The Only Thing Certain is Change – Doucette

The Only Thing Certain is Change

New AASM Scoring Criteria is just the tip of the iceberg in an ever-evolving industry

The entire sleep medicine industry is on the verge of dramatic upheaval, and the consequences will be far-reaching for those that cannot keep pace. Sleep laboratories that want to be in business – successfully – five years from now, have to alter their approach. While demand for sleep studies is at an all time high, the industry is beginning to see some major shifts in regulation, delivery of scoring services and certification that will impact sleep laboratories around the globe. Failure to embrace these changes and develop corresponding business practices will render many sleep laboratories irrelevant in an aggressively competitive landscape. Will you be ready?

New AASM Scoring Rules

Effective July 1, 2008 the new AASM scoring guidelines take effect. Sleep laboratories across the country are scrambling to ensure that both their sleep software and technologists are compliant and new processes are established. Preoccupied with day-to-day operations, many sleep facilities have put the implementation of these new rules on the back burner. What they might not realize is that in order to maintain or receive accreditation by the ASSM, they have to be compliant.

One strategy to understand and employ these new guidelines in time is to consult with outside vendors for assistance. Fortunately several peripheral companies saw the change coming and have developed integration and preparation courses to ease sleep laboratories through the new guidelines transition. Most often, this means assistance in educating technologists as well as making internal policies and procedures compliant.

The most comprehensive of these training providers will include blended programs including a mix of onsite education, online training sessions, audit reviews of scored sleep studies, inter-rater reliability and one-on-one consulting. This is the ideal scenario to ensure the guidelines are addressed from all angles of your business.

The benefit is clear: maintain your focus on business operations while external specialists help you with due diligence. To keep costs in check, look for companies that offer the training as a value added service. Sleep scoring companies, for example, have become one of the most popular providers for these preparation courses. As the AASM deadline fast approaches, the additional resources will come in handy, but the industry changes do not end there.

Getting Comfortable with New At-Home Rules

Ambulatory testing, or at-home sleep study as it is also known, is currently a subject of heated debate and controversy. Like it or not, trends indicate that home monitoring is quickly becoming an integral part of sleep medicine.

With even the American Academy of Sleep Medicine (AASM) stating that a home sleep test can be used to detect obstructive sleep apnea (OSA) in select adults, the phenomenon is only growing. Sleep laboratories who once considered home testing a threat will now have to contemplate the integration of this new approved form of testing into their laboratory service offerings.

A second stream of testing will move patients waiting to be screened for their potential disorder to the front of the line sooner. This is refreshing news for some patients, but the standard overnight sleep study will still remain the ultimate test for diagnosing most sleep disorders. At this point, only patients with OSA are approved candidates for ambulatory testing. A controlled laboratory setting with high tech equipment remains the ideal environment for dealing with a population with other co-morbidities or other sleep disorders.

Aside from the convenience portable testing provides, OSA patients diagnosed with portable monitoring may qualify for CMS CPAP coverage. However, the reimbursement that testing service providers will receive is fractional compared to what they have experienced in the past. The new policy marks a significant departure from current CMS coverage for CPAP and diagnosis of OSA. For this reason, many sleep labs are shunning the notion. But to avoid losing patients to less qualified service providers, sleep labs should consider providing ambulatory testing as an additional service. By incorporating this new offering into their own facilities, they assure the preservation of testing integrity is performed by having the sleep technologists manually score the ambulatory sleep studies as recommended by the AASM.

Earning Points with Sleep Scoring Services

Sleep laboratories today must be prepared to meet current requirements, while at the same time remaining adaptable to future demands. That is where third party specialists come in. Industry professionals predict that the tremendous changes in sleep medicine healthcare will be eclipsed by advancements and new and more efficient ways of working internally, as well as with external service providers. With the onslaught of shortages of registered technologists, hospitals and private sleep facilities are incorporating sleep scoring services into their business practices. What was once seen as a stopgap remedy has now flourished into a common practice by sleep labs to maintain efficiency levels and ensure that patients are diagnosed and treated as soon as possible for their sleep disorders.

Sleep scoring services in the sleep medicine healthcare sector have come a long way. Highly specialized and quality- driven companies are changing the landscape of the industry. As the sleep scoring industry evolves into a key strategic tool, leading hospitals and sleep laboratories demand greater flexibility and better integration from their scoring vendors without compromising quality.

