It’s a common problem. A sleep lab finds itself shorthanded during a busy week and ends up with a backlog of studies to be scored. Outsourcing these records is often an attractive solution for labs in this situation—but it can be a challenge to find a qualified tech nearby.

Enter SleepScore.com, an auction-based Web site designed to connect sleep labs with available scorers. The Web site, which was launched in May, allows scorers to bid on projects submitted by sleep labs, and labs to select the bids that best meet their criteria. SleepScore.com also provides the means to transfer sleep studies securely between the two parties.

“We don’t supply the service of scoring; we supply the service of matchmaking for scorers and labs,” says Julio Cacoilo, president and cofounder of the Woodbridge, Ontario-based company.

The Web-based company has been compared to matchmaking services, such as eHarmony.com, or eBay, which connects buyers and sellers. Cacoilo accepts these comparisons to a point, but notes that facilitating the transfer of medical records between labs and techs sets SleepScore.com apart.

“We are similar to auction sites in that services are bid on, but that is where the analogy ends for us,” he says. “Effectively, the services these sites provide end when a match is made.”

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HOW IT WORKS

Development for SleepScore.com commenced in January 2008, and the company received positive response from the Sleep 2008 show. “I’ve found that this community is very, very enthusiastic about what we’re doing, especially on the scoring side,” Cacoilo says.

In addition to individual techs looking to freelance on the side, scorers include scoring companies and even sleep labs themselves. “One of the things we learned from users—they want to be both buyers and sellers in our system,” says Cacoilo, who adds that some labs see this as a way to increase productivity during downtime.

After agreeing to SleepScore.com’s terms of use and privacy standards, scorers fill out a free profile page, where they can give as much detail about their background and experience as they like. The form also includes standard fields asking whether the tech is an RPSGT, how many years of experience they have, and whether the tech has liability insurance.

Techs also choose how much information they want to appear on their “public” profile. In some cases, techs do not even list their full name in the public view. The detailed version is available only to the labs they submit bids to.

“People have told us that they are going to be moonlighting, or they’re going to be doing work after hours from their home,” Cacoilo says. “And maybe they do; maybe they don’t want their current employer to know that. We heard that from a sufficient number of people so we felt it was important to create privacy for them.”

To submit a project for bidding, labs fill out the criteria for the project, such as the experience level of the tech, the language to score in, the software used, and the turnaround time desired. Labs can also add notes about the type of study, such as whether it is a pediatric record. No patient data is revealed to bidding scorers.

THE BOTTOM LINE

Despite the fact that scoring studies is the bread and butter of sleep labs everywhere, there’s no one-price-fits-all scenario. The cost depends on a variety of factors—the type of study, the turnaround time, and whether you score in-house or hire someone from the outside. Fees also vary widely depending on the outsourcing option you choose.

“The pricing is all over the map when it comes to outsourcing sleep studies,” says Chad Doucette, vice president of sales and marketing for Sleep Strategies Inc, a sleep scoring company based in Ottawa.

Most sleep labs rely on full-time employees to handle the bulk of the scoring load, with many also turning to an outside option for relief during busy times. Here are some of the available options, and what you can expect to pay:

  • In-house scoring. Staff wages and salaries will vary depending on the location of the lab and the experience of the tech, among other factors. You also have to budget for benefits and overtime. Suzy Alpers, RPSGT, a tech for Munson Sleep Disorder Center at Munson Medical Center, Traverse City, Mich, earns $50 per hour for scoring a study in the lab. Rather than paying overtime, her lab has arranged an after-hours “scoring service” for participating employees, who earn a flat fee of $50 per record. “Sometimes you get a record that takes only an hour, so it’s a great deal,” Alpers says. “And sometimes you have a longer one, so it balances out.”
  • Scoring companies. Labs large and small look to outsourcing companies such as Sleep Strategies for a variety of reasons. Sometimes, a lab needs regular help to avoid backlogs; other times, the lab just needs someone to fill in while a tech is on vacation. Pricing varies based on the lab’s needs. “Our prices start at around $69 for a scored sleep study, for a 72-hour turnaround time,” Doucette says. Sometimes, the size of the caseload is a factor—for example, multilocation centers that guarantee a certain number of records might be eligible for a discount. Scoring companies also often provide value-added services, such as quality assurance, technical assistance, and additional training for on-staff scorers. They can also act as a clinical resource.
  • Freelance/offshore scoring. For smaller project loads, some labs look to independent contractors—usually “moonlighting” scorers who work in a lab during the day and do freelance work after hours—or even offshore options in India or the Philippines. The prices vary widely in this category depending on the tech’s level of experience and whether the tech is registered. “We’ve seen it as low as $35 or $40,” says Doucette, adding that an experienced, registered freelancer can pull in between $45 and $85 per study.
  • Auction scoring. It’s still too early to tell what labs can expect to pay techs through auction scoring Web sites, such as SleepScore.com. Years of experience, quality ratings, and turnaround times all play a role in determining each bid. Alpers notes that auction scoring will likely be attractive to labs, as they do not have to pay employee benefits on top of the flat rate. “I might make only $50 hourly per record, but when you add my benefits package, the lab is paying me $67,” she says. “With SleepScore.com, the lab doesn’t have to do that.”

