Coming of Age

One of the industry’s leading sleep scoring companies - Sleep Strategies - walks us through the evolution of a once new industry now beginning to mature.

Third party scoring services have gained tremendous momentum over the last few years. Hospitals and private sleep facilities are turning to this business solution as a means to combat the shortage of registered technologists, manage their growth and streamline their businesses. But within its popularity, remain many unanswered questions about what the sleep scoring industry is really all about.

To help decode the lesser-known aspects of sleep scoring, Sleep Diagnosis and Therapy’s editor sat down with President & CEO Natalie Morin of Sleep Strategies - one of the industry’s first and largest leading sleep scoring companies. The result is a candid and informative glimpse at a maturing industry through the eyes of a woman who helped conceive it.

Birth of an Industry

Asleep study typically involves the completion of an over-night patient study performed in-house followed by data analysis. The most time-consuming portion of the sleep study process is the scoring of patient data. It takes up precious time from staff and is seen as one of the first things that can cause a backlog of studies, resulting in unnecessary delays in diagnosis and patient treatment.

Third party, or outsourced, scoring services provide an interesting solution. They act as a virtual extension of a sleep laboratory in their focused ability to complete all scoring tasks. In turn, they become trusted partners that can help hospitals and laboratories during busy periods, through vacation time or in between staff changeovers. Their key benefits include quick turnaround times - ranging from same day service to 72 hours - and specialized insight into the scoring process. “Sleep scoring companies are just like an IT or transcription service. We are a business solution that can help heighten productivity and improve efficiency, while placing patient care first and foremost,” explains Morin.

In the past, solutions to scoring overflow were scarce. A physician’s best bet in times of backlog was to seek out a technologist looking to earn some extra cash on the side. These part time freelancers, however, posed legal problems as they raised liability and accountability concerns. Other issues included reliability, lack of quality control measures and volume limitations.

Freelancers still exist today, performing an important function for smaller scale labs. But with the rise of regulated and specialized scoring services, the quality gap between the two outsourcing options remains an important factor for close consideration. Even so, seemingly established sleep scorers pose concerns as well. With increased demand and popularity comes a parade of fly-by-nights who claim legitimacy simply because they have a website.

Finding an Identity

“There is no doubt, third party sleep record scoring has been met with some hesitation,” admits Morin. Many physicians previously questioned the quality measures of this practice and believe that it was impossible to replicate the standards of an in-house scoring technologist externally - and that is if the technologist is even registered. Their concerns were justified. A handful of companies using under-trained, unregistered technologists to score sleep studies at discounted rates risk tarnishing the industry. Then there is the issue of offshore sleep scoring business. Cultural consistency, quality concerns, employee turnover, RPSGT certification and communication (language) barriers are just some of the hotly debated topics when the question of offshore outsourcing arises.

There is no denying that offshore sleep record outsourcing of patient studies may be an effective business tool. But being lured in by a firm that prioritizes price over patient care is a trap that even the most well-intentioned laboratories are not immune to.

Morin offers some suggestions to establish who is worth working with. “To assess the integrity and qualifications of a sleep scorer, there are a few main areas to examine. Ask about insurance - they should have their own coverage. Inquire about quality control procedures - ideally, the organization should have an entire department devoted to this. Make sure technologists are registered and find out whether they have HIPAA policies and analysis licenses.”

The reality is that a reputable scoring service is meant to complement in-house scoring - not detract from it. An industry- recognized scoring service will in most respects improve your quality standards and assure your patients that turn around times are the fastest possible.

From a business point of view, there’s no denying the value that sleep record outsourcing is a cost-effective solution to giving your business more bandwidth. “As the industry moves through the adoption phase and into acceptance, we can see how suppliers are changing their approach to make use of us as well,” Morin explains in reference to peripheral businesses that are catching on to the importance of scoring services. “Take sleep software companies for example. They seek us out for valuable feedback we can offer on both sides of the scoring process. We have unique insight into the reactions of our customers concerning new products, versions and computer bugs. Also, we can usually inform these software firms of potential future expansions so their sales teams can begin the sales process of providing new equipment.”

Hesitation is giving way to a where have you been all my life attitude. What was once thought of as a stop-gap measure is now a crucial business practice that competitive sleep labs see as a necessity.

Playing the Field

The market shift from doubt to devotion has been largely helped along by the educational initiatives of companies like Sleep Strategies. “We have taught the market what to expect - like quality and turn around times,” says Morin. According to her, patients should not have to wait weeks for results of a sleep study. Sleep Strategies goes on record saying that anything longer than three business days for the scoring of a sleep study is a sign that things are not working efficiently.

