http://www.nytimes.com/2011/03/07/sports/basketball/07naps.html?_r=1&src=me&ref=sports
Some N.B.A. teams have received an education in the art of napping from Dr. Charles Czeisler, the director of the Division of Sleep Medicine at Harvard Medical School.
Czeisler said that players who got nine hours of sleep were more likely to react quicker, remember plays better and generally maintain their health more consistently.
---
still working on this
Monday, March 07, 2011
Tuesday, November 16, 2010
Reggie White Sleep Disorder Centers
The above is from the open h0use of the Tupelo branch of Reggie White Sleep Disorder Centers
Monday, November 01, 2010
How to Find a Medical Director for your Sleep Lab
I was recently contacted by a non-physician regarding how to find a medical director for a sleep lab she is opening. This sleep lab is not in my state (Mississippi). Here is my answer to her:
You can try advertising- either on the American Academy of Sleep Medicine Job Board, or in one of the sleep journals (either "Sleep" or "The Journal of Clincal Sleep Medicine"). You can also post the position at the Annual Sleep Meeting.
Another option is calling sleep physicians in your state (medical directors of existing sleep labs) and asking them if they are interested in being medical director of your sleep lab.
You can try advertising- either on the American Academy of Sleep Medicine Job Board, or in one of the sleep journals (either "Sleep" or "The Journal of Clincal Sleep Medicine"). You can also post the position at the Annual Sleep Meeting.
Another option is calling sleep physicians in your state (medical directors of existing sleep labs) and asking them if they are interested in being medical director of your sleep lab.
Sunday, June 27, 2010
Medicare qualifications for a Sleep Technician
Sleep studies performed on patients with medicare at an IDTF must be done by appropriately certified technicians. Below is the regulation (copied from an old reader comment):
CMS document 410.33 (2)(c) states "Nonphysician personnel. Any non-physician personnel used by the IDTF to perform tests must demonstrate the basic qualifications to perform the tests in question and have training and proficiency as evidenced by licensure or certification by the appropiate State health or education department. In the absence of a State licensing board, the technician must be certified by an appropiate national credentialing body. The IDTF must maintain documentation available for review that these requirements are met."
In most states there is no state licensure for sleep technicians.
It is fairly well accepted that the RPSGT and RRT credentials meet CMS requirements. It is unclear if RN (or LPN) is acceptable. The CPSGT credential is probably not sufficient, but I have not seen this officially.
If any readers have any clarification on this regulation, I would appreciate a comment.
Please note, this regulation applies only to IDTF's, not to hospital-associated sleep labs or to sleep labs organized as an extentsion to a physician practice.
CMS document 410.33 (2)(c) states "Nonphysician personnel. Any non-physician personnel used by the IDTF to perform tests must demonstrate the basic qualifications to perform the tests in question and have training and proficiency as evidenced by licensure or certification by the appropiate State health or education department. In the absence of a State licensing board, the technician must be certified by an appropiate national credentialing body. The IDTF must maintain documentation available for review that these requirements are met."
In most states there is no state licensure for sleep technicians.
It is fairly well accepted that the RPSGT and RRT credentials meet CMS requirements. It is unclear if RN (or LPN) is acceptable. The CPSGT credential is probably not sufficient, but I have not seen this officially.
If any readers have any clarification on this regulation, I would appreciate a comment.
Please note, this regulation applies only to IDTF's, not to hospital-associated sleep labs or to sleep labs organized as an extentsion to a physician practice.
Billing for Sleep Studies
I recently received an email asking about billing globally for sleep studies vs billing the professional and technical components separately. I came across this reference today:
http://www.arkmedicare.com/provider/viewarticle.aspx?articleid=8365
CPT 95805: Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness.
CPT 95810: Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist.
CPT 95811: Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist.