While Robert Lindsey, RPSGT, program director for the Tennessee Academy for Sleep Medicine, Hixson, Tenn, acknowledges that outsourcing is a viable option for short-term relief, he believes that training night techs to stage and score is the best long-term strategy.

—Ann H. Carlson

Scorers review the available projects and place bids on the ones that match their qualifications. They can monitor the status of the auction, see who else is bidding, and make additional bids, if desired. The lab can look at each bidder’s profile and even call or e-mail the tech directly about any details or concerns before making a choice.

“The winning bid for SleepScore.com is not defined based on price,” Cacoilo says. “The list for the lab is not actually sorted based on pricing. The lab is able to pick among anyone who has bid.”

Sleep labs upload the records to SleepScore.com’s secure server, where the selected scorers can download them to their own computers. (The Web site also utilizes 256-bit encryption throughout.) In keeping with patient privacy standards, such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the availability of patient records is restricted.

“The patient record is only transferred and available to a scorer once that specific scorer is selected as a winning bid,” Cacoilo says. “Prior to this, no scorer can view actual patient data. Only the selected scorer is allowed to ever view the actual patient record.”

MONEY MATTERS

Before putting a sleep study up for bid, the sleep lab funds an account with SleepScore.com. Once a tech is awarded the bid, the agreed fee is put in “escrow”—meaning neither party can lay claim to it until after the work is completed. Once the scoring is complete, the tech uploads the file for the sleep lab to access. The lab reviews the study and clicks “Approve,” if satisfied with the results. The tech is paid immediately into a PayPal account—less a 5% fee, which goes to SleepScore.com.

If the lab is dissatisfied, it has 7 days to resolve the problem, either through a revision process or through dispute resolution services. The money is held during that time until a resolution is reached.

“Communication between the two parties is logged and stored as part of the record being worked on,” Cacoilo says. “SleepScore.com will use this communication in trying to work out any disputes, if called upon to do so.”

Suzy Alpers, RPSGT, is a participating scorer who provided feedback to SleepScore.com during the development phase. “I think the method of payment is great,” she says. “It’s a safe way to do it.”

For scorers, knowing what to bid can be a challenge. Alpers is also a full-time technician for Munson Sleep Disorder Center at Munson Medical Center, Traverse City, Mich, where she earns $50 per hour for scoring records—and she plans to use that figure as a benchmark for her bids on SleepScore.com.

“You don’t want to undersell, you don’t want to oversell. It’s going to be a fine line,” Alpers says. “But you also can offer a service. If I can say, as soon as you accept me as your tech, I can have that record back to you within 3 hours, then they might be willing to pay a little bit more for that.”

While Alpers is generally enthusiastic about the auction model of the site, she worries that technicians who bid too low could reduce the competitive rate well below the standard hourly wage.

“That’s a concern because there’s nothing to mandate that,” she says.

Cacoilo says this is a common concern he hears from the sleep community—that the auction model will drive down scoring fees to an unreasonable low. “We certainly don’t want that to happen—we have no interest in doing that,” he says. “In fact, in our system, our revenue is predicated on a fair fee for the scorer.

“I think people are going to bid what they feel is appropriate for their services and for their level of experience,” he adds.

