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SLEEP : An Update The Village Sleep Lab Accredited by the American Academy of Sleep Medicine

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SLEEP : An Update The Village Sleep Lab Accredited by the American Academy of Sleep Medicine Juan A. Albino, MD, FCCP Board Certified in Sleep Medicine – PowerPoint PPT presentation

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Title: SLEEP : An Update The Village Sleep Lab Accredited by the American Academy of Sleep Medicine


1
SLEEP An Update The Village Sleep
Lab Accredited by the American Academy of
Sleep Medicine
  • Juan A. Albino, MD, FCCP
  • Board Certified in Sleep Medicine
  • 751-4955 February, 2009

2
Thank You !!!
  • Phillip Ratliff, AWAKE Group
  • Lois Brach, AWAKE Group
  • Heather Ellington, Office Manager
  • Melyssa Rivera, Sleep Technologist
  • Jim Grazis, Sleep Technologist
  • Miyoshi Scott, Nurse
  • Lisa Grasso, Receptionist

3
Introduce Sleep Technologists
  • Melyssa Rivera
  • Jim Grazis
  • Anna Barker

4
Update on Sleep Apnea
  • Relationship with cardiovascular disease
  • Atypical presentation for sleep apnea
  • Positive pressure devices types, monitoring
  • Home studies for diagnosis insurance issues
  • Quality issues physicians, facilities,
    technicians, vendors

5
Heart Attacks Strokes
  • Studies on patients admitted to the hospital for
    heart attacks and strokes
  • After discharge had sleep studies
  • Heart attacks at least one third had sleep
    apnea
  • Strokes at least half had sleep apnea

6
Sleep Apnea Risk Factor
  • Sleep apnea risk factor like hypertension, high
    cholesterol, diabetes, smoking
  • Metabolic Syndrome obesity, borderline
    hypertension, diabetes, cholesterol
  • Suggestion add sleep apnea to the Metabolic
    Syndrome list

7
Presentation of Sleep Apnea
  • Snoring and Sleepiness and Apneas
  • Obesity and High blood pressure
  • Usually a combination of signs or symptoms
  • But sleep apnea chronic disease that slowly
    worsens over time
  • Beware women and over 65 do not have to be obese
    and often snore very little

8
Presentation of Sleep Apnea
  • First symptom or sign can be a heart attack or
    stroke
  • Day fatigue and exercise intolerance
  • Night restlessness and insomnia
  • Problem spouse no longer sleeps in the same room
  • Problem other illness has the same or similar
    symptoms

9
Positive Pressure Devices
  • CPAP Continuous Positive Airway Pressure one
    pressure over face, cheapest device for OSAS
  • AutoPAP or AutoCpap pressure varies depending on
    resistance, snoring,
  • BIPAP Respironics, Bilevel positive airway
    pressure, on inhalation higher pressure than on
    exhalation, more expensive
  • Bilevel Auto, varies pressures
  • Adaptive Servo Ventilation SV device used for
    some types of difficult central sleep apnea,
    varies pressure continuously
  • NIV Devices Noninvasive ventilation

10
Medicare CPAP Monitoring
  • Medicare mandating monitoring of PAP devices for
    sleep apnea begin Jan 2009
  • From day 31 to 90 of using CPAP there must be
    objective evidence of usage
  • Use over 4 hours, over 70 of nights
  • This is minimum usage necessary to see positive
    results, but the greater the compliance the
    greater the benefit

11
Home Studies for Sleep Apnea
  • Patient sent home with monitoring equipment to
    diagnose sleep apnea
  • Patient must be capable of understanding the
    equipment
  • Two visits to sleep facility put on and take off
  • Who interprets the studies, judges their quality,
    Medicare wants sleep specialists

12
Home Sleep Studies
  • Not intended for patients with heart disease,
    lung disease, neurological disease, little home
    support
  • Not intended for patients that may have central
    apnea, periodic leg movements, behavior disorders
  • Artifacts or recording problems negate many
    studies

