"Insurers push clinic sleep testing into homes" by Chelsea Conaboy | Globe Staff, February 02, 2013
Researchers have found that the cheaper and often more convenient home tests are about as good at detecting the breathing interruptions that characterize obstructive sleep apnea. Massachusetts insurance companies looking to clamp down on the booming field of sleep medicine have responded by restricting use of the in-lab tests, which run about $650 to $1,000, in favor of home testing at about one-third the cost.
Sleep HealthCenters, a chain of sleep clinics that included 11 in Massachusetts, cited the drop in insurance payments when it closed suddenly last week, leaving nearly 150 employees looking for work.
Sleep medicine physicians say the change, which is likely to spread to other states, has occurred too quickly for them to adjust their business models and that insurers have taken it to an extreme, cutting some patients off from tests their doctors think they need. But a report released last week estimated that shifting three-quarters of the tests to the home could save New England’s health care system about $35 million a year.
Though workers have lost their jobs, the change in sleep testing is a prime example of the kind of shift — the replacement of an outmoded and expensive health care service with a cheaper technology — that’s necessary to control health care costs, said Austin Frakt, a Boston University health economist. “If we’re really going to save money in health care, it means that somebody’s going to get paid less,” said Frakt, a member of the New England Comparative Effectiveness Public Advisory Council, which issued the report. “Maybe some of the ways of delivering health care just won’t be viable.”
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The shift to home testing, however, could increase the number of incorrect test results compared with those done at sleep clinics, the council found. And some members were concerned the convenience could lead patients unlikely to have apnea to be tested at home, resulting in overdiagnosis.
Sleep medicine is an attractive target for cost-cutters. It is a young field, formalized as a medical specialty little more than a decade ago. But it has grown quickly, with greater public awareness that apnea — affecting up to 7 percent of men and 5 percent of women — can lead to dangerous drowsy driving and increase the risk of heart failure or stroke. For-profit companies such as Sleep HealthCenters that saw an opportunity to make money from testing and treating these patients also have driven the expansion....
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