As president of the American Academy of Sleep Medicine, one of the most common complaints I hear from members is that a particular aspect of an insurer’s policy conflicts with the AASM’s evidence-based clinical practice recommendations. In addition to being an administrative hassle, these deviations can hinder our ability to provide quality care for patients with sleep disorders.
When these problems are brought to our attention, the AASM responds proactively by urging insurers to adhere to our standards of practice. Examples of how the AASM has intervened to address previous issues with insurers are available on our Practice Management webpage.
However, the board of directors has recognized that the AASM needs to implement a more systematic approach to tracking insurer policies and challenging their shortcomings. Therefore, the AASM has appointed an Insurance Policy Review Committee led by Chair Vishesh Kapur, MD, and Vice-Chair Neeraj Kaplish.
The committee has begun its work by prioritizing the top policy issues that need to be addressed by payers. At the top of this list are aspects of diagnostic testing for obstructive sleep apnea (OSA), including when to use home sleep apnea testing (HSAT) and how to define both HSAT and the apnea-hypopnea index (AHI). Other high-priority topics identified by the committee include coverage for in-center positive airway pressure (PAP) titration and modafinil/armodafinil.
The committee’s next step will be to develop from AASM guidelines a list of clear, concise and relevant recommendations, which payers will be urged to adopt in their policies. Then the committee will create a mechanism to assess and publicly report the adherence of selected payers.
I look forward to seeing the results of this committee’s efforts, and I am grateful for the hard work of all of our committee and task force volunteers. Together we are promoting high quality, patient-centered care for the millions of people who suffer from a sleep disorder.
Nathaniel F. Watson, MD, MSc