If a provider bills for the codes listed above without modifiers, the technical AND professional components are included in payment. If the professional component was not provided by a facility, the facility should bill the code using the TC modifier and the interpreting physician may bill with the -26 modifier. If the facility employs a provider who performs the professional component, then the facility may bill for the global code (without a modifier or the code with the -26 AND -TC modifiers).
http://www.arkmedicare.com/provider/viewarticle.aspx?articleid=8365
CPT 95805: Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness.
CPT 95810: Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist.
CPT 95811: Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist.
If a provider bills for the codes listed above without modifiers, the technical AND professional components are included in payment. If the professional component was not provided by a facility, the facility should bill the code using the TC modifier and the interpreting physician may bill with the -26 modifier. If the facility employs a provider who performs the professional component, then the facility may bill for the global code (without a modifier or the code with the -26 AND -TC modifiers).
prn MSLT's
A doctor asked on the AASM message board about prn (as needed) MSLT's. In his sleep medicine group, doctors sometimes order a nocturnal polysomnogram to evaluate for OSA, with instructions to the technicians to perform an MSLT if OSA is not found.
Should the practice of "prn" MSLT be abandoned? Is it a bad idea?
Here is my answer to the the doctor's question?
yes and yes.
If you think someone has narcolepsy/idiopathic hypersomnia it is reasonable to order a psg/MSLT with instructions that the MSLT be canceled if OSA is present (with the sleep physician being avaliable in the am to review the psg in borderline cases).
I think it is unreasonable and puts too much responsibility on the techs to have them decide whether an MSLT is neeed on large numbers of patients being evaluated for OSA.
Should the practice of "prn" MSLT be abandoned? Is it a bad idea?
Here is my answer to the the doctor's question?
yes and yes.
If you think someone has narcolepsy/idiopathic hypersomnia it is reasonable to order a psg/MSLT with instructions that the MSLT be canceled if OSA is present (with the sleep physician being avaliable in the am to review the psg in borderline cases).
I think it is unreasonable and puts too much responsibility on the techs to have them decide whether an MSLT is neeed on large numbers of patients being evaluated for OSA.
Saturday, April 24, 2010
CPT code 94660
94660 is the cpt code for CPAP initiation and management. This is a poorly understood code; there is always disagreement when someone asks about it at an American Academy of Sleep Medicine business seminar.
I used to bill this along with a level 3 (99213) evaluation and management code when I saw someone in the office, prescribed CPAP, and the patient's CPAP machine was set up on site. Usually on-site CPAP set up was done only for patients with Blue Cross/Blue Shield plans; it was done by a DME company that I had no ownership interest in.
I did find a mention of this code in an article in the American College of Chest Physicians. Although BC/BS payed for both codes (99213/94660) in Mississippi, apparently most insurers won't recognize both codes by the same provider on the same day: the 94660 code
is mutually exclusive of all E/M services during the same session by the same provider, according to the article (see the evaluation and management services section).
I do recommend that physicians not use the code 94660 with medicare/medicaid patients. If CPAP is being set up on site at your office (while the physician is present in the office complex), most insurers will not pay both codes at the same time. I do advise checking with the major insurers in your state to find out their policies for reimbursement of the 94660 code.
I used to bill this along with a level 3 (99213) evaluation and management code when I saw someone in the office, prescribed CPAP, and the patient's CPAP machine was set up on site. Usually on-site CPAP set up was done only for patients with Blue Cross/Blue Shield plans; it was done by a DME company that I had no ownership interest in.
I did find a mention of this code in an article in the American College of Chest Physicians. Although BC/BS payed for both codes (99213/94660) in Mississippi, apparently most insurers won't recognize both codes by the same provider on the same day: the 94660 code
is mutually exclusive of all E/M services during the same session by the same provider, according to the article (see the evaluation and management services section).
I do recommend that physicians not use the code 94660 with medicare/medicaid patients. If CPAP is being set up on site at your office (while the physician is present in the office complex), most insurers will not pay both codes at the same time. I do advise checking with the major insurers in your state to find out their policies for reimbursement of the 94660 code.
Saturday, April 10, 2010
Sleeping Pills and Obstructive sleep apnea
This question was recently posted on Medscape's Physician connect:
I am treating a man who has sleep apnea and uses CPAP. He is on Trileptal and Lamictal. Recent problems with insomnia has made me suggest Sonata. Are there any concerns about this? Contraindications?
This is my answer (which also includes a response to a few of the comments posted on Physician Connect):
If a person is on an effective cpap pressure, the adverse effects of hypnotics should be no different than in someone without osa. I have treated thousands of patients with osa; some of them require ambien/lunesta/Sonata. I occasionally use benzodiazepines, especially restoril. There have been several studies showing that moderate doses of alcohol do not effect cpap requirements (not that I recommend alcohol). I do agree with having the patient check with the sleep clinic, however. What the patient is calling "insomnia" may be a sign of problems with cpap and should be addressed by his sleep physician.
I am treating a man who has sleep apnea and uses CPAP. He is on Trileptal and Lamictal. Recent problems with insomnia has made me suggest Sonata. Are there any concerns about this? Contraindications?
This is my answer (which also includes a response to a few of the comments posted on Physician Connect):
If a person is on an effective cpap pressure, the adverse effects of hypnotics should be no different than in someone without osa. I have treated thousands of patients with osa; some of them require ambien/lunesta/Sonata. I occasionally use benzodiazepines, especially restoril. There have been several studies showing that moderate doses of alcohol do not effect cpap requirements (not that I recommend alcohol). I do agree with having the patient check with the sleep clinic, however. What the patient is calling "insomnia" may be a sign of problems with cpap and should be addressed by his sleep physician.
Monday, February 08, 2010
Man Dies during Sleep Study
(from the Atlanta Journal-Constitution, via Drudge) A 25 year old man recently died during a sleep study at Emory:
Harris, a medical assistant, entered the Emory sleep center on Jan. 22, said his mother....... By the next morning he was dead.
Emory said in a statement that he died of sudden cardiac arrest....
The article doesn't give many details and doesn't specify whether Mr. Harris was having a diagnostic study or a CPAP titration study.
Usually the most dangerous part of a sleep study is the drive to the sleep center.
Harris, a medical assistant, entered the Emory sleep center on Jan. 22, said his mother....... By the next morning he was dead.
Emory said in a statement that he died of sudden cardiac arrest....
The article doesn't give many details and doesn't specify whether Mr. Harris was having a diagnostic study or a CPAP titration study.
Usually the most dangerous part of a sleep study is the drive to the sleep center.
Tuesday, February 02, 2010
Sleep Apnea in the Wall Street Journal
The Wall Street Journal has an article today giving a good overview of obstructive sleep apnea:
http://online.wsj.com/article/SB10001424052748704107204575039101390202576.html?mod=WSJ_hp_editorsPicks
http://online.wsj.com/article/SB10001424052748704107204575039101390202576.html?mod=WSJ_hp_editorsPicks
Saturday, January 02, 2010
Problems with Pediatric Sleep Medicine
Pediatric sleep medicine is a difficult field. Pediatric sleep studies are hard to interpret and firm guidelines for diagnosing sleep apnea in children are lacking. The new scoring manual (The AASM Manual for the Scoring of Sleep and Associated Events) has brought some much needed uniformity to the scoring of respiratory events for children (and also adults), however.
One of the problems with this field is that good textbooks are lacking; there is nothing comparable to Kryger, Roth, and Dement's "Principles and Practice of Sleep Medicine", which focuses on adult sleep medicine.
I have a teenager with a slow-wave sleep parasomnia coming in next week. I unwrapped my copy of the 2nd edition of "A Clinical Guide to Pediatric Sleep" by Jodi A. Mindell, Phd, and Judith A. Ownes, MD, Phd. Both are luminaries in the field of pediatric sleep medicine. This clinical guide appears to primarily aimed at pediatricians and family practitioners. I found several errors when briefly skimming through this book. Most notably, in several places in the book tricyclic antidepressants are called "potent SWS suppressants", while in reality the tricyclics have variable effects on SWS (slow wave sleep) and may actually slightly increase SWS.
