28 May Australian Doctor News reports that Medicares sleep apnoea assessments are deeply flawed
On the 27th May 2019, Mr Anthony Scholefield posted an article to the AusDoc website highlighting what many medical practitioners well know; the new mandatory screening tools for GP referred sleep studies may not be fit for purpose.
In November 2018, the MBS changed their item codes for sleep studies. While the codes did rightly remove some of the ambiguity with performing/billing the different types of sleep studies, some of the changes have impacted on the diagnostic screening availability for some patients. This is particularly true for patients with obstructive sleep apnoea (OSA) who are not symptomatic, or are not mindful of these symptoms, particularly being sleepy (desensitised or denial) or snoring (no bed partner or denial).
The STOP BANG, Berlin and OSA50 questionnaires are useful screening tools to assess a high pre-test probability of having a sleep related breathing disorder. However for GP’s to now be able to refer directly for a MBS funded sleep study, a positive score on the Epworth Sleepiness Scale (ESS) is also required. So, a GP may have a patient who has a high probability of having a sleep disorder (eg OSA), but who may not be subjectively sleepy. Also conversely, a patient may have a high Epworth but not meet the STOP BANG, OSA50 or Berlin questionnaire requirements for a sleep study. Mr Scholefield suggests that more than half (64%) of patients who may have OSA may be missed due to these new restrictions. He suggests one solution of reducing the STOP BANG or OSA50 requirements, another may be to reduce or remove the ESS restriction.
It’s worth noting however that these restrictions do not apply to sleep specialist referrals. The Wesley Sleep Disorders Centre follows a physician led model of care, with a sleep physician routinely on site and a team of highly trained allied health and nursing staff ready to help meet the MBS requirements for our referring physicians. We have not found these restrictions as problematic when compared to some of the reported difficulties other service providers (non-physician led, or those without physician on site) are experiencing.
Original article can be found here: