Finally, the CMS to expand Medicare coverage for CPAP for beneficiaries with a clinical diagnosis of OSA, without the PSG or HST only supplied as part of a clinical trial that meets specific standards. A clinical study seeking Medicare coverage for CPAP in covering the evidence for evolution must necessarily respond to specific questions as stipulated in the fight against noncommunicable diseases.

Changing the two-hour rule as proposed is likely to be perceived positively by all parties acquired. However, what used to diagnose OSA unattended HST has the potential to fundamentally change the provision of assistance to the dream, the economy and results in a way that is difficult to predict with certainty.

Debate on the use of HST to establish the diagnosis PART began long before the revision of 2007, CMS NCD 240.4 Policy. In fact, net of HST has been reviewed by CMS since 1989, and subsequent evaluations, in 1995, 2001 and 2005. The most recent challenge before the NCD 240.4 happened in 2004 and culminated in April 2005, CMS took the view that "... there is enough evidence to conclude that the unique portable multi-channel sleep study testing is reasonable and necessary for the diagnosis of OSA for CPAP therapy, and these tests are not belong-to this end. "At first I was surprised by the decision to include CMS NCD 240.4 HST unattended, especially without the supervision of professional skills and HST clearly defined a comprehensive evaluation of sleep. After careful consideration of the proposed changes and the determination of CMS coverage of the political process, I will offer my understanding of the changes proposed NCD 240

In January 2007, Dr. David R. Nielsen, Executive Vice President and Chief Executive Officer of the American Academy of Otolaryngology-Head and Neck Surgery requested that CMS revise NCD 240.4. Among the challenges for 2005 NCD policy included the idea that the diagnosis of OSA limit the liability of PSG, has described the test as expensive and not widely available. In addition, Dr Nielsen believes that HST had been established, a less expensive PSG, and also less expensive paradigms for the diagnosis and treatment have been examined and that the HST has been an important first step in promoting and working for these alternatives.

American Academy of Sleep Medicine (AASM), the response to the CMS when the President, Dr. Michael Silber, provides a review of the literature throughout the U.S. access PSG, PSG and sleep research experts waiting times AASM accredited facilities, and by reviewing the patient's clinical and financial information on HST after the challenge to the 2004 NCD 240.4. AASM April 10, 2007 letter from the Director of CMS coverage and Analysis Group, Dr. Steve Phurrough, to systematically establish the factual basis for the AASM positions:

More recent data, PSG is generally available in the U.S..

There is no evidence that a change in policy against NCD for HST will have a significant impact on patient access.

The studies published until 2004 did not provide evidence in support of HST for the diagnosis of OSA.

After 2004, two studies provide evidence in support of HST, when used in very selected and managed intensively in academic centers of sleep.

The available data do not indicate that HST is more profitable than PSG, especially taking into account the technical failures, and false negatives and false positives.

Widespread use of the HST by a lack of training of physicians and / or experience in sleep disorders may result in adverse patient outcomes.

There is credible evidence that patients with OSA in AASM accredited sleep centers have better results.

If the HST is detected in future be used in the management of some patients suspected of having OSA, it is necessary that these procedures can be used in accredited sleep to ensure optimal care for patients.

CMS used multiple sources of evidence in its decision to amend the NCD 240.4. In addition to receiving feedback from professional associations, businesses and individuals, prepared for the decision that CMS set out an external evaluation of the technology from the Agency for Healthcare Research and Quality (AHRQ) to examine clinical data published the use of HST in diagnosing OSA, 2 reviews the relevant guidelines published evidence-based since 2003 and had a Medicare Advisory Committee (MedCAC) meeting of September 12, 2007. Collectively, the evidence is designed to answer three fundamental questions about OSA and CPAP coverage. First, CMS asked whether there was sufficient evidence to establish that the diagnostic strategies second that the plant is based PSG to accurately identify patients with OSA who benefit from CPAP treatment. Second, they challenged the idea that at least two hours of sleep recorded continuously is necessary for accurate diagnosis of OSA.

AASM evidence that I gave most of the panel MedCAC AASM April 10, 2007 letter from CMS. Other professional societies involved in the certification of the American Academy of Otolaryngology-Head and Neck Surgery (HST), the American Association of Respiratory Care (discussed a provision of 2 hours), the American College of Chest Physicians (ACCP) and American Thoracic Society (ATS). Although there has been a change of belief, usually AASM, ACCP and ATS testified against the indiscriminate TAV. AASM member Dr. David Kuhlmann testified to a private party and supported the position of the AASM's.

Since generally MedCAC panel and review of AHRQ Technology Assessment expressed greater confidence in the diagnosis PSG in HST (especially in Type IV HST units) which led CMS to allow HST in the paradigm diagnostic for determining the coverage CPAP? In simple terms, the decision came CMS 2007-NCD 240.4 in a way fundamentally different from previous assessments. Unlike the 2005 decision of CMS in which the diagnostic accuracy was the main determinant for CPAP coverage in 2007, CMS discontinued the accuracy of diagnosis rather than the strategies most likely to predict a favorable outcome for the treatment of OSA by CPAP. Since the available evidence does conclude with confidence that the indices derived from either PSG or HST may be used to reliably predict treatment outcome in patients treated with CPAP OSA, could not be specifically excluded from the political determination coverage.

CMS has not ruled PSG as reasonable and necessary for the diagnosis of OSA and does not provide for subordination of CPAP titration. The proposed amendment to NCD 240.4 no specific management strategies after a trial at home CPAP failure patients with OSA by clinical assessment and HST. In this regard continuing PSG for the diagnosis and treatment of OSA. But in terms of earnings CPAP as reasonable and necessary for continuous coverage of treatment, CMS encourage the medical community in general and sleep medicine in particular in the sense of a chronic care approach to OSA? Many patients with OSA have coexistence of sleep disorders like insomnia and residual sleepiness despite adequate CPAP treatment, conditions that increase the likelihood of a trial fiasco when combined CPAP sleep disorders are not taken into account.

Recognizing the potential performance gains of healthcare and the economy offered by the paradigms of chronic conditions, 4.5 in January 2007, I proposed a meeting of leaders of the AASM to improve our understanding of patterns of care chronic, consider models of chronic care sleep practices and to define the role of the AASM in the development of chronic care models specific to sleep medicine. The meeting, scheduled to coincide with the April 2008 meeting of the board AASM randomly fall shortly after the final decision on the CMS NCD 240.4 AASM provides leadership to focus the discussion on the basis of the final decision. I am convinced that this conference will serve as a catalyst to promote sleep health strategies that emphasize long-term care for our patients.

This editorial comment on the order to avoid inconsistencies and inaccuracies in the draft decision by CMS. A number of serious deficiencies, including failure of CMS to define the conditions that affect the determination of coverage, such as "evaluation" and "benefit from CPAP" are excluded because the official response to the proposed change AASM NCD 240.4 will shed light on these and other key issues. To share my experience and perspective is hoped that this editorial to help prepare the individual to sleep expert and a court challenge of Sleep Medicine.

4 and the message that CMS is sending to the community of sleep. An assessment of the events leading up to the 2007 decision is helpful to understand the reasoning behind the decision of the CMS. Therefore, I will start with a brief history.

Third, CMS has asked for a diagnosis of OSA by clinical criteria alone are sufficient to require CPAP.