Morin explains why she works so hard to set exceedingly high standards in an industry still yet to establish a norm. “Our success is based on our clients’ success. Our goal is to not only meet but exceed our market expectations by delivering the highest level of scoring, on-time, every time.”

We ask her if that explains her company’s achievements and leadership position. “Well that is part of it. We saw an opportunity to both start an industry and define it. Much of that definition includes trust. Trust established through confidence in a technologist’s scoring abilities and pricing that makes us a viable addition to a hospital or sleep laboratory’s supplier list.”

Quality is a pillar of the organization. Sleep Strategies was the first to devote an entire department to quality assurance including self-imposed audit reviews on all scoring technologists, inter-rater testing and continuing education on industry changes and standards. Their inability to settle for less has earned Sleep Strategies partnerships with some of the industry’s largest hospitals, universities, research organizations and pharmaceutical companies. They employ the largest number of registered sleep technologists and have grown over 1500% in the last seven years.

“We are constantly looking for ways to increase quality standards and develop programs for our clients. Most recently, we developed an on-line webinar program to educate our customers on the new AASM scoring guidelines. This was just another value added service to ensure our clients are receiving the most up-to-date services,” remarks Morin.

Sleep Strategies goes further to offer complete scoring services including full PSG, pediatrics, ambulatory and MSLT performed by only registered technologists as well as physician interpretation. Sleep Strategies also offers a comprehensive sleep medicine training course - to assist sleep labs in hiring new staff or for continuing education for their current techs. These educational initiatives will come in handy as the industry braces for the next evolution.

Into the Future

Morin and other industry experts see several evolutions on the horizon. Sleep research is a promising area for the application of sleep scoring outsourcing. What pharmaceutical companies and university research departments like in firms such as Sleep Strategies is that they can act as a centralized scoring headquarters. They can act as non-biased professionals and perform the scoring of the research studies following various protocols. Morin describes that her own research division has grown significantly over the years as the industry of sleep medicine continues to make advancements through technology and medicine.

“At-home sleep studies will also be a huge factor in the next few years. Our ambulatory scoring division is growing leaps and bounds - more than we could have anticipated,” she explains. The new ruling to modify the NCD (National Coverage Determination) by CMS to include coverage for CPAP devices in beneficiaries who have been diagnosed with obstructive sleep apnea (OSA) using home sleep testing, has opened the doors for many organizations and sleep labs to expand their service offerings to ambulatory sleep studies. This in turn will factor in to the growth of the sleep scoring services industry as brick and mortar study space becomes less of an obstacle to expert care.

To promote consistency, the AASM has released scoring guidelines around the recertification of registered technologists. These new measures increase market confidence and forecast significant continual growth as witnessed over the course of the last few years. Unfortunately, while the demand for sleep studies is still at an all time high, the number of qualified and registered sleep technologists are still low. While the AASM provides guidelines around certification, it still is not mandatory.

This is why Sleep Strategy’s mission is for hospitals and sleep labs to improve quality stands by incorporating audit review by outside companies. Scoring companies are not biased bodies that can objectively evaluate the scoring of sleep studies to ensure they are meeting industry standards. They hope that this quality practice will be embraced by the industry to ensure the patient care come first.

According to Morin, “It is imperative that we, as an industry, uphold the importance of the RPSGT credentials to ensure that patients are receiving the highest quality of care. I have witnessed many sleep facilities using automated scoring without a technologist reviewing the results - which is appalling. While Sleep Strategies manually scores, automated scoring can be helpful, but the technology needs to be tested, perfected and always overseen by a registered technologist.”

Self-Reflection

Pioneering an industry was the first step for Sleep Strategies, establishing standards, expectations and understanding was the second. “Sleep Strategies has an aggressive marketing strategy to not only promote our service offerings but to educate the sleep medicine industry. I want hospitals and sleep facilities of all sizes to realize that there are alternatives and options to the way they run their facility. Sleep scoring services have evolved and can be a highly effective business practice but only if we maintain market trust,” explains the company’s President.

Becoming a leader was not easy for the company. Breaking down the misconceptions of the scoring services industry and educating the sleep medicine community on its benefits has taken years.

Seven years ago, sleep record scoring services was a business practice seldom used by sleep laboratories. Today, Sleep Strategies has managed to build a brand and business concept that today is becoming the preferred method for the scoring of patients’ sleep studies. It would appear that Sleep Strategies is somewhat of a mentor and a solution to an industry that is about to experience some serious growing pains.

Natalie Morin, RPSGT, is the president and chief executive officer of Sleep Strategies, a leading provider of sleep scoring and consulting services for hospitals and sleep laboratories across North America. For more information on Sleep Strategies, visit www.sleepstrategies.com .

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