Sleep physicians warned over referrals to CPAP suppliers

Sleep physicians working for equipment suppliers have been warned about sending sleep study reports printed on the back of letters referring patients to these companies.

The Medicare claims watchdog the Professional Services Review (PSR) says the practice may not actionable as inappropriate practice but it brings into question the independence of practitioners from the companies that market sleep apnoea equipment.

In the PSR’s annual report, director Professor Julie Quinlivan says that when reviewing claims by practitioners in relation to sleep studies, the PSR noted that some referred sleep physicians were employed or contracted by companies that were subsidiaries of larger corporations that sold sleep medicine equipment.

“In some reviewed cases sleep study reports were printed on the back of letters directing patients to these suppliers. Whilst this observation did not form the basis of any finding of inappropriate practice, the sleep medicine profession might like to reflect upon whether such associations are in the interest of the philosophy of medical independence,” she wrote.

The PSR report said that its investigations into inappropriate MBS item claiming by sleep medicine practitioners highlighted concerns about sleep studies not being clinically indicated, not performed with an appropriate level of supervision, not performed or scored appropriately and/or not adequately reported.

It said sleep study reports were sometimes too ‘OSA- centric’ and focussed on a need for CPAP, yet failed to mention other clinically important abnormalities apparent from patients data including the presence of chronic hypoxaemia and significant abnormalities of the cardiac ECG, brain EEG or limb movements.

But Professor Quinlivan commended senior representatives of the sleep medicine profession, who she said had responded rapidly and positively to the issues raised by the PSR.

“The response of the profession has been exemplary with considerable engagement by practitioners to address concerns and improve the quality of conduct and reporting of sleep studies,” she wrote.

Clarification of sleep study MBS item descriptors following recommendations from the Medicare Review Taskforce had also helped address the issues around reporting of sleep studies, she added.

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