Several years ago when I read Sheldon, Ferber, and Kryger's "Principles and Practice of Pediatric Sleep Medicine", I found the chapters uneven in quality but am not able to recall enough to offer a detailed criticism in this post.
If anyone has come across a good pediatric sleep medicine textbook, please leave it's name in the comment section. thanks.
One of the problems with this field is that good textbooks are lacking; there is nothing comparable to Kryger, Roth, and Dement's "Principles and Practice of Sleep Medicine", which focuses on adult sleep medicine.
I have a teenager with a slow-wave sleep parasomnia coming in next week. I unwrapped my copy of the 2nd edition of "A Clinical Guide to Pediatric Sleep" by Jodi A. Mindell, Phd, and Judith A. Ownes, MD, Phd. Both are luminaries in the field of pediatric sleep medicine. This clinical guide appears to primarily aimed at pediatricians and family practitioners. I found several errors when briefly skimming through this book. Most notably, in several places in the book tricyclic antidepressants are called "potent SWS suppressants", while in reality the tricyclics have variable effects on SWS (slow wave sleep) and may actually slightly increase SWS.
Several years ago when I read Sheldon, Ferber, and Kryger's "Principles and Practice of Pediatric Sleep Medicine", I found the chapters uneven in quality but am not able to recall enough to offer a detailed criticism in this post.
If anyone has come across a good pediatric sleep medicine textbook, please leave it's name in the comment section. thanks.
Thursday, November 19, 2009
Sleep Center Accreditation
Sleep Review magazine's November issue is now available online.
It has an article about accreditation; I agree with every word of it:
http://www.sleepreviewmag.com/issues/articles/2009-11_02.asp
It has an article about accreditation; I agree with every word of it:
http://www.sleepreviewmag.com/issues/articles/2009-11_02.asp
Thursday, November 12, 2009
Medpedia
sleepdoctor is now included in Medpedia's News and Analysis Section.
Here is some more information about Medpedia:
http://www.medpedia.com/press
I encourage you to check out Medpedia:
http://www.medpedia.com/home
Here is the link for their Sleep Disorders Community:
http://www.medpedia.com/communities/148-Sleep-Disorders
Here is some more information about Medpedia:
http://www.medpedia.com/press
I encourage you to check out Medpedia:
http://www.medpedia.com/home
Here is the link for their Sleep Disorders Community:
http://www.medpedia.com/communities/148-Sleep-Disorders
Thursday, October 29, 2009
SIDS and Slow Wave Sleep
There's an interesting discussion about the possible relationship between SIDS and Slow Wave sleep here:
http://sleepdoctor.blogspot.com/2009/10/osa-sleep-deprivation-and-alcohol.html
http://sleepdoctor.blogspot.com/2009/10/osa-sleep-deprivation-and-alcohol.html
Sunday, October 11, 2009
OSA, Sleep Deprivation, and Alcohol
Once a person has one sleep problem, they are less able to cope with another one. For example, persons with obstructive sleep apnea are less able to cope with the demands of shift work.
