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Home Sleep Testing and Impacts for Sleep Centers. Presented by Rebecca Boarts , RPSGT . January 2013 Sleep HealthCenters operating mostly in New England with some sites in Arizona abruptly closes all of its sleep centers. Over 150 employees and thousands of patients are affected immediately. - PowerPoint PPT Presentation
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Home Sleep Testing and
Impacts for Sleep Centers
Presented by Rebecca Boarts, RPSGT
An eye catching story. . .
January 2013 Sleep
HealthCenters operating mostly in New England with some sites in Arizona abruptly closes all of its sleep centers.
Over 150 employees and thousands of patients are affected immediately
Sadly many sleep centers started to react like this. . .more on that later
Home Sleep Testing (HST) is typically defined as “an unattended form of polysomnogrpahy”
Generally HST is performed in the patient home, but can be done in the sleep center or inpatient hospital room.
Generally done with less measuring channels than traditional polysomnogram.
What is Home Sleep Testing (HST)?
There are a variety of devices. Commonly known as a type I, II, III or IV.
What devices are used for HST?
Attended full polysomnogram recording with full staging of sleep EEG patterns.
Must include these channels
EEG EOG ECG Limb EMG Respiratory effort at chest and abdomen Airflow Pulse oximetry CPAP, CO2, PH, etc channels
Type I Devices
Examples of Type 1 devices
Sapphire PSG with DreamPort
by CleveMed
Grael on Portable Unit by Compumedics
Unattended polysomnogram , with a minimum of 7 channels.
Must include these channels
EOG ECG EMG Airflow Respiratory effort Oxygen saturation
Type 2 devices
Example of a Type II device
Somte system by Compumedics, no video recording or
technologist present, no EEG channels
Unattended polysomnogram , with a minimum of 4 channels
Must include these channels
respiratory effort airflow ECG or heartrate oxygen saturation
Type III devices
Examples of Type III Devices
Nomad by Nihon Kohden
ApneaLink Plus by Resmed
Unattended polysomnogram , with a minimum of 3 channels.
Must include these channels or ability to measure the following
Channels that allow direct calculation of an AHI or RDI as the result of measuring airflow or thoracoabdominal movement
Type IV devices
Example of a Type IV device
ApneaLink by Resmed, no effort measured,
only heartrate, airflow and pulse oximetry.
Cost Patient Convenience and Comfort Push from insurance payers and CMS
Why do Home Sleep Testing?
Cost is typically about 35-25% of a traditional in center polysomnogram
For example patient cash cost at SMHC is approx. $300 for HST vs. $1200 for an in center polysomnogram
Affects both patients and medical providers
Home Sleep Testing Costs
Homebound patients-elderly, transportation issues, medical issues
Inpatient sleep testing The “comfort of the patient’s own bed”
Home Sleep Testing Convenience
As part of the Affordable Care Act, more commonly known as “Obamacare” more patients will enter healthcare on a whole.
Public aide programs, i.e. Medicaid and Medicare will undergo cost cutting measures including sleep testing.
Affordable Care Act Impacts
As a result of the Affordable Care Act, many insurance companies are looking to cut costs to offset the expected losses.
Insurance Payer Impacts
Many Insurance Payers are now requiring prior authorization for sleep testing
Requirements may include that the pt have a co-morbid condition, i.e. hypertension, CHF, COPD
May require the physician to fill out a qualification form
Depending on the conditions of the form the patient may be required to proceed with HST, and traditional in center polysomnogram denied.
Insurance Payer Impacts
Example of Pre-Auth/Qualification Form
Less in lab testing completed Increase in or begin to offer HST
alternative Develop a “total sleep health” approach
to patient care Increase in physician “facetime” Challenge to change model of care and
train staff
What are the Impacts to Sleep Centers?
Estimates vary dramatically from up to 70% home based testing, to around 25% home based testing
Shift to more HST expected Choice of sleep center and/or insurance
payer to offer sleep center based HST vs. mail order
Less in Center Testing, More HST
Changed approach to providing more for patients than just a polysomnogram
Compliance with treatment Care managed by board certified sleep
physician Expected increase in clinic or office visits Follow up testing for patient as needed
What is “Total Sleep Health”?
Many sleep centers will have to adjust the types of services they offer
Compliance follow up HST PAP nap And the skills and schedules of their staff
Challenge of Model of Care Changes and Staff Training
Research supports that the effecacy of HST is adequate in making a positive diagnosis of OSA
However there are many conflicting studies about the outcomes and compliance of the patients months or years later
Is HST Comparable to In Center Testing?
Studies published in the American Journal of Clinical Sleep Medicine indicated that HST patients had higher rate of dropout from therapy
On the other hand studies performed by the University of Pittsburgh and VA of Pittsburgh found the outcomes and compliance were similar 3 months post study
HST Outcomes and Compliance
In the fall of 2012 Priority Health became the first high volume local insurance payer to mandate HST in some cases, mostly though hospital based sleep centers
Other insurance payers with high volume in Michigan; United, Blue Cross Blue Shield, Aetna have routed some testing to HST as well.
Several sleep centers including all hospital based programs in Grand Rapids offer HST to applicable patientsImpacts for Michigan
Sleep Centers
Executives and medical directors of Sleep HealthCenters did cite the changing sleep market as a factor
Other factors included the facilities lease contracts for sleep center space and lack of clear hospital base
The AASM has issued a statement to all Sleep HealthCenter patients offering advice and assistance to find a new source for sleep care
The Conclusion to Our Eye Catching Story?
The Moral of the Story. . .