Considerations to weigh and questions to ask when outsourcing aspects of your HST workflow. 

By Jane Kollmer

Direct-ship home sleep testing (HST) companies are in the business of helping sleep physicians and sleep labs reach more patients by taking care of the operational processes that can hamper workflows; however, their offerings vary. Some focus on shipping logistics, while others handle everything including patient payment, and a few vendors even offer multiple options. To fit your sleep business’s needs, consider the following when selecting an HST vendor. 

Should You Partner with a Direct-Ship HST Company?

Some sleep medicine businesses find themselves with a patient backlog that is difficult to manage when in-house resources, such as team members and the number of devices, are limited.

Rather than buying more capital equipment or trying to hire amid a staffing shortage, a direct-ship HST company can be a more cost-effective way to meet inventory and fulfillment needs. In-house clinical staff could then shift hours spent on home sleep testing logistics and support to more lucrative or specialized work.

Outsourcing can also allow for sleep disorders centers and private sleep practices to reach patients outside of their local area and quickly grow their business, which could create downstream revenue.

Common Direct-Ship HST Options

A direct-ship HST service can look differently based on how much of the process is outsourced. Three common scenarios are:

  1. The sleep lab/practice does the initial screening and orders the test, then the direct-ship company handles everything else, even the payment and interpretation in some cases.
  1. The sleep lab/practice handles most of it in-house, and the direct-ship company handles the logistics of mailing the device, getting the device back, and uploading the data.
  1. The sleep lab/practice is bypassed altogether and the patient completes an HST through a direct-to-consumer company using telemedicine.

For sleep businesses that choose to have some or all of the logistics handled by a company, considerations to weigh include devices, workflow, and payment.


Direct-ship companies may offer their own devices or use ones made by other companies. Physicians should first determine the clinical data most important to record. For example, some home sleep testing devices collect positional data, and others do not; some estimate sleep time, while others only capture recording time. Also worth considering is whether your preference is for disposable or reusable home sleep tests.

New home sleep tests are being released at a quick pace, so it’s important to lock up with a company that stays on top of the equipment coming down the pike, according to John Mathias, chief development officer of MedBridge Healthcare, a company that provides sleep laboratory management services and home sleep apnea testing to hospitals and physician practices. “You don’t want to have a device that may be outdated,” he says.

On the test process itself, consider these questions: How easy is the device for patients to use? How is the data downloaded from the device—will it need to be mailed back or is it uploaded to the cloud instantly?

“The easier that you make the devices and technology, the higher the success rate of those studies,” says Melih Alvo, senior director of commercial marketing for ZOLL Itamar, which offers the disposable WatchPAT for direct ship.

Another benefit of using direct-ship companies is they will often handle the patient education aspect. Many offer around-the-clock customer support. “If I’m a physician looking to outsource the service, I don’t want to get a call at two in the morning because of patients having trouble with their device,” says Mathias.

Alvo says, “The patient education piece is really important to complete a successful sleep study. WatchPAT services provide 1:1 patient education and offer 24/7 patient support.”

Keep in mind: some insurance carriers allow for reimbursements for specific devices only. Some devices are suitable for both children and adults, whereas others might be for adults only. So patient population and payor details should also be considered.


Software capability is another factor to consider. What should the software be able to do? At the minimum, the direct-ship company should provide reports that contain all of the clinical data required for an accurate diagnosis. 

For businesses that want help with scoring, analysis, and interpretation, some direct-ship companies will use their own nationwide network of board-certified sleep physicians for these functions.

In that case, it is helpful to know the average turnaround time from the date of the study order to interpreted results.

Then there is the matter of how to access the information. Do you want a turnkey solution or will you need access to raw data? Some companies build their own proprietary software platform, while others integrate with software that physicians already use, such as BioSerenity LabRetriever or Somnoware.

Physicians should consider how seamless they want the experience to be, as well as if any more sophisticated features would help better manage their business. For example, some vendors allow physicians to see the end-to-end process.

“We understand the individual needs of each sleep clinic. That’s why at ZOLL Itamar we offer customizable solutions from ship-to-patient to end-to-end turnkey solutions,” Alvo says.

“There’s a lot of complexity that goes into HST management,” says Jon Fedele, co-founder and board member of VirtuOx, which offers SaaS to enable sleep testing providers to start and scale home sleep apnea testing. “Having software with built-in, automated workflows, and dashboards like HSATpro gives them full visibility into where all their tests are in process.”


Some HST direct-ship companies can handle everything from verification and authorization of benefits to submitting and collecting insurance claims or cash payments. With other models, the ordering provider submits the professional fee.

Some may wonder if this presents a conflict because the sleep lab may lose out on payment for the HST. Because insurance companies have made it harder for physicians to turn a profit on HSTs, the concern is moot, according to some direct-ship vendors.

“With decreasing reimbursement rates, running an HST program is becoming very unsustainable,” Alvo says. “So instead of putting the effort in-house, you can outsource an external solution and free up your staff to focus on other billable procedures.”

Mathias says, “We’re not there to compete against the client. We are capable of taking on patients that the client doesn’t want to take, such as if they don’t have a certain insurance, there may be ways for us to supplement and support them.”

Direct-to-consumer companies may be viewed as competition, but many representatives of direct-ship service companies say they see their role as an extension of what sleep labs and sleep physicians do.

“We’re a menu of services company, so one size doesn’t fit all,” says Fedele. “We are looking at what a sleep practice or lab is currently doing, and then what they can outsource to address their pain points.”

Overall, by offering scalable and customizable solutions, direct-ship companies are helping sleep disorders centers and private sleep practices reduce their patient backlog, scale up their practice, and expand their patient reach. Each sleep business should vet vendors to find the one that best meets their needs.

Jane Kollmer is a freelance writer based in Chicago.

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