The retirement haven of Lady Lake, Fla., boasts several golf courses and country clubs -- and apparently many residents who have restless sleep.
In three years, Medicare spending there for small bedside ventilators that help treat a serious sleep-related condition soared 324 percent, to $1.4 million last year.
Doctors in the central Florida town say their community is at the forefront of a national trend that has made the devices one of Medicare's fastest-growing medical equipment expenses, up 96 percent nationwide since 2004.
The booming sleep industry and an aging and increasingly obese population have prompted greater use of the devices, which treat sleep apnea, a condition that causes snoring, brief breathing lapses and tiredness.
"As we get older and as we get fatter, we have more sleep apnea," says Juan A. Albino, a pulmonologist and sleep specialist in Lady Lake.
Nationwide, the program for the elderly and disabled approved $571 million in payments for the devices, called continuous positive airway pressure (CPAP) machines last year, up from $291 million in 2004, Medicare data requested by USA TODAY show.
Spending could grow even faster under a new federal rule that makes it easier for patients to get the devices by testing for sleep apnea at home rather than in a sleep testing lab.
Medicare estimates that 2 to 4 percent of Americans have sleep apnea, which is linked to health problems such as coronary artery disease and strokes. About 10 percent of those over 65 and 20 percent of the obese suffer from the condition.
By city, Medicare data show:
Miami, Chicago and Houston led the nation in total government payments for CPAP devices.
Texas had six cities in the top 20 for CPAP spending; Florida had three.
Several cities, including Lady Lake, had spending jumps of more than 100% since 2004.
Focus on Sleep Apnea
CPAPs are the seventh-largest category of Medicare's $12.3 billion in spending on medical equipment. Spending on oxygen supplies, the largest category, rose 5.8 percent from 2004 to 2007. Spending on wheelchairs fell 17.6 percent after a fraud crackdown.
Sleep experts say the CPAP growth is not surprising, given the increased attention to sleep apnea.
About $2 billion worth of the devices are sold annually worldwide, with most sales in the USA, says Marketdata, a market research publication based in Tampa.
The machines cost $200 to $1,500 or more. Medicare generally pays 80 percent. Patients pay 20 percent.
Some experts warn there is a potential for unneeded prescriptions for CPAPs. "Are people getting treatment they don't need?" asks Fred Holt of the National Health Care Anti-Fraud Association, composed of health insurers and law enforcement groups.
"Not everyone with a diagnosis of sleep apnea needs CPAP," says Holt, an ear, nose and throat surgeon. "Weight loss, avoiding alcohol and sedatives at bedtime or changing sleep position could eliminate the problem for some."
For others, treatment involves sleeping with a mask connected to the CPAP machine, which blows air into the patient's nose, helping prevent obstruction to breathing.
Until this spring, Medicare would pay for CPAP machines only if a sleep center diagnosed patients with apnea. New rules say a diagnosis can be made with a test taken at home.
Opponents say home testing is less accurate. "To be adequately treated, you have to make sure patients are adequately diagnosed," says Mary Susan Esther, president of the American Academy of Sleep Medicine, a trade group representing sleep labs.
Proponents such as William Abraham, a sleep expert and chief of the division of cardiovascular medicine at Ohio State University, say the change makes it possible for more patients to get tested.
"By allowing home testing, perhaps Medicare is opening the floodgates," he says. Yet given the problems of untreated apnea, "it's not only the right thing to do, but may ultimately prove to be a cost savings."
Testing Centers Spread
Sleep testing centers, where patients stay overnight for observation, have boomed nationwide -- including in Lady Lake.
Across the USA, 1,475 centers are accredited by the sleep medicine academy, up from 857 in 2004. Sleep testing labs increased bed capacity nationwide by 13 percent in the past year and plan a 17 percent increase next year, says a July report by analyst Michael Matson of Wachovia Capital Markets.
"At one point, we had 16 beds" in sleep testing labs in the area, says Albino, whose center has four beds. "Sleep centers were seen as a profit-making venture."
Lady Lake and its surrounding community for the over-55 population, The Villages, has grown to more than 75,000 people in a few years. That's helped fuel the increase, Albino says.
Albino, who runs a sleep testing lab as part of his practice, says about four testing beds per 100,000 people is generally considered ideal. Lady Lake and its surrounding area have more than four times that number.
"This is a disease of the future," he says.