A. Vakulin and colleagues pubished "Effects of Alcohol and Sleep Restriction on Simulated Driving Performance in Untreated Patients With Obstructive Sleep Apnea" in this months issue of Annals of Internal Medicine. This study compared patients with untreated OSA and matched controls on a driving simulator. The study found that "Patients with OSA are more vulnerable than healthy persons to the effects of alcohol consumption and sleep restriction on various driving performance variables. "
A. Vakulin and colleagues pubished "Effects of Alcohol and Sleep Restriction on Simulated Driving Performance in Untreated Patients With Obstructive Sleep Apnea" in this months issue of Annals of Internal Medicine. This study compared patients with untreated OSA and matched controls on a driving simulator. The study found that "Patients with OSA are more vulnerable than healthy persons to the effects of alcohol consumption and sleep restriction on various driving performance variables. "
Sunday, October 04, 2009
Alcohol, Sleep, and Pregnancy
Below is a small excerpt from the article "Sleep disorders associated with alcohol use and abuse," available at Medlink Neurology:
Alcohol use should be avoided during pregnancy. The potential adverse physical and neurocognitive effects, including fetal alcohol syndrome, of maternal alcohol consumption on the developing fetus have been extensively reviewed (Wattendorf and Muenke M 2005). Recent research has clarified the effects of prenatal alcohol consumption on the child’s postnatal sleep. Maternal prenatal consumption of alcohol results in infant postnatal sleep fragmentation as well as the suppression of spontaneous movements during sleep, at 6 to 8 weeks of age (Troese et al 2008). In utero alcohol exposure results in altered neonatal autonomic control during sleep, possibly increasing the risk of Sudden Infant Death Syndrome (Fifer et al 2009).
References:
Wattendorf DJ, Muenke M. Fetal alcohol spectrum disorders. Am Fam Physician 2005;72(2):279-82, 285.
Troese M, Fukumizu M, Sallinen BJ, Gilles AA, Wellman JD, Paul JA, Brown ER, Hayes MJ. Sleep fragmentation and evidence for sleep debt in alcohol-exposed infants. Early Hum Dev 2008;84(9):577-85.
Fifer WP, Fingers ST, Youngman M, Gomez-Gribben E, Myers MM. Effects of alcohol and smoking during pregnancy on infant autonomic control. Dev Psychobiol 2009;51(3):234-42.
Alcohol use should be avoided during pregnancy. The potential adverse physical and neurocognitive effects, including fetal alcohol syndrome, of maternal alcohol consumption on the developing fetus have been extensively reviewed (Wattendorf and Muenke M 2005). Recent research has clarified the effects of prenatal alcohol consumption on the child’s postnatal sleep. Maternal prenatal consumption of alcohol results in infant postnatal sleep fragmentation as well as the suppression of spontaneous movements during sleep, at 6 to 8 weeks of age (Troese et al 2008). In utero alcohol exposure results in altered neonatal autonomic control during sleep, possibly increasing the risk of Sudden Infant Death Syndrome (Fifer et al 2009).
References:
Wattendorf DJ, Muenke M. Fetal alcohol spectrum disorders. Am Fam Physician 2005;72(2):279-82, 285.
Troese M, Fukumizu M, Sallinen BJ, Gilles AA, Wellman JD, Paul JA, Brown ER, Hayes MJ. Sleep fragmentation and evidence for sleep debt in alcohol-exposed infants. Early Hum Dev 2008;84(9):577-85.
Fifer WP, Fingers ST, Youngman M, Gomez-Gribben E, Myers MM. Effects of alcohol and smoking during pregnancy on infant autonomic control. Dev Psychobiol 2009;51(3):234-42.
Tuesday, September 29, 2009
It's been a while...
It's been over a month since I even looked at the comments on this site. Things have been busy at the sleep centers I work at; I am currently reading about 200 sleep studies a month. Also I have been writing an article for Sleep Review , as well as working with some physicians, researchers, and statisticians analyzing data from the Jackson Heart Study.
I do expect things to slow down a little for the rest of the year. My association with Hancock Medical Center is ending. Dr. Brenda Hines is working with me and seeing patients at Somnus Sleep Clinic. She has been a big help.
I do plan on posting more for the rest of the year. I will be reading the comments over the next several days. Thanks for reading sleepdoctor!
I do expect things to slow down a little for the rest of the year. My association with Hancock Medical Center is ending. Dr. Brenda Hines is working with me and seeing patients at Somnus Sleep Clinic. She has been a big help.
I do plan on posting more for the rest of the year. I will be reading the comments over the next several days. Thanks for reading sleepdoctor!
