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Optimal NIV Medicare Access Promotion: Patients With OSA: A Technical Expert Panel Report From the American College of Chest Physicians, the American Association for Respiratory Care, the American Academy of Sleep Medicine, and the American Thoracic Society.

Publication ,  Journal Article
Patil, SP; Collop, NA; Chediak, AD; Olson, EJ; Vohra, KP; ONMAP Technical Expert Panel,
Published in: Chest
November 2021

This document summarizes the work of the CPAP and bilevel PAP therapy for OSA Technical Expert Panel working group. For positive airway pressure (PAP) therapy, the most pressing current coverage barriers identified were: an insufficient symptom list describing all potential symptoms in patients with mild OSA; the 4 h per night of PAP usage requirement to keep the device; the additional sleep studies requirement to re-qualify for PAP or supplemental oxygen; and the inability to use telehealth visits for follow-up visits. Critical evidence supports changes to current policies and includes: symptom list inadequate to cover all scenarios based on updated clinical practice guidelines; published evidence that 2 h per night of PAP use can result in benefit to quality of life and other metrics; the costs of another sleep study not justified for all nonadherent patients or for supplemental oxygen due to other types of assessment currently available; and the remarkable success and acceptance of telehealth visits. To achieve optimal access for patients on PAP therapy, we make the following key suggestions: removing symptom criteria for mild OSA; reduce continued coverage criteria to > 2 h per night; eliminate the need for a sleep study to re-qualify if nonadherent or for new Centers for Medicare & Medicaid Services beneficiaries already on and adherent to PAP therapy; allow telehealth visits for documenting benefit and adherence; and allow PAP reports and domiciliary oximetry to qualify for supplemental oxygen with PAP if needed. This paper shares our best vision for bringing the right device to the right patient at the right time.

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Published In

Chest

DOI

EISSN

1931-3543

Publication Date

November 2021

Volume

160

Issue

5

Start / End Page

e409 / e417

Location

United States

Related Subject Headings

  • United States
  • Telemedicine
  • Symptom Assessment
  • Sleep Apnea, Obstructive
  • Severity of Illness Index
  • Respiratory System
  • Quality of Life
  • Positive-Pressure Respiration
  • Patient Selection
  • Patient Compliance
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Patil, S. P., Collop, N. A., Chediak, A. D., Olson, E. J., Vohra, K. P., & ONMAP Technical Expert Panel, . (2021). Optimal NIV Medicare Access Promotion: Patients With OSA: A Technical Expert Panel Report From the American College of Chest Physicians, the American Association for Respiratory Care, the American Academy of Sleep Medicine, and the American Thoracic Society. Chest, 160(5), e409–e417. https://doi.org/10.1016/j.chest.2021.06.084
Patil, Susheel P., Nancy A. Collop, Alejandro D. Chediak, Eric J. Olson, Kunwar Praveen Vohra, and Kunwar Praveen ONMAP Technical Expert Panel. “Optimal NIV Medicare Access Promotion: Patients With OSA: A Technical Expert Panel Report From the American College of Chest Physicians, the American Association for Respiratory Care, the American Academy of Sleep Medicine, and the American Thoracic Society.Chest 160, no. 5 (November 2021): e409–17. https://doi.org/10.1016/j.chest.2021.06.084.

Published In

Chest

DOI

EISSN

1931-3543

Publication Date

November 2021

Volume

160

Issue

5

Start / End Page

e409 / e417

Location

United States

Related Subject Headings

  • United States
  • Telemedicine
  • Symptom Assessment
  • Sleep Apnea, Obstructive
  • Severity of Illness Index
  • Respiratory System
  • Quality of Life
  • Positive-Pressure Respiration
  • Patient Selection
  • Patient Compliance