Re: Medicare to allow home studies
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Re: Medicare to allow home studies


Posted by bob on May 08, 2004 at 14:02:01:

In Reply to: Re: Medicare to allow home studies posted by Old Sleeper on May 07, 2004 at 09:01:13:

Disclaimer - I work part-time in Europe for a Medcare Distibutor.
You are correct that research techs are far more involved and self-initiating in general. I have been reminded of this several times over the years - sometimes to my intense chagrin! I believe - perhaps in error - that the definition of a PSG by most authorities includes EEG, EMG (subm & Leg), L&R EOG, plus the usual others. In our definition any study which does not include the above is a polygraphy, not a PSG. I agree that there will always be a place for in-lab online studies for certain maladies and at the very least a sizable percentage of CPAP titrations. Having said that extensive experience in Europe and elsewhere has shown that by far the greater majority of OSAS patients can be effectively safely and efficiently diagnosed at home with techniques less intensive than full PSG. To the great benefit of all actors in the system.
Now the ice under me gets a little thinner - I believe that at least a majority of these patients could be titrated effectively at home given the proper system of CPAP introduction and selection.
The equipment for the diagnostic part of this is available today - has been available for years in fact. It is reliable, effective and tried-and-tested. The auto-titrating systems are somewhat newer and the methodology and practical aspects of this are far less developed. Nonetheless, as my medical director is wont to say - If we always take the attitude that progress is unnecessary then medicine would still be at the Greek Stage! I say that we should be brave and progressive enough to at least approach this with an open mind and experiment with the possibilities.
I know that in Scandinavia there are moves and the opening experiments with making OSAS screening standard for all cardiac patients. This will necessitate new approaches I believe.

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