Saturday, July 25, 2009
Sleep Disorders Linked to Aviation Accidents
Sleep disorders, especially obstructive sleep apnea, are common among truck drivers. USAToday reports that the National Transportation Safety Board is investigating fatigue as a cause of accidents in the aviation industry:
While efforts to reduce fatigue in aviation have focused on pilots' schedules, federal accident investigators say pilots and other vehicle operators also need to be screened for sleep disorders. The National Transportation Safety Board (NTSB) is preparing to take a stand on the issue within weeks, according to testimony at a recent public meeting.
Sunday, June 21, 2009
Preparing for a Sleep Fellowship
A reader asks:
I'm a current first year (almost second year) internal medicine resident and I'm currently looking into the possibility of sleep medicine as a fellowship choice. Everything I learn about sleep medicine sounds great and I find myself very interested in the subject of sleep and sleep disorders, so I think it would be a great choice for me. I was wondering if you could give me any pointers about the process of applying to sleep fellowships, doing rotations, building my application and so forth. Also, what sort of career options are there for internists who do a fellowship in sleep med? Any good textbooks that you would recommend me starting with?
I previously posted a little about sleep fellowships here.
As an internal medicine resident, elective rotations that would be helpful include pulmonary, psychiatry, neurology, ENT, and sleep medicine (if available). The ENT rotation should include a large outpatient component in which you learn the head and neck exam as well as gain expertise in evaluating and treating sinus problems.
Sleep medicine fellowships are becoming very competitive, especially for those who have only completed a general Internal Medicine residency. Research, especially something related to sleep, would be helpful in getting accepted to a sleep fellowship.
Join the American Academy of Sleep Medicine
Books that I recommend include Sleep Medicine Pearls by Richard Berry, MD. Unfortunately, the current (2002) edition obviously doesn't include the new AASM sleep scoring/staging guidelines.
I also recommend getting The AASM Manual for the Scoring of Sleep and Associated Events.
Principles and Practice of Sleep Medicine is the standard textbook. I would recommend waiting until the new (5th) edition comes out in several months.
Journals you should be reading include Sleep and The Journal of Clinical Sleep Medicine, which are availabe with membership in the American Academy of Sleep Medicine. Non-members can read older articles free on-line.
I have posted regarding career options previously in this blog, and will do so again later this month.
I'm a current first year (almost second year) internal medicine resident and I'm currently looking into the possibility of sleep medicine as a fellowship choice. Everything I learn about sleep medicine sounds great and I find myself very interested in the subject of sleep and sleep disorders, so I think it would be a great choice for me. I was wondering if you could give me any pointers about the process of applying to sleep fellowships, doing rotations, building my application and so forth. Also, what sort of career options are there for internists who do a fellowship in sleep med? Any good textbooks that you would recommend me starting with?
I previously posted a little about sleep fellowships here.
As an internal medicine resident, elective rotations that would be helpful include pulmonary, psychiatry, neurology, ENT, and sleep medicine (if available). The ENT rotation should include a large outpatient component in which you learn the head and neck exam as well as gain expertise in evaluating and treating sinus problems.
Sleep medicine fellowships are becoming very competitive, especially for those who have only completed a general Internal Medicine residency. Research, especially something related to sleep, would be helpful in getting accepted to a sleep fellowship.
Join the American Academy of Sleep Medicine
Books that I recommend include Sleep Medicine Pearls by Richard Berry, MD. Unfortunately, the current (2002) edition obviously doesn't include the new AASM sleep scoring/staging guidelines.
I also recommend getting The AASM Manual for the Scoring of Sleep and Associated Events.
Principles and Practice of Sleep Medicine is the standard textbook. I would recommend waiting until the new (5th) edition comes out in several months.
Journals you should be reading include Sleep and The Journal of Clinical Sleep Medicine, which are availabe with membership in the American Academy of Sleep Medicine. Non-members can read older articles free on-line.
I have posted regarding career options previously in this blog, and will do so again later this month.
