Lower Reimbursement, Greater Regulation Threaten to Shutter Sleep Centers

HSTs can also be a source of referrals for PSG. Twenty-five percent of HSTs will yield negative results even though the patients are displaying symptoms of sleep apnea. This could be happening for a variety of reasons. Perhaps the patients only have apnea when sleeping on their backs, and during the test they slept on their sides. Perhaps undergoing the test made them so nervous they did not really sleep that night. These patients with “suspicious negatives” should undergo a full, in-lab PSG to find the source of their symptoms.

Dr. O’Brien recommends that centers also expand their pediatric studies, given the fact that HST is not permitted for children. Pre-operative sleep apnea testing can be done on pediatric tonsillectomy/adenoidectomy candidates and repeated post-operatively to confirm the surgery’s success.

The transformation of the sleep medicine marketplace, while drastic, is not the first sea change the health care industry has experienced. The advent of Medicare is a prime example of a revolutionary shift in the way medical professionals did business. Now, as then, those who survive are those who can adapt. “Don’t be a passenger on the bus,” said Dr. O’Brien. “Changes in sleep medicine are happening so fast, you have to change direction quickly to keep up, so drive your bus.”