New Local Insurance Criteria Could Affect Reimbursement For Sleep Apnea Patients

Friday, October 8th, 2010 at 9:18 PM

New local coverage determination (LCD) adherence criteria for continued reimbursement of continuous positive airway pressure after 90 days among patients with obstructive sleep apnea may have a negative impact on their clinical care, according to research published in the October issue of Chest.

Mark S. Aloia, Ph.D., of National Jewish Health in Denver, and colleagues evaluated information from a retrospective database of 150 patients who received neuropsychologic testing before treatment as well as three and six months after treatment. Patients were categorized using the new LCD criteria.

The investigators found that 37 percent of patients did not meet the new LCD criteria. However, they noted that this number may not reflect actual adherence rates in clinical settings, as some efforts beyond standard care were made to ensure adherence among many patients. Only 28 of 50 patients (56 percent) who did not receive any special adherence intervention met the new LCD criteria. Patients with poor adherence demonstrated neuropsychologic improvements similar to those of adherent patients on most measures. From three to six months post treatment, non-adherent patients experienced additional improvements in working memory.

“These data were taken from a study that was not designed to examine these criteria, so controlled trials are needed to better understand the effect of the guidelines on adherence and treatment outcomes,” say the researchers.