Treating Sleep Disorders Can Wake Up Your Bottom Line

Article excerpt

New diagnostic technologies spell opportunities for improving patient health while bolstering revenue

Approximately 20 million American adults are thought to experience symptoms of sleep disorder, primarily obstructive sleep apnea (OSA). That prevalence of sleep problems, combined with a growing array of user-friendly devices for conducting home sleep tests, represents an opportunity for primary care physicians (PCPs) to add a new income stream and improve the quality of life for many of their patients. **

AT THE SAME TIME, experts and physicians with experience in the field warn that it's important to be aware of the pitfalls surrounding sleep testing and treatment. For example, training and licensing requirements for reading the results of sleep tests differ from state to state, and the coding and billing for sleep testing services can be tricky. And as with any ancillary service, you need to be sure you have a sufficiently large patient base to make it profitable.

Nonetheless, the trend-and opportunity-are apparent The prevalence of sleep disorders has been growing in recent years. According to a National Ambulatory Medical Care survey, physician office visits for sleep apnea rose from 2 million in 2000 to 3.7 million in 2009, an increase of 85%. The percentage increases in visits for insomnia and narcolepsy were even greater-137%, and 133%, respectively. In addition, a growing body of research links OSA to conditions such as hypertension, diabetes, depression, and obesity.

Although no specific data exists regarding the number of PCPs offering diagnosis and treatment for sleep disorders, internal medicine physicians account for about 9%, and family practice physicians about 2% of the in-laboratory diagnostic sleep studies billed to Medicare.


PCPs cite a variety of reasons for the decision to offer home sleep testing services to their patients. Jack Maxwell, DO, got interested in sleep disorders about 8 years ago, largely because of their link to chronic conditions such as hypertension, elevated cholesterol, and diabetes. His interest led him to become board-certified in sleep medicine, a relative rarity among family practitioners. Today his eight-provider practice in the Dallas, Texas suburb of Lewisville orders 80 to 100 sleep tests each year.

Because he is board-certified, Maxwell is qualified to interpret the results of home sleep tests, and thus able to bill for all three components of the testing process-test administration, interpretation, and CPAP initiation and management Consequently, he says, each patient treated for sleep disorders brings about $1,500 in revenue to the practice, compared with approximately $360 for other patients.

Some patients initially resist taking a sleep test or using CPAP, but Maxwell usually is able to persuade them. ? lot of it is salesmanship," he says. "You start talking about how the heart is damaged by long-term obstructive sleep apnea, and they get the picture pretty quickly. And I've been in practice long enough (26 years) that my patients trust me and will go in the direction I try to steer them."

For PCPs thinking of offering sleep disorder diagnosis and treatment as ancillary services, Maxwell advises including sleep-related questions as part of the screening process for routine medical care, partnering with a reputable sleep lab that employs licensed technicians, obtaining continuing medical education credits on sleep diagnosis and treatment, and learning the appropriate billing codes for polysomnograms and CPAP titrations.

Barrett Tilley, MD, began offering home sleep testing in his Fremont, California family practice in 2011. The practice already offered in-house testing for cardiac, lung, and a variety of other diseases and conditions, so when medical device manufacturer Mid-mark asked to use his practice as a test site for at-home sleep testing equipment, Tilley readily agreed.

Tilley sends test results to a board-certified sleep specialist for interpretation, but his practice is paid for the test administration component of the service and, where needed, for initiation and management of continuous positive airway pressure (CPAP) therapy. …