended from the upper and lower jaws, thereby enlarging the entire upper airway. The AAOMS site notes that for some individuals, the MMA is the only technique that can create the necessary air passageway to resolve their OSA condition.
A: There have been recent media stories discussing insurer concerns that in-patient, overnight sleep testing is being over-prescribed. The American Academy of Sleep Medicine said in 2012 that the organization had 2,485 accredited sleep-disorder centers, nearly five times the 502 that were accredited in 2000 (www.dispatch.com). Medicare payments alone to sleep clinics nearly quadrupled between 2001 and 2009, from $62 million to $235 million, according to the U.S. Department of Health and Human Services’ Office of Inspector General. Some health insurers are looking at more at-home sleep studies that at around $400 are lower priced than overnight tests
at a free-standing sleep center or in a hospital outpatient setting (www.dispatch.com). One story broadcast on National Public Radio earlier this year estimates that a night at a hospital sleep lab can cost a patient’s insurer around $1,900. NPR also noted that some patients may spend two nights at a lab—one to test for apnea and the second to test-drive a CPAP machine if one is prescribed. The upshot is that with the increased interest in the field, insurers could be concerned about the potential abuse of overnight sleep studies and complex treatment options. Dentists should err on the side of caution in forming relationships with physicians and specialists in the field and ensure that any suggestion or referral given to a patient is centered on the best interest of the patient.
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GDA ACTION MAY 2013