Sleep HealthCenters plans to establish a national network of outpatient sleep medicine clinics.

The National Jewish (NJ) Medical and Research Center, Denver, recently partnered with Newton, Mass-based Sleep HealthCenters┬« (SHC) in an effort to improve sleep health services. NJ’s new and improved sleep medicine clinic will diagnose a variety of sleep disorders such as sleep apnea and insomnia. Under SHC management, the American Sleep Disorders Association (ASDA)-accredited program will provide services such as CPAP (continuous positive air pressure), CPAP compliance management, oral appliance therapy, surgical consults, medications, and behavior modification.

“Expanding the traditional range of services—from primarily diagnostic to include all pertinent therapeutic regimens, delivered by a multidisciplinary team of experts…will clearly set SHC at NJ apart from other programs in Colorado,” says Verne Singleton, NJ’s chief administrative officer.

SHC’s CEO, David Barone, hopes to continue partnering with established hospitals throughout the country to create the nation’s finest network of specialized sleep medicine outpatient clinics. Barone explains that SHC’s strategy is to enter into relationships with existing hospital sleep disorder programs that are already affiliated with well-respected institutions. “We expand the programs considerably and add additional diagnostic services and treatment services,” Barone says. “We provide the resources to further expand the whole program and create a comprehensive service that, in most cases, doesn’t exist today.”

By combining diagnosis and treatment under one roof, Barone hopes to consolidate what he calls the “fragmented” US market. “The people who provide therapies, whether they are home health care companies or ENT surgeons, have very little interaction with each other and very little interaction with the sleep center,” he says. “The patient essentially has to move through the process by himself—and no one feels fully responsible for the patient because everyone is just seeing a small segment of the overall care.”

Of the Hospital, But Not Always in the Hospital
SHC opened its first clinic in Bedford, Mass, followed by one in Newton, then in Denver at NJ. In the case of Bedford, SHC took the outpatient facility originally located on the McLean Hospital campus in Belmont and moved it to a nearby community where it could provide a better physical setting. SHC’s second facility in Newton (affiliated with Brigham and Women’s Hospital of Boston) is also located off campus. NJ’s Denver facility is on campus.

Barone says the proper physical setting is often the key to making patients feel comfortable. Proponents of home-based sleep studies say that patients will most likely feel most comfortable in their own homes. SHC responds to the comfort issue by designing residential-looking diagnostic suites that Barone says look like nice hotel rooms.

SHC hopes to quiet critics who say laboratories are too slow and overcrowded to provide timely service. “Our goal is to have 90% of the patients diagnosed within 3 weeks, that’s our standard,” he says.

Lessons from Israel
SHC has learned a lot from Sleep Disorders Centers (SDC) Ltd in Israel—the largest provider of sleep disorder services in that nation. Through an exclusive agreement, SDC has shared comprehensive clinical and case management protocols with SHC. These invaluable best practices have helped SHC develop a framework for success.

“SDC Israel is a 100% managed care market. They’ve worked effectively with managed care by demonstrating and developing comprehensive protocols to manage patients—not only to diagnose patients, but to measure outcomes,” Barone says. “By managing the patient all the way from the diagnosis through the treatment and ongoing care, they’re able to demonstrate true outcomes. SDC started to measure outcomes before people here had invented the term, which is now the buzzword of the industry.”

Barone says SDC showed him how to integrate multidisciplinary physicians and work in conjunction with academia. Combine all this with measured outcomes and Barone says you have the credibility that is the key to managed care reimbursement. “From the payor’s point of view, they’re seeing a front-loaded system where they’re paying lots of dollars for diagnosis,” he says, “but for the majority of patients, they’re not getting the ultimate benefit—which is getting better.”

Barone believes SHC’s strategy costs less and is more effective than home-based methods. “From a clinical point of view, there is no advantage to doing the study outside of the lab. The lab provides for better and more extensive monitoring and direct interaction between the technician and the patient,” he says. “The risk of doing it at home is that you underdiagnose patients.”

Barone says the total process of diagnosis and treatment (especially for a patient that has sleep apnea) is ultimately cheaper since both the diagnosis and setting of the CPAP can be done in one night in what is called “split night.”