KNOW THE SCORER

Robert Lindsey, RPSGT, program director for the Tennessee Academy for Sleep Medicine, Hixson, Tenn, says that SleepScore.com could be a good fit for some sleep labs, especially smaller community hospitals (30 to 50 beds) in rural areas that plan to outsource their scoring but don’t have ready access to scorers.

“The company pairs prospective clients with people who are scoring, and that’s a good arrangement,” he says. “This is just a meeting ground—a place to start and check out prospective scorers. I think that labs that have that need would be open to it.”

Still, Lindsey recommends proceeding with care. “The only thing I’ve noticed about the site that would cause me concern as a hospital is that you don’t know really who’s doing your scoring and what their background is,” he says.

Lindsey recommends checking the prospective scorer’s references in addition to credentials. “I’d look for either lab director, physician, or medical director type references, just like you would when you interview anyone else for a job,” he says.

To put labs at ease about their qualifications, Alpers thinks that participating scorers should be encouraged to comply with the same interscorer reliability standards that the American Academy of Sleep Medicine mandates for accredited labs.

Even though SleepScore.com does not currently require this step for techs, Alpers recommends that scorers note interscorer reliability participation in their profiles and make their results available. “When a lab wants to say, how did they compare, well, this is their comparison,” she says.

Alpers also suggests that scorers provide as much detail about their qualifications as possible, including years of experience, turnaround time, and software used, as well as their comfort level with more difficult modalities, such as pediatrics—which might catch a lab’s attention.

“I think the more information you can give about what you’re able to do for them and your turnaround time, that will be key,” she says. “I think it will become clear who is professional at this and who isn’t.”

Through SleepScore.com, labs are given the contact information for scorers who submit bids on their projects. This allows them to work with the scorer directly to get the information they need before approving a bid. It is also a good opportunity for scorers to find out about the particular requirements of the lab and address any concerns. For example, Alpers says scorers have to make sure they can let labs know if a study is unreadable.

“We have to have a way to send that back to the lab to say this isn’t scorable,” she says.

OUTSOURCING OPTIONS

SleepScore.com provides a different model from a traditional scoring company, such as the Ottawa-based Sleep Strategies Inc, which employs and insures its own scorers. For Chad Doucette, vice president of sales and marketing for Sleep Strategies, the main concern about the auction model is that the lure of a low bid price might override quality considerations.

“You’ve got to place quality as the number one priority,” he says.

Sleep Strategies houses an internal quality assurance department to ensure that customers are satisfied with their results. The scorers are also educated and regularly updated on privacy standards, such as HIPAA. These are services that SleepScore.com—which does not employ the scorers—does not provide.

To enroll with SleepScore.com, however, all technicians must agree to the company’s terms of service for privacy and security, which cover privacy standards regarding patient data. “They must revalidate this standard prior to being permitted to bid on each study,” Cacoilo says. “It really is a reminder: Respect patient data.”

Doucette recommends that participating labs ensure that they work with scorers who are aware of privacy and liability concerns. “Make sure that they are educated on HIPAA and trained and updated on it,” he says. “Ensure that they fully understand the legal ramifications, and make certain that they’re protected.”

NEXT STEPS

As of this writing, SleepScore.com had just launched, and scorers and labs were beginning to submit their profiles to the site.

“We’re not going to be for everybody,” Cacoilo says. “We are, we believe, going to be for occasional use. So, if a lab needs someone to score while a tech is off on vacation, we would be a good choice for that.”

Cacoilo says that there are plenty of plans in the works for more developed features, such as allowing labs to bypass the auction process altogether and transfer files directly to their preferred scorers using the site’s uploader feature.

Currently, SleepScore.com is working with vendors such as Respironics and CompuMedix to provide a variety of sleep software solutions to participating scorers. Scorers would be able to use the software through SleepScore.com, which would cover the system setup fee.

“In an ideal world, we would be able to supply access to those systems free of charge to the scorers,” Cacoilo says. “We’re working really hard to make that happen.” The alternative would be a modest per-use fee.

Cacoilo says the company also plans to expand its reach by incorporating features such as a job board to help labs hire full-time techs directly. “SleepScore.com acknowledges our solution will not be for everyone or everyday, but we would like to do our part to improve matters for those in the industry,” he says. “We see this complementing what we do, and we hope to build community goodwill through this.”


Ann H. Carlson is a contributing writer for Sleep Review. She can be reached at sleepreviewmag@allied360.com.