OSA testing as an additional service for my new practice

[ventana]

New practice up and running 

For the past 10 years it has been a PIA to get home sleep testing for patients.  Now wondering if this might be an opportunity for a cash practice.  
 

anyone offering these?

training for interpreting them?

worthwhile idea?

[iconic]

Aren’t there companies doing this? I don’t see how a clinician ordering would make a profit from this 

[rev ronin]

So, if you're going to do this, as I've considered, I'd want to do them for the cash-pay market--truck drivers with BMI 35+. Using a NightOwl or similar disposable device, you'd be able to turn around a study pretty quick. Only catch, though, is you don't want to pay an AASM-boarded sleep doc to interp the studies, so you can't charge insurance for them without that. Hence, go for the cash market.

[CornellSPA]

I have used NovaSOM/Bioserenity 3 day home sleep study (https://bioserenity.com/) fill out an online order, it gets shipped to the patients house, and you get a minute by minute interpretation and recommendations for home therapy.  Not making money on the service but its a great service to offer and patients love not having to go to the hospital, and you can start someone on Positive pressure therapy with a + STOP-BANG and + Novasom! No referrals needed!

[sas5814]

Not to hijack the thread but what is the criteria for home vs sleep lab studies? I have the choice to offer either and, of course, most people prefer home.

[CornellSPA]

Hi Scott:
Current guidelines per my understanding and UpToDate:

Overnight test at sleep center : 1. evaluation of patients with advanced cardiopulmonary disease (refractory hypertension, atrial fibrillation, nocturnal angina or dysrhythmias, congestive heart failure, stroke, and transient ischemic attacks), 2. who have a higher likelihood of central apneas, 3. and in patients suspected of having other comorbid sleep disorders.  In my experience this is a small percent of people running around w OSA!  Most do fine w the 3 day home test 

[rev ronin]

1 hour ago, CornellSPA said:

Hi Scott:
Current guidelines per my understanding and UpToDate:

Overnight test at sleep center : 1. evaluation of patients with advanced cardiopulmonary disease (refractory hypertension, atrial fibrillation, nocturnal angina or dysrhythmias, congestive heart failure, stroke, and transient ischemic attacks), 2. who have a higher likelihood of central apneas, 3. and in patients suspected of having other comorbid sleep disorders.  In my experience this is a small percent of people running around w OSA!  Most do fine w the 3 day home test 

4. Anyone for whom a home OSA test is equivocal or negative but you don't believe it.

5. Any time you're going to need an EEG to diagnose REM disorders, nighttime seizures, etc.

6. Any time you're going to need a follow-on MSLT to r/o narcolepsy.

[rev ronin]

3 hours ago, CornellSPA said:

I have used NovaSOM/Bioserenity 3 day home sleep study (https://bioserenity.com/) fill out an online order, it gets shipped to the patients house, and you get a minute by minute interpretation and recommendations for home therapy.  Not making money on the service but its a great service to offer and patients love not having to go to the hospital, and you can start someone on Positive pressure therapy with a + STOP-BANG and + Novasom! No referrals needed!

This is what I'm doing right now as well. If I were doing more frequent sleep studies (I probably refer for 1/month right now) for cash pay patients who don't NEED a board certified sleep doc to read it, I would look for something that didn't have the interp built in to the pricing.

[CornellSPA]

4 hours ago, rev ronin said:

4. Anyone for whom a home OSA test is equivocal or negative but you don't believe it.

5. Any time you're going to need an EEG to diagnose REM disorders, nighttime seizures, etc.

6. Any time you're going to need a follow-on MSLT to r/o narcolepsy.

Fantastic! Thanks for the additions!

[taotaox1]

Just as an add on here, home sleep studies have a 15-20% false negative rate and should never be used to rule out sleep apnea.  

Great for cheaper rule ins, but I weekly get positive in lab studies I order after a normal HSAT.

 

If medicare would let me rule sleep apnea in with an overnight oximetry I could save them a million dollars a year, no joke.

[rev ronin]

36 minutes ago, taotaox1 said:

Just as an add on here, home sleep studies have a 15-20% false negative rate and should never be used to rule out sleep apnea. 

There's a matter of practicality involved, of course.  I never trust a negative sleep study that I don't trust--tautological, I know, but I usually test for OSA to confirm what I think I know, and only occasionally do I test when I really don't have diagnostic certainty before the test. These last bits are often females with negative thyroid workups and otherwise unexplained fatigue, so I'm going along with the referral because it makes sense in the overall workup.

But yeah, if I don't believe a negative HST? I order an in-lab if the patient will tolerate it.

To your point about allowing overnight SpO2 to diagnose OSA? Why do we even bother running tests for people with STOP BANG 5+? The positive predictive value is sufficient that using the Medicare criteria of 4h 70% of the time should be a good enough measure of who actually has sleep apnea sufficient to prompt payment...