Bulk Billing Sleep Studies Reduced
This is from a Facebook post I wrote yesterday (19 November 2018).
For the urgent attention of people with sleep disorders in Australia.
I’ve just come from a meeting and also a phone conference with industry stakeholders and can advise that due to the government’s wisdom and lack of (any?) effective lobbying by the Australasian Sleep Association and other ‘peak’ bodies Snore Australia, Australia’s largest provider of PSG/MSLT sleep studies has shut down. They officially shut down on 1st November.
Because new government guidelines say that home sleep studies must make up 90% of MBS claims leaving only 10% for on-site sleep studies. This leaves Snore’s business unviable. (Why would ‘peak’ bodies like the ASA not put up a tremendous fight against this? That is, perhaps, for another post...).
Research has shown that home sleep studies are adequate for appropriately testing for severe to moderate sleep apnea. So for straight forward (uncomplicated) moderate-severe sleep apnea a home study will suffice but what about the many people (only 5% of sleep apnea is considered severe) that a home sleep study isn’t suitable for? This includes everyone that requires a MSLT (and/or a MWT).
What impact will this have on people with sleep disorders?
Home sleep studies are not suitable for all cases of sleep apnea. Two of Australia’s leading sleep specialists have told me that home studies are not appropriate for many people with mild sleep apnea for a range of reasons, one of them is that people with mild sleep apnea can have other causes of their daytime symptoms that may need assessing with a MSLT or MWT (that’s just one reason, there are others). Home studies are also not suitable for complex breathing disorders. The people this effects more than anyone else is people with Narcolepsy and Idiopathic Hypersomnia.
I can not stress enough that people with these diseases MUST have an on-site sleep study that involves a MSLT to access medication, and in some cases they may also need to do a MWT to retain their drivers licence. This is not their choice, this is not a money making exercise via the MBS by sleep specialists. The PBS and various State S8 medication laws require people with N and IH to have a MSLT. ie; one government rule has now made it extremely difficult for people with N and IH to comply with other government rules regarding access to the only treatment available to them.
This is unacceptable. I will be meeting with others to discuss this issue further.
What does that mean to people that need a PSG/MSLT?
If you do not have Gold (top level) hospital cover your only option is to go on a public hospital waiting list - or you can have the study done in a private hospital at your (massive) expense. Waiting lists vary from State to State but we know that in SA this is a big problem with the likely loss of the RAH sleep lab, it only leaves QEH and Flinders and in Brisbane there is approx only a dozen public beds available.
What can you do about it?
If you are faced with a lengthy wait time for a PSG/MSLT urge your doctor to write to the local area health authorities who helped create this situation (they will or should know who this is). Also urge them to express their concerns to the ASA. If you really want to make a difference write to the Federal Health Minister, Greg Hunt. This is a link to his contact details including his social media. Make some noise on that!
To understand more about it read the MBS factsheet. In a post by the Limbic Dr Barnes (ex ASA President) said “This is a way of giving patients more access to sleep studies and expedite them.” Yes, more access to a subgroup of patients but at a cost to access to sleep studies for other sleep disorder patients!
I agree with what Maree has said here “In the past all (sleep studies) were done under 12203 so when we are looking at the data we don’t know who is having what type of sleep study for what indication. That makes it very difficult to plan delivery of services.” However, if the ASA are happy with the outcomes, “Dr Barnes says the ASA is happy with the outcomes of the MBS Review... “We think this is a good outcome for patients that is hopefully going to lead to better outcomes, better and more clear management pathways...” the ASA have clearly neglected to consider the impact this was going to have on all people with sleep disorders.
I will keep you posted....
Michelle Chadwick Founder/Executive Director Hypersomnolence Australia Director of Sleep Disorders Australia