While cost savings are still the principal motivator for hiring a scoring service, quality is becoming the main battleground between one scoring service provider and another. Companies offering rock bottom scoring services are being met with quality control issues and consistency concerns related to their accuracy of scoring. Sleep laboratories should be leery of outsourcing companies that offer scoring services using non-registered technologists. In this case, they get around current regulations by reserving registered technologists for simple report reviews instead of performing the entire analysis. The integrity of the entire industry rests on its ability to uphold the importance of RPSGT credentials and favor patient studies that are manually scored by a trained and experienced registered tech rather than uncertified imposters. Any company that does not use this criteria in their business practice risks failing to give their patients accurate results.

As more and more sleep labs introduce sleep scoring services to help improve quality, efficiency, and patient care while lowering costs and creating new opportunities, it is imperative that the industry work to establish standards. Establish them and maintain them too.

Certification Now has A Life Span

In the healthcare industry decisions must be based on the best interests of the patients. It is in the best interests of the patients suffering from sleep disorders and in the care of RPSGTs to uphold core competencies and define skill.

To ensure this, the BRPT has recently implemented a recertification policy that requires all RPSGTs to recertify every 5 years in order to maintain their credential. Up until now, once technologists were certified, it was permanent – that is no longer the case. Not surprisingly, this new policy has been met with some resistance. Some in the industry speculate that this will result in a shortage of technologists as temporarily out-of-practice RPSGTs fail to renew their registration. While this restructured certification program will no doubt be an obstacle to some, it should be seen as an industry enhancement as we elevate RPSGT criteria and push for a gold standard.

The industry as a whole saw a need to better educate both patients, physicians and administrators on the importance of a proper sleep diagnosis and the role of RPSGTs. It can only get better from here – right?

Awareness, Agility and Excellence

Smart sleep laboratories will act assertively now to build relationships with service providers and secure partners that uphold the integrity of a business based on the fastest growing disorder in North America. Third party alliances could come in the form of scoring services, placement agencies and educational and training companies. Sleep labs who have heard the wake-up call will look for new opportunities, then streamline their businesses into a few key areas of focus. Remaining constantly aware of change and understanding your ideal position in a fluctuating market landscape is the best way to secure longevity.

With the severe pressure sleep labs are currently undergoing, improving quality of care, reducing wait times and remaining compliant with new industry standards will not happen on its own. Securing competent, experienced, educated and dedicated employees and technologists is strategically essential. Without these individuals, sleep laboratories will not be able to fulfill their missions.

Stocking your team up with highly competent employees is not as easy as it sounds. Sleep laboratories in most regions face increasingly severe shortages of qualified, willing and expensive sleep technologists. Applicants are not as readily available as they used to be and competition for registered sleep technologists is intensifying.

As a result, a frightening proportion of sleep labs lack employees with basic qualifications to perform the work necessary. For years, this mediocrity has permeated the industry, becoming so status quo that we accept it. The temporary pain of adjusting to new regulations and embracing new certification intervals could be a blessing in disguise.

The shortage of registered technologists will intensify in the years ahead as more jobs openings become available. But increased excellence from a more regulated and organized industry might attract new blood as well. In the meantime, sleep labs will face aggressive competition for registered and experienced techs from competitors in the industry who want to attract high-performing employees.

Qualified registered technologists can write their own tickets. They can work wherever they want, choose the kind of work they will do and decide for themselves how they will go about doing it. The custom of staying at one sleep laboratory for decades is gone and sleep laboratories are seeing increasing technologist turnover as the industry continues to grow and become more competitive.

With workers in the driver’s seat, savvy employers are changing their relationship with employees. Those sleep labs that do not pay very careful attention to what is happening today could easily find themselves with an insufficient labor force before they know what has hit them. Aligning your sleep facility with industry-recognized vendors who can assist in keeping your sleep facility stable is paramount.

Gross margin and profitability are two business objectives that almost all sleep laboratories have. But in order for sleep laboratories to accomplish these goals they need to build a lean and agile operational system which may include reorganizing internal resources and management process and establishing partnerships with industry experts while trying to determine the most productive use of employee resources. The industry is changing and so must you.

Chad Doucette
V.P. Sales & Marketing
Sleep Strategies Inc.

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