Sleep-Record Outsourcing No Yawning Matter – Chad Doucette

Looming Shortages of Registered Sleep Technologists Fuels a New Business Model that is Being Adopted by Sleep Labs Worldwide

Sleep disorders are like an epidemic sweeping across North America. According to Stanford University Center of Excellence for the Diagnosis and Treatment of Sleep Disorders, obstructive sleep apnea tops the list with an estimated 30 million Americans being afflicted. An estimated 12 million Americans twitch and kick their way through the night with restless legs syndrome and roughly 14 percent of Americans are afflicted with chronic insomnia. Nightmares, night terrors, sleepwalking, head banging and grinding teeth round out a partial list of growing sleep problems called parasomnias.

All this adds up to a sleepy if not cranky population. Fatigue is the most common problem that can lead to higher absenteeism, higher worker’s compensation, increased errors, diminished productivity and a host of costly workforce productivity issues. All this is putting tremendous pressure on sleep facilities. As the number of people dreaming of getting a good night’s sleep increases, more sleep facilities face mounting backlogs of patient’s sleep studies that need to be analyzed. Not surprisingly the pent-up demand for sleep tests is fueling a brand new red-hot trend in sleep medicine: Sleep-record outsourcing. An increasing number of leading hospitals and private sleep facilities are turning to this innovative business practice as a quick cure for staffing shortages, or as a long-term substitute for costly operational expenses. The benefits of record outsourcing are compelling:

  • Increased profitability
  • Heightened efficiency and productivity
  • Reduced overhead costs
  • Restored work/life balance for employees
  • Raise revenue by increasing the number of patients you can assess/treat
  • Improved patient services due to faster turnaround of completed sleep studies
  • Alleviates staff shortages during peak volume periods
  • Gain access to industry experts

In addition to these and other benefits, most sleep laboratories and hospitals will be motivated to incorporate sleep record outsourcing into their business practice as a proactive measure to deal with a looming staff crisis.

Easing Sleep Medicine’s Impending Staffing Shortage

In recent years, demand has outstripped the supply of registered sleep technologists. Lack of qualified staff has left many sleep laboratories working short staffed, many of them working excessive hours of overtime and being frequently called back to work after having completed their shift. Vacant positions are not filled or, in the case of many rural health districts, they are temporarily filled by laboratory aides or other department staff who cannot completely score patient’s studies. Shortages of technologist have also led to longer turn-around times for test results with staff feeling overwhelmed by the workload. In addition, a significant number of technologists will be eligible to retire in the next several years.

In response to this tsunami sized labor crisis, the numbers of scoring companies is expected to increase significantly over the next few years. Until recently the sleep industry has been slow to adopt outsourcing. However, the laws of supply and demand coupled with the proven benefits and cost effectiveness of outsourcing are widely expected to make this a normal if not preferred business practice to account for future growth and the onslaught of employee shortages.

“Who is Scoring My Sleep Studies?”

The sleep record scoring industry is a relatively new and innovative concept. Until recently, the only viable option available to sleep labs and hospitals was to use freelance technologists to score sleep studies on the side. Although this helped to ease some of the workload, a single technologist can only be stretched so far. Factor in concerns over HIPPA compliance and liability insurance coverage, and the single technologist option becomes a short term, stopgap measure at best. Over the past few years we have seen the emergence of some very reputable, value driven companies who place quality at the heart of their organization. As with any industry growth surge, we have seen some companies offering scoring services at very low rates with questionable quality controls and unregistered technologists performing the work. While the benefits of outsourcing are attractive, the key question that a facility should ask when thinking about outsourcing is “Who is scoring my sleep studies?”

Selecting a company that only uses registered technologists to manually score the entire study is a key factor for a successful outsourcing partnership. Scoring companies that do not hire registered technologists as scorers are not ensuring quality control or recognizing the importance of the RPSGT credentials. Cutting corners to save a few dollars by signing on companies whose studies are scored by unregistered technologists can place the quality and reputation of your facility in jeopardy. It is imperative that a standard be set in the outsourcing industry-one that ensures that only registered technologists perform the scoring of the entire sleep study. With the upcoming changes in AASM scoring criteria; this only solidifies the fact that hiring a reputable scoring company who keeps abreast with the changes in the industry and only uses registered technologists be mandatory.

Some sleep labs have considered an offshore option with the actual scoring being conducted in countries as far away as India. This method is tempting because of its cost effectiveness, but caution should be observed: it is critical to ensure these facilities are following the same internal standards established by your facility when it comes to HIPPA and patient security as well as the practice of hiring only registered technologists.

The concept of computer generated scoring has also emerged as a topic of debate. While this option is currently available, its adoption by the industry has not been widely accepted. Many sleep disorder laboratories have different protocols and procedures in conjunction with scoring to R&K standards and medical directors often have diverse perspectives regarding scoring of sleep studies. These factors can undermine the effectiveness of computer generated scoring and may make it difficult for this practice to find a solid home in the sleep medicine industry at this time. While we cannot discount advances in technology, the role of a registered sleep technologist cannot be easily replaced by a computer. As time progresses and continued advancement in technology occurs we may see automatic scoring becoming more of a reality that complements rather than replaces manual scoring of sleep studies.

Here is the bottom line: will your studies be scored by a registered technologist? If the answer is yes, then be sure to and ask for copies of the technologist’s certifications.

How to Make the Best Choice

Finding the right sleep record scoring company can be the difference between the success and failure of your sleep laboratory. How do you know which sleep scoring company is the best? One sure way is to assess the company’s industry reputation or ask for recommendations. Both are valid approaches and both mean you have to do your homework while establishing standards for your investigation to ensure you find the best company for the job.

Price is another consideration. Sleep laboratories, like the majority of healthcare departments, typically have limited budgets. However price needs to be considered in the context of quality, reliability and efficiency. Choosing the vendor with the cheapest service offering can be a shortsighted view that ultimately costs the sleep laboratory more money due to quality issues. More importantly, it can also damage the lab’s reputation.

Here is another important tip when selecting a scoring vendor: find out whether a team of registered technologists will change or will you have a select number specifically assigned to your account. The ability to select a scoring service that does not have a revolving number of technologists scoring on your account will allow your medical directors to become familiar with the scoring technologists while helping to ensure greater continuity and quality in the services provided. It takes time for new resources to ramp up and understand your expectations, so having a dedicated team is far more desirable.

Remember: when it comes to outsourcing, you are the customer. Be as diligent selecting a vendor as you want your referring physicians and patients to be with you. Your patients expect the best when it comes to the service you provide. Do not cut corners by aligning yourself with a company that does not put quality first. As the outsourcing industry continues to grow we can expect to see the emergence of industry standards that will mandate the use of registered technologists to score patient studies.

Outsourcing as a Long-Term Strategy

One thing is certain: sleep record scoring companies and the concept of outsourcing by sleep laboratories worldwide is here to stay. Staffing issues and the growing demand for sleep studies are forcing sleep laboratories worldwide to adopt this as the business model of choice. More sleep labs are “waking up” to the important benefits of outsourcing their studies – and in so doing they have been able to cut costs, free up internal resources and increase productivity. When hiring a scoring company, ensure you are working with qualified, registered technologists to ensure quality and to safeguard your own reputation. And finally, a reputable scoring company will act as an invaluable virtual extension of your team – and in so doing give you more reasons to sleep soundly knowing that your patients’ sleep studies are being analyzed by professional, knowledgeable resources. Pleasant dreams!

Chad Doucette
V.P. Sales and Marketing
Sleep Strategies Inc
Ottawa, Ontario

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