Dealing with a Paradigm Shift

Abstract

Recent changes in policies by insurance companies with respect to mandating home sleep apnea testing rather than in-laboratory studies have a large impact on the financial viability of clinical sleep centers. Coping with this disruptive change requires forward planning. First, it is important to be well positioned with respect to facilities so that these can be quickly downsized to control costs. There is also a need to develop, in advance, an accredited home sleep study program so that centers can respond to the rapidly changing environment. Following the change there is a need to control costs by rapidly downsizing the technology workforce. Technologists can be retrained for other essential roles. Centralizing the precertification process with knowledgeable, well-trained staff and a robust auditing process is an essential component. The approach taken at the University of Pennsylvania to this change is described as is how one can ensure continued financial viability of a comprehensive sleep center program in a major academic medical center.

Keywords: home sleep studies; polysomnography; sleep technology.

Figure 1. Number of laboratory sleep studies per month from July 2012 to June 2013 (top line, black) and from July 2013 to end of June 2014 (bottom line, red) and from July to December 2014 (bottom line, blue).

This red line illustrates the initial precipitous drop in laboratory sleep studies following the disruptive paradigm shift in September 2013. The number declined to about 50% of what we had been doing and has shown a slow recovery from the nadir in February 2014. The blue line indicates that laboratory studies are slowly increasing towards the pre-disruptive level (top black line).