Health Reform Hits Sleep: Speakers encourage specialists to get involved in initiatives

Minneapolis, Minn.—As in all of medicine, the future of sleep medicine will be defined in part by changes evolving under the health care reform law and by the need to slow the unsustainable cost of medical care, experts said here last month at a session at SLEEP 2011, the 25th Annual Meeting of the Associated Professional Sleep Societies,

Patrick Strollo, MD, medical director of the University of Pittsburgh Medical Center Sleep Medicine Center and past president of the American Academy of Sleep Medicine (AASM), outlined steps being taken by the academy to meet the challenges of the changing health care landscape. One step is a soon-to-be published white paper titled “The Future of Sleep Medicine Initiative.” The session was, in part, a forum to gather input from audience members on issues to be included in the white paper.

Sam Fleishman, MD, medical director at Cape Fear Valley Sleep Center and Behavioral Health in Fayetteville, N.C., and president-elect of AASM, gave a brief overview on the tools that the working group identified as providing value to the acute and chronic management of patients with sleep disorders. These tools include actigraphy, portable monitoring, transcutaneous C02 monitoring, nasal endoscopy, neurocognitive testing, ambulatory blood pressure monitoring, high density electroencephalography (EEG) analysis, phenotyping obstructive sleep apnea (OSA) and circadian rhythm testing.

Clete Kushida, MD, PhD, professor of psychiatry and behavioral science at the Sleep Center in Stanford Hospital and Clinics in Stanford, Calif., said an of c interest involves intermediate measures and biomarkers that provide some assessment of cardiovascular risk for OSA patients. Among the reasons to look at outcomes measures, he said, is to help provide information on the pathophysiological stresses relevant to sleep-disordered breathing as well as to look at the heterogeneity among patients who have sleep-disordered breathing and different cardiovascular profiles.

New Care Models

Michael Coppola, MD, associate clinical professor of medicine at Tufts University School of Medicine in Boston, talked about two structural changes happening in clinical practice. One is the patient-centered medical home (PCMH), a model of care provided by physician practices and designed to strengthen the physician/patient relationship by replacing episodic care based on illnesses and patient complaints with coordinated care. The second includes accountable care organizations (ACOs), which are defined by the Centers for Medicare and Medicaid Services as organizations of health care providers that agree to be accountable for quality, cost and overall care of Medicare beneficiaries.