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Cost of Sleep Studies for U.S. Medicare Beneficiaries Is High

by Samara E. Kuehne •

What are the prevalence and types of sleep studies performed for U.S. Medicare beneficiaries, and what are healthcare specialists’ billing and reimbursement rates?

Bottom line
The healthcare burden of administering sleep studies is substantial, although the annual cost is declining. Unattended sleep studies contribute to decreasing costs and should be considered for patients who meet the correct indications.

Background: Obstructive sleep apnea (OSA) is estimated to affect 15% of men and 5% of women in North America. Many of these patients remain undiagnosed and untreated. Full night polysomnography (PSG), split-night studies (PSG followed by administration of continuous positive airway pressure [CPAP] in the same night), and home sleep tests (HST) provide the objective data necessary to diagnose OSA. To date, the prevalence and cost burden of sleep studies performed in the United States have not been quantified. In 2016, the American Academy of Sleep Medicine released two reports relating to the estimated national economic impact of OSA. The reports estimate that the national cost for diagnosis, treatment, and follow-up among individuals diagnosed with OSA is $800 million, but does not enumerate the cost burden of sleep studies.

Study design: Retrospective longitudinal study of the Centers for Medicare and Medicaid Services (CMS) Part B National Summary Data and Medicare Provider Utilization and Payment Data from 2000 to 2014.

Synopsis: Sleep study data were analyzed according to type of study performed, total expenditure amount, provider specialty, and geographic location. In 2014, 845,569 sleep studies were completed by 1.4% of Medicare beneficiaries for a total of $189 million. Since 2010, annual expenditures for sleep studies have declined, whereas the number of studies performed has increased by 9.1%. In 2014, polysomnography, split-night PSG, and unattended home sleep studies accounted for 40%, 48%, and 12%, respectively, of total sleep studies. This represents a dramatic growth in the number of unattended sleep studies performed since 2000, when they represented only 0.9%. Pulmonologists, independent diagnostic testing facilities, and neurologists are the top specialties that bill for sleep studies. Sleep medicine is a growing specialty and ranked fifth among providers.

Citation: Chiao W, Durr ML. Trends in sleep studies performed for Medicare beneficiaries. Laryngoscope. 2017;127:2891–2896.