Monday, June 08, 2009
The Future of Sleep Technicians
I'm in Seattle at the annual Sleep meeting. I'm about to go to the opening session and hear a talk by Dr. Howard Roffwarg on REM sleep.
I have a few minutes before the session starts and will take the time to answer a question from a few weeks ago:
A reader (TimRPSGT) asks:
I have a couple of questions about the future of sleep medicine. First, how do you see the role of the sleep technologist changing over the coming years? I'm also curious bout the new approval for home studies with type 2 and 3 devices. Is there a possible business opportunity here for RPSGT's to do home studies as independent contractors for doctors?
I don't see the role of sleep technologists changing much in sleep centers over the coming years. One trend that has been developing over the last several years is the movement towards certification of sleep technicians. Within several years all new sleep technicians will be required to complete commnunity/vocational college training program to work at an accredited sleep center. I am not totally up to date on RPSGT/AASM sleep tech requirements, but I believe that A-STEP was designed as a transitional program and will be phased out in several years in favor of community/vocational college-based programs (see this page for further details:
http://www.aasmnet.org/astep/RPSGTExam.aspx). On the job training of technicians is on the way out.
I don't see the role of sleep technicians changing much; they will still perform in-lab sleep studies as well as frequently perform administrative duties within the sleep lab.
Type 2 studies (full sleep study done at a patient's home)- I don't think many of this type of study will be done.
Type 3 studies (4-6 channel portable)- Reimbursement for these portable studies remain low.
The 2 ways to make a profit from type 3 studies is 1) use it as a loss leader for a sleep center or 2) do the study very cheaply. As margins at sleep centers are continually squeezed, I don't think it will be possible to portable studies as a loss leader much longer. As far as doing type 3 studies cheaply, the way to do this is to give the patient very little support. The patient picks up the device or has it shipped to them, and is given little instruction from a live person (and if there is any, it is from a secretary rather than a technician).
Neither of the 2 ways is appealing to me; I generally don't do home studies. There are business opportunities out there for entrepeneurial RPSGT's to work with doctors and provide home sleep studies., but I wouldn't recommend it.
I have a few minutes before the session starts and will take the time to answer a question from a few weeks ago:
A reader (TimRPSGT) asks:
I have a couple of questions about the future of sleep medicine. First, how do you see the role of the sleep technologist changing over the coming years? I'm also curious bout the new approval for home studies with type 2 and 3 devices. Is there a possible business opportunity here for RPSGT's to do home studies as independent contractors for doctors?
I don't see the role of sleep technologists changing much in sleep centers over the coming years. One trend that has been developing over the last several years is the movement towards certification of sleep technicians. Within several years all new sleep technicians will be required to complete commnunity/vocational college training program to work at an accredited sleep center. I am not totally up to date on RPSGT/AASM sleep tech requirements, but I believe that A-STEP was designed as a transitional program and will be phased out in several years in favor of community/vocational college-based programs (see this page for further details:
http://www.aasmnet.org/astep/RPSGTExam.aspx). On the job training of technicians is on the way out.
I don't see the role of sleep technicians changing much; they will still perform in-lab sleep studies as well as frequently perform administrative duties within the sleep lab.
Type 2 studies (full sleep study done at a patient's home)- I don't think many of this type of study will be done.
Type 3 studies (4-6 channel portable)- Reimbursement for these portable studies remain low.
The 2 ways to make a profit from type 3 studies is 1) use it as a loss leader for a sleep center or 2) do the study very cheaply. As margins at sleep centers are continually squeezed, I don't think it will be possible to portable studies as a loss leader much longer. As far as doing type 3 studies cheaply, the way to do this is to give the patient very little support. The patient picks up the device or has it shipped to them, and is given little instruction from a live person (and if there is any, it is from a secretary rather than a technician).
Neither of the 2 ways is appealing to me; I generally don't do home studies. There are business opportunities out there for entrepeneurial RPSGT's to work with doctors and provide home sleep studies., but I wouldn't recommend it.
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