Sleep labs can now rely on revenue from scoring and interpretation.
Sleep laboratories and sleep physicians have long complained that it’s difficult to make money with home sleep testing (HST). The key to making it work could well be to expand revenue-producing services associated with HST.
Hani Kayyali, president of Cleveland Medical Devices (CleveMed), believes the idea can work if sleep specialists can successfully reach out and offer interpreting and/or scoring services to ordering clinicians. Those healthcare providers could be primary care physicians (PCPs), nurse practitioners (NP), dentists, cardiologists, and many more providers who typically care for those patients all the time, are interested in adding sleep evaluation to their practice but desperately need sleep specialist’s oversight and disease management expertise.
“Some sleep labs are facing considerable challenges due to losing their referrals to mail-order Home Sleep Testing, worsening no-show rates, or high cost structure and PSG-based workflow that cannot be re-factored easily to handle the lower reimbursement HST,” explains Kayyali from his Ohio-based office, “but our web portal technology allows those local sleep labs and / or sleep physicians to expand the reach of their sleep services and to make up for some of the lost revenues by scoring and interpreting sleep studies — even though patient screening and home sleep testing are initiated from a different site.”
“Once screened for OSA by the healthcare provider, patients go home with the SleepView monitor and self-administer it that same night”, says Kayyali, “next day, practice staff can upload the data to our web portal, which is then forwarded to RPSGT and sleep physician for scoring and interpretation. Guided by the sleep doctor’s diagnostic report, which includes therapy recommendations, the ordering provider would then initiate treatment or send the patient to the sleep lab for more extensive workup if needed. The whole point is that sleep labs now have a tool that can easily deliver their professional services to other practitioners. In addition to study reads, sleep specialists can offer other valuable clinical expertise such as training providers on screening, care pathways, and others”.
While CleveMed has its own network of sleep physicians licensed in all 50 states, Kayyali maintains that the recently-added web portal flexibility allows any practice to seamlessly assign sleep studies to qualified sleep scorers or physicians of their choosing, which can strengthen local relationships and enhance the continuity of patient care. “Our overall web portal adoption is seeing double digit growth every month” adds Sarah Weimer, director of Sleep Products at CleveMed. “Many healthcare providers want to adopt HST. They see sleep apnea patients all the time and hear of their symptoms before anyone else. These providers frequently request local sleep specialists to provide oversight, which can be easily done with our newest web portal release.”
According to Kayyali, making it convenient for healthcare providers to initiate care for sleep disordered breathing will not only generate revenue for both the ordering physicians and sleep specialists, but more importantly has immediate patient care benefits as it can speed diagnosis and treatment. For example, research done by CleveMed showed that the entire process from the time the patient first discusses symptoms with their primary care provider to diagnosis was 3.1 days.
Within the Realm of Primary Care Settings?
The healthcare system has always recognized the need to improve delivery of care of chronic diseases like hypertension, diabetes, and asthma, and many believe that the recent focus on care coordination between primary care and specialists will help achieve that goal. “Sleep apnea is now being bundled with those high cost chronic diseases and I believe that the various healthcare stakeholders can peacefully coexist with the CleveMed model”, Kayyali says. “As long as sleep physicians maintain oversight on scoring, interpretation and follow-up, sleep labs could accept a Provider Practice-based HST Model.”, he says.
Kayyali says clinical guidelines for portable monitoring do not preclude non-sleep specialists from screening and initiating the sleep test. “Practice staff like nurse practitioners and physician assistants has been trusted for decades to care for complex diseases like asthma and diabetes. So, there is no reason to doubt their ability to handle OSA including administering sleepiness questionnaires, training on monitor sensor hookup, and others as evidenced by research findings,” says Kayyali. “Furthermore, due to the strong on-going patient-doctor relationship and the face-to-face training in the office, it is expected that compliance with HST and eventually treatment will likely be higher than any other HST model. However, as said before, identifying at-risk patients and dispensing monitors is only one piece of the puzzle and must always be complemented with sleep specialty oversight whether it is for baseline diagnosis or follow-up management to ensure proper continuity of care. That is why the clinical guidelines correctly require that studies be scored by registered sleep technologists and read by board certified sleep physicians “, he says.
While not all insurance carriers reimburse for Provider Practice-based HST, healthcare in general and third party payers in specific are demanding improved delivery of care while avoiding traditional in-lab costs, “Our technologies allow various stakeholders to be engaged, who together offer a more efficient solution to the patient without compromising care or burdening any one entity with all the work”, says Kayyali.
Ultimately, Kayyali says, “Our long-term success in controlling the spiraling human and financial costs of chronic diseases, including sleep apnea, must incorporate a pivotal role for primary care practitioners including the new and emerging workforce; nurse practitioners and physician assistants. The sooner we incorporate their skills in sleep apnea care pathways the better off we will all be”.
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