Home Sleep Testing and Impacts for Sleep Centers - PowerPoint Presentation

Slide1

Home Sleep Testing and Impacts for Sleep Centers

Presented by Rebecca

Boarts

, RPSGT Slide2

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 immediatelySlide3

Sadly many sleep centers started to react like this. . .more on that laterSlide4

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)?Slide5

There are a variety of devices.Commonly known as a type I, II, III or IV.

What devices are used for HST?Slide6

Attended full

polysomnogram

recording with full staging of sleep EEG patterns.

Must include these channelsEEGEOG

ECG

Limb EMG

Respiratory effort at chest and abdomen

Airflow

Pulse

oximetry

CPAP, CO2, PH,

etc channels

Type I DevicesSlide7

Examples of Type 1 devices

Sapphire PSG with

DreamPort

by

CleveMed

Grael

on Portable Unit by

CompumedicsSlide8

Unattended polysomnogram

,

with a minimum of 7 channels

.Must include these channels EOGECGEMG

Airflow

Respiratory effort

Oxygen saturation

Type 2 devicesSlide9

Example of a Type II device

Somte

system by

Compumedics

, no video recording or technologist present, no EEG channelsSlide10

Unattended polysomnogram

, with

a minimum of 4

channelsMust include these channels respiratory effort airflow

ECG or

heartrate

oxygen

saturation

Type III devices Slide11

Examples of Type III Devices

Nomad by Nihon

Kohden

ApneaLink

Plus by

ResmedSlide12

Unattended polysomnogram

, with a minimum

of 3 channels.

Must include these channels or ability to measure the followingChannels that allow direct calculation of an AHI or RDI as the result of measuring airflow or

thoracoabdominal

movement

Type IV devicesSlide13

Example of a Type IV device

ApneaLink

by

Resmed

, no effort measured, only

heartrate

, airflow and pulse

oximetry

.Slide14

Cost Patient Convenience and Comfort

Push from insurance payers and CMS

Why do Home Sleep Testing?Slide15

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 CostsSlide16

Homebound patients-elderly, transportation issues, medical issuesInpatient sleep testing

The “comfort of the patient’s own bed”

Home Sleep Testing ConvenienceSlide17

As part of the Affordable Care Act, more commonly known as “Obamacare

” more patients will enter healthcare on a whole.

P

ublic aide programs, i.e. Medicaid and Medicare will undergo cost cutting measures including sleep testing.

Affordable Care Act ImpactsSlide18

As a result of the Affordable Care Act, many insurance companies are looking to cut costs to offset the expected losses.

Insurance Payer ImpactsSlide19

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, COPDMay 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 ImpactsSlide20

Example of Pre-

Auth

/Qualification FormSlide21

Less in lab testing completedIncrease 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?Slide22

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 HSTSlide23

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 visitsFollow up testing for patient as needed

What is “Total Sleep Health”?Slide24

Many sleep centers will have to adjust the types of services they offer

Compliance follow up

HST

PAP napAnd the skills and schedules of their staff

Challenge of Model of Care Changes and Staff TrainingSlide25

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?Slide26

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 Slide27

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 patients

Impacts for Michigan Sleep CentersSlide28

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?Slide29

The Moral of the Story. .

.