13
Home Sleep Studies
  • Intended for young or middle aged obese males
    that snore loudly, with witnessed apneas, sleepy
    during day, and otherwise healthy
  • Intention of Medicare is to save money while not
    sacrificing quality care
  • But main intention of many companies is to sell
    equipment

14
Home Sleep Studies
  • Problem once diagnose sleep apnea at home, how
    to treat
  • Either bring to lab to titrate or do CPAP study,
    or give Auto-CPAP
  • But if bring to lab for sleep study then no
    benefit over split night study
  • If use Auto-CPAP then must guess at the mask and
    machine expensive

15
Medicare Advantage Plans HMOs Others
  • Health Maintenance Organizations very spotty
    record but push home studies
  • Medicare Part D in effect run like an HMO
  • Trying to come into Villages
  • Never been shown to improve health care
  • Never been shown to save money
  • Do make money for the administrators and owners
    who quickly move on

16
Medicare Advantage Plans HMOs Others
  • Patients often do not know what they are getting
    into
  • Told that this is Medicare but better dental
    and eye care added, besides meds
  • Ways of making money cut back services to
    patients, cut back on brand name drugs, cut back
    on doctor hospital reimbursements
  • Real Goal short term profits among profit making
    plans, some plans non-profit

17
Medicare Advantage Plans
  • Aggressively moving into the area
  • Much positive advertising and endorsements
  • Run by commercial insurance companies or business
    people
  • False claim save money, deliver better and more
    medical care (except dental, eye)
  • However these plans receive 12 more funds than
    regular Medicare, or over 10 billion/year

18
Quality Among Health Plans
  • National Committee for Quality Assurance (NCQA)
    www.ncqa.org monitors health care quality among
    health plans
  • NCQA accreditation of health plans
  • Types commercial, Medicare, Medicaid
  • NCQA with US News World Report ranking of best
    health plans 2008-2009

19
NCQA Accreditation and Rankingof Medicare
Health Plans in Florida
  • Number 7 Capital Health Plan
  • Number 22 Health First Health Plans
  • Number 55 AvMed Health Plans
  • Number 66 Health Options
  • Number 73 Universal Health Care
  • Number 75 Humana Medical Plan
  • Number 77 Freedom Health
  • Out of 78 ranked, accredited plans

20
Quality in Sleep MedicineCertification of
Physicians
  • American Board of Sleep Medicine www.absm.org
  • American Board of Internal Medicine www.abim.org
  • American Board of Family Medicine, or Pediatrics,
    or Psychiatry Neurology, or Otolaryngology

21
Accreditation of Sleep Centers
  • American Academy of Sleep Medicine
    www.sleepcenters.org or email accreditation
    _at_aasmnet.org
  • Process is time consuming and expensive
  • The Village Sleep Lab only accredited sleep
    center in the area
  • Medicare also lists The Joint Commission as
    acceptable for payment purposes

22
Vendors
  • DME Durable Medical Equipment suppliers
  • Medicare generally prohibits physicians from
    providing CPAP equipment
  • Physicians and health care facilities highly
    regulated, quality monitored
  • Vendors have escaped close regulation buyer
    beware, quality not monitored, room for
    improvement among many

23
Websites
  • The Village Sleep Lab villagesleeplab.com
  • National Sleep Foundation sleepfoundation.org
  • American Sleep Apnea Association sleepapnea.org
  • American Academy of Sleep Medicine
    sleepeducation.com
  • Restless Legs Syndrome Foundation rls.org
  • National Center on Sleep Disorders
    healthfinder.gov/orgs/HR2536.htm
  • Commercial MyResmed.com
  • Commercial Respironics.com
  • Commercial talkaboutsleep.com
  • Commercial ABCpap.com

24
Books
  • The Promise of Sleep by William Dement
  • Sleeping Well by Michael Thorpy
  • No More Sleepless Nights by Peter Hauri
  • A Womans Guide to Sleep Disorders by Meir
    H. Kryger
  • Restless Legs Syndrome by Robert H. Yoakum
  • Say Good Night to Insomnia by Gregg D. Jacobs
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