The Sleep Activist: Be active-Be engaged
An electronic newsletter for healthcare providers who work directly with sleep medicine patients, families and practitioners to coordinate and manage patient care, improve outcomes and patient self-management, educate patients and the community, and advocate for the importance of good sleep.
Welcome to the Fall/Winter 2015 Sleep Activist Newsletter! This newsletter is intended to serve as a forum for new developments regarding the advancement and recognition of clinical sleep health specialists. Our goal is to provide relevant and timely information to spark your interest, as well as to share sleep educator stories from the field.
Thanks to the many inquiries and recommendations from practicing sleep educators regarding appropriate billing codes, BRPT has been able to compile a Reimbursement Guide of billing codes and requirements for reimbursement of sleep services. The Reimbursement Guide is a free resource available here on the BRPT website and represents the collaborative efforts of sleep activists to move the profession forward, emphasizing the importance of sharing your experiences.
In this edition, we’re delighted to include a view from Dr. Barbara Phillips on the importance of the CCSH credential, a stellar CCSH story from T. “Massey” Arrington, RPSGT, CCSH, and some thoughts on how the role of the sleep professional can possibly be integrated into an ACO model. The next issue will discuss chronic care principles and its application to sleep health. Stay tuned!
The BRPT offered two CSE programs this past year, one in conjunction with the Focus Conference at Walt Disney World in May and the second at the BRPT Symposia held in Dallas this September. In addition, the BRPT held a CCSH board exam review course at the Symposia in Dallas. The advanced-level CCSH exam is now offered on-demand with immediate test results. For more information on the CCSH exam, please visit http://www.brpt.org/default.asp?contentID=300.
Sleep medicine and sleep health are changing, along with other transitions in healthcare. There are increasing mergers and acquisitions among insurers. Most recently Aetna and Humana, now Aetna and Anthem. Will these changes reduce competition or further limit services? Will they alter how healthcare is delivered? One thing is for sure, an increased focus on outcomes is certain. Yet, how this will impact sleep health care is uncertain. The Affordable Care Act (ACA) has significantly increased the numbers of individuals with health insurance. During informal inquiry at regional and national sleep meetings, it seems our field is busier than ever. Wait times for testing have grown and many sleep clinics are unable to find adequate staff to accommodate this uptick in patient flow. This means we have an important opportunity to set our course! Now it is up to clinical sleep educators and CCSH credential holders to continue the forward momentum by engaging professional and local communities, and enhancing awareness of the value of this professional specialty.
We want to hear from you! Let us know if you have spoken with your elected officials or worked with your administration to become part of an interdisciplinary team to address the spectrum of health issues associated with sleep disorders.
My friend and colleague Dr. Barbara Phillips, who was instrumental in creating the Clinical Sleep Educator (CSE) program, and who is a strong advocate for the CCSH credential and the expanded role of health care providers in promoting sleep awareness and follow on care, shares the following insights into this emerging role.
Why the Certification in Clinical Sleep Health (CCSH) Credential is More Valuable Than Ever Before
Barbara Phillips, MD, MSPH, FCCP
Congratulations for considering and pursuing the Certification in Clinical Sleep Health (CCSH) credential. My belief is that the CCSH credential will be increasingly valuable in years to come. The primary reason for this is that the number of board-certified sleep specialist physicians is plummeting. The number of doctors board-certified in sleep medicine probably peaked around 2013, after grandfathering of those already in the field before the implementation of the American Board of Medical Specialties examination in sleep medicine. Now, the only path to sleep board certification for physicians is successful completion of a sleep medicine fellowship and passing a certifying examination. In the 2013 sleep medicine fellowship match, 64 programs offered 129 positions to start in July 2013, but many of these positions went unfilled. So, the pipeline of newly-minted sleep board certified physicians is now about 100 a year. With retirement of the older cohort of grandfathered sleep specialist physicians and the very small pipeline of future board certified sleep specialists, the number of sleep specialist physicians is already dropping rapidly.
Second, obstructive sleep apnea (OSA) is prevalent and becoming more so. It is clear that OSA is increasing in the population because of aging, increasing rates of obesity, immigration, and changing diagnostic standards. Among US adults 30–70 years of age, approximately 13% of men and 6% of women have moderate to severe sleep apnea.
OSA is more prevalent than asthma.
Third, current insurance and industry reimbursement policies in the US are somewhat labor-intensive, requiring visits 30-90 days after CPAP initiation, then annually. That’s a lot of care. Ready access to diagnosis and management of OSA as a chronic disease and to meet documentation requirements fostered by third party payers is not possible solely with supply of sleep-board-certified physicians available. In fact, there are simply not enough doctors of any specialty to manage all the patients with sleep-disordered breathing. (Never mind other sleep conditions and problems!)
At this point, a look at what has happened with care for asthma, another prevalent and deadly disease, can be informative. Because asthma is recognized as a common, treatable and deadly disease, front-line care for asthma is largely delivered by generalists, many of whom are non-physicians. Indeed, many resources are available to assist clinicians of all disciplines in the management of asthma. This situation is strikingly similar to the situation with OSA. Because it is likely that many people with OSA will be forced to seek care from clinicians who are not boarded in Sleep Medicine in the very near future (simply because there are not enough board certified Sleep Specialists to go around), those clinicians (for example primary care physicians) will be faced with management of a complex condition with which they have very little practical training or experience. And this is where you come in. Management of OSA is one of the things that the CCSH does best! Going forward, I would predict that many patients with uncomplicated OSA will be primarily managed by generalist clinicians, including non-MDs, similar to the approach for other chronic medical conditions such as COPD or asthma. And those with the CCSH credential will be uniquely positioned to help fill that gap in needed care, improving the health and outcomes for patients with OSA. Go for it!