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Cardiologists' Frequently Asked Questions
I have no training in sleep medicine, how can I help my patients?
Won't I cause a problem among the pulmonary and internal medicine community in my area if I get involved in this?
Are there any self referral or Stark related problems?
How can we bill for services when our physicians are not actually performing the service or supervising the technicians?
How will we be viewed supplying CPAP out of our office?
I know nothing about CPAP, how will I deal with a patient's problems once they are on therapy?
My office staff can't take on another project, how can I make this work?
What is our economic incentive?
How will I be able to screen patients for this disorder?
I have been seeing these patients for years and have never asked them about this condition before, how will they react to a new line of questioning?
I have a question that is not addressed here, how can I get more information?
I have questions regarding Medicare...
I have no training in sleep medicine, how can I help my patients?
The Healthy Heart Sleep Program™ (HHSP) provides cardiology practices with a fully operational sleep lab. Major features and benefits are:
- Comprehensive and ongoing training in sleep medicine as it specifically applies to the cardiovascular population. This includes:
- An understanding of Sleep Disordered Breathing diagnosis and the fundamental rules of polysomnographic analysis as well as ambulatory testing options
- An understanding of normal sleep and sleep disorders from the cardiologist's perspective
- An understanding of polysomnographic interpretation and treatment options
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Won't I cause a problem among the pulmonary and internal medicine community in my area if I get involved in this?
The reality is that since you will be diagnosing and treating your own patients you will not be taking any business away from existing sleep labs. PCP's have expressed strong optimism about the program because they know that treating a cardiology patient's sleep disordered breathing will help them manage that same patient's hypertension.
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Are there any self referral or Stark related problems?
We have spent a great deal of time (and money) on this issue and have had several independent legal opinions specify that our entire program meets all criteria under existing federal guidelines. We are happy to share this information with you and your attorney.
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How can we bill for services when our physicians are not actually performing the service or supervising the technicians?
You are hiring a management company to run a sub-division of your practice, specifically a sleep lab. A few relevant examples that come to mind in healthcare are:
- Companies that are hired by cardiology practices to provide in office vascular labs
- Physician practice management arrangements
- Hiring a dietician and charging for dietary consults
- Hiring a part time physician and billing for his/her services
The most important thing your practice has recognized, and believes in, is the correlation between SDB and CVD. Armed with information about what SDB is doing to your patient's blood pressure, rhythm, cardiac output and oxygenation, you have decided to do the right thing and take care of your patients in the best possible way available. At this time using a management company like HHSP makes the most sense. HHSP works for you, and therefore the techs, physicians, scorers also work for your practice.
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How will we be viewed supplying CPAP out of our office?
This is an understandable concern. However, you are prescribing the therapy based upon the diagnosis performed and which you have signed off. Tracking these patients closely while on therapy to insure compliance and satisfaction is perhaps the entire goal of the program. Frankly, the "Cadillac" diagnosis we offer is worth nothing if the patient receives "Yugo" treatment. Unfortunately, that is what happens all too often when left to a DME company.
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I know nothing about CPAP, how will I deal with a patient's problems once they are on therapy?
Our compliance program begins on the night that the patient is first titrated with CPAP. The nighttime technologist administering the titration study is also the patient's key contact during the first 30 days of therapy. A Healthy Heart CPAP therapist will set the patient up, educate him and establish the patient's compliance program. There is a CPAP therapist available 24/7 for the patient to speak with should they have any problems. In most cases there is a therapist available during the day to meet with the patient at the office.
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My office staff can't take on another project, how can I make this work?
Strong office support by HHSP personnel provides your cardiology practice with an on-site coordinator whose role is to:
- Screen selected patients using a pre-defined protocol, approved by the practice to identify potential high-risk SDB patients.
- Interface with the referring physician, if applicable, to insure proper physician communication and ensure that doctors and patients are kept informed of all testing and therapies.
- Coordinate all facets of the patient's testing, including patient education on the condition of OSA, as well as how to use the portable diagnostic provided.
- Coordinate any additional testing required, such as CPAP therapy including setup, compliance monitoring and follow-up
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What is our economic incentive?
HHSP provides a complete management system for the diagnosis and treatment of OSA. The practice contracts with HHSP and bills the patient's insurance company directly for the Polysomnogram, CPAP titration and CPAP device. Additionally, there are other incremental revenues created as a result of these activities, such as:
- Exams related to CPAP follow up and test results review
- Initial consultations
- Follow-up echocardiograms to closely monitor patient's progress
- Rental of space for performing the testing
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How will I be able to screen patients for this disorder?
The unique nature of the HHSP program is that its goal is to integrate sleep breathing assessment and management into cardiovascular care, unlike a typical sleep lab that is trying to diagnose Obstructive Sleep Apnea. Objective measures drive management of a patients cholesterol, blood pressure or potassium, and sleep-disordered breathing in this population is no different. Silent ischemia is treated and is an important target, "Silent" SDB can be thought of similarly.
Therefore, while we will use a cardiology specific screening tool to identify those with a high clinical probability (i.e. daytime sleepiness, snoring, witnessed apneas etc), we will also teach the practice to test all patients with diastolic heart failure, morbid obesity and heart related problems, ejection fraction less than 40% and patients with difficult to control CHF.
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I have been seeing these patients for years and have never asked them about this condition before, how will they react to a new line of questioning?
Over the last few years there has been a great deal of peer reviewed literature on the independent risk factors of SDM and CVD and you will certainly be able to share that information with them. However, we believe that an educated patient will be able to raise this question on their own. HHSP will provide a great deal of patient education in the form of brochures, posters and web site assistance to help them better understand this new found knowledge. The best thing that can happen is to have the patient ask you about the co-morbidities associated between SDB and their CVD, and that is our goal.
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I have a question that is not addressed here, how can I get more information?
Please contact us and we will be happy to assist you.
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Benefits 