Despite being a young subspecialty, sleep medicine has already seen its share of disruptive changes. In the past several years alone, we have seen home sleep testing enter new markets, the aggregation of healthcare services by large health systems, and the passage of the Affordable Care Act. While we have weathered a lot, the storm of change is not over. There will be some good news in 2016: Sleep center patient volumes are expected to increase. But I expect some bad news too: Payor reimbursements are also expected to continue along their current trajectory. That is to say that sleep medicine reimbursements, especially in specific service categories and in certain markets, will continue their decline next year.
So to thrive in 2016 (and beyond), sleep medicine professionals should implement innovative strategies to lower costs without compromising patient care. That may not be as impossible as it sounds. A silver lining to some of the strategies I suggest below may be the resulting positive consequences beyond cost-effectiveness. Savvy strategies can also benefit a sleep center and its patients in other ways, such as by improving efficiency, workflow, and reach.
Speak to the masses. Group clinics are an area of emerging interest to sleep medicine, and there is evidence suggesting they work as well as individual appointments for patients, while saving both time and cost to the practitioner. Good options to start with include routine instructional visits, for example, explaining to obstructive sleep apnea suspects how to use a home sleep test (HST) or an APAP device. Group cognitive behavioral therapy for insomnia (CBT-I) should also be explored. This has the added advantage of being a solution to the dearth of CBT-I therapists in the United States. In any kind of group session, prerecorded video instruction and physician assistants or nurse practitioners may also offer additional cost savings in a viable way.
Grow your referral base, strategically. Many sleep centers have grown their referral bases in recent years, a necessity to increase patient volume and counteract lower reimbursement rates of HST versus in-lab studies. Growing patient volume for HST studies is a great strategy, but sleep centers should also look to patient populations who are strong candidates for in-lab studies, such as patients with comorbidities that contraindicate HST or young children. Catering to these populations poses challenges (for example, the need to hire or train staff with specific skillsets) but it may better position your center for financial success.
Automate tasks via software. Selecting the right computer programs for your center can save time and money in the long run. In the latest version of our sleep medicine software guide, we have compiled 8 software solutions and let each company explain how it can make sleep professionals’ lives easier. While this guide features prominent device-agnostic options, many CPAP and other device manufacturers have their own software programs with cost-saving features as well. Judicious use of software can accomplish everything from increasing patient compliance to scoring sleep tests more quickly to reducing paper waste.
These are simply a few suggestions, based on my interactions with sleep medicine professionals nationwide. But the best ideas come from practicing professionals in the trenches. Send me an e-mail with the cost-saving strategies you have implemented. I would love to hear from you.
Sree Roy is editor of Sleep Review.