Managing the Business of Sleep
Preetam Schramm, PhD., RPSGT., Senior Clinical Specialist and Tom Anderson, MBA., Director of Product Management at Embla Systems present the Enterprise Business Management Software System from Embla.
The focus of sleep medicine remains principally on sleep disordered breathing (SDB) and its clinical presentation, diagnosis, treatment and management. Prevalence studies estimate that 15 to 18 million persons in the US live with life threatening sleep apnea and approximately 5% of the entire US population have a sleep disorder.1 Epidemiological studies indicate that obesity is near pandemic proportions in the world’s more industrialized countries and the link of obesity to SDB, heart disease and mortality has been described.2 The Center for Medicare and Medicaid Services (CMS) recently allowed the use of portable monitoring to diagnose SDB and requires a sleep reassessment every 90 days to maintain reimbursement for continuous positive airway pressure (CPAP) treatment.3 This information may be perceived as frightening and overwhelming to many in the sleep field, particularly for those unprepared to face the demand from a business and marketing perspective.
The potential market for new, existing and referred patients with sleep disorders is enormous and growing. This means more sleep patient business opportunities for those capable of meeting the demand and who possess the right business tools and strategies to address the increase in patient flow. Additionally, patient management and tracking will become more important. Increasing the awareness of utilizing new technologies to help physicians, sleep lab managers and facilities to handle data, be effective in dealing with the accreditation requirements for American Academy of Sleep Medicine (AASM)4 improving patient services, extending business opportunities and delivering optimal patient care is the aim of this commentary.
After physicians, sleep lab owners and managers invest in the organization, business planning and actions necessary to establish a profitable and quality patient orientated service; the next logical step is to estimate a realistic budget and construct effective management. Keeping costs and overhead to a minimum while providing excellent service is challenging. Simple tools currently exist to assist sleep labs in reaching budgeted revenue goals, while providing optimal tools to control costs, manage patient revenue; price services directly with patients or third party payers and allows managers to track all facets of the business as well as patients. The Enterprise system (Embla, Inc., Broomfield, CO) is a sophisticated yet easy to use software package designed to offer the paperless solution sleep labs need.
One time data entry
The multi–step process of a patient being referred for a sleep study to the reporting of the data often involves multiple entries of the same patient data. Enterprise simplifies this by making the one–time–data–entry available for the life cycle of the patient’s data. A key feature in Enterprise allows labs to interface to other systems thus minimizing the chance of errors or missing data. Enterprise manages the various states that a study is in from referred to closing of the file. Any state change triggers sending data to other systems including billing or hospital databases. Enterprise can also be linked to practice management systems in order to provide a complete picture of the patient care. Furthermore, the software is ideal to facilitate many facets of clinical and epidemiological research by making data quires easy and manageable.
Intuitively designed to replicate the sleep lab’s work flow, Enterprise begins by helping to organize and schedule patients. The database functions allows integration of complete patient files in electronic form to allow sleep physicians and lab personnel direct access to patient information without wasting time searching for patient folders. The Query Manager searches the database for any previous visits by the patient and displays any previously recorded data quickly and easily. Based on the patient’s needs or physician requests, the Scheduler feature in Enterprise makes scheduling of a patient’s sleep study into prioritized lists. This feature is essential for keeping a sleep lab’s beds occupied by having a waiting list of patients willing to come in on very short notice when others have cancelled their appointment.
The technician has direct access to the patient’s record and the physician’s requests for the sleep study using Enterprise. On completion of the sleep study, the scored sleep data can be directly published from Embla PSG systems or many other platforms (i.e. Sandman or Alice) to Enterprise with all documents and graphics stored in a single location, easily accessed locally or remotely. Simple operation of Enterprise’s Query Manager can populate the database with additional patient information and sleep study interpretations. Sleep lab managers and physicians can access the entire patient’s information, create and print custom reports, email or fax reports or other correspondences from within Enterprise, efficiently while saving time.
Effective patient communication is an essential function of any sleep lab and Enterprise offers a plethora of templates which allow users to create patient appointments, meeting notices, sleep information documents including questionnaires and reminder letters. All templates used are seamlessly integrated into the database providing optimal documentation management. Any document created using an Enterprise template can be edited, saved, shared and accessed repeatedly. Data can be used to generate Interpretations including health and physical information from customized questionnaires, sleep parameters from the sleep study or any other information that can be populated to customizable fields in Enterprise. The data structure is completely open allowing labs to collect the data they need to help manage patient care or undertake research.
Embla Enterprise System: Patient Scheduling
Embla Enterprise has been designed with features that assist in the accreditation process. Many reports have been designed to easily present information on study types, referrals, insurance, quality assurance and outcomes. Patient communication and history of care is easily accessed as are all follow up activities. Workflow and efficiency statistics are tracked and can be compared to previous periods or to other facilities. Finally historic records are easy to access and are part of the file server and SQL data base.
Patient management will become an essential and significant part of any sleep lab’s business operation particularly when having to follow PAP therapy status. CMS requires notification on a patient’s PAP need for continued reimbursement every 90 days. Enterprise can easily be used to manage all aspects of documentation to make this process simple. Coding of sleep medicine services can be done directly with Enterprise. In addition, it provides tools to guide sleep lab managers with revenue and budgets, provides a means to control costs and pricing of services, and negotiating third party contracts. Enterprise provides the optimum tracking tool.
The Enterprise Multi–Center Module allows multiple sleep facilities to be managed from a single location. The data collected from the satellite facilities are consolidated into a single database, giving a clear overview of the organization. The Enterprise Scheduler can be used to schedule across facilities and Enterprise Business Reports can be categorized by individual facilities. Reports can be generated on individual facilities or on the organization as a whole.
Daily or any time period segments of business operations can be evaluated and tracked with Enterprise to ensure that business plans are being followed and costs remain within budgets. This flexibility allows for quick identification of superfluous spending and indicates where reductions of wasted resources can be made before financial problems become serious. Enterprise helps provide marketing data, tracking referrals by physician, region, referral source or payer. The Enterprise package provides the essentials for sleep labs to compete in the growing market, assure quality and efficient performance, keep pace with increasing demands for accreditation requirements, and maintain statistics on the patient population and workflow. Finally, the Enterprise team encourages customer input and suggestions to improve the platform providing continued evolution of a quality product tailored to meet the changing demands of the sleep lab.
1. Hiestand DM, Britz P, Goldman M, Phillips B. (2006) Prevalence of Symptoms and Risk of Sleep Apnea in the US Population. Chest, 130:780–786.
2. Trupp RJ and Corwin EJ. (2008) An integrated approach to managing sleep disordered breathing and cardiovascular disease. Heart Fail Rev., Dec
3 [Epub]. 3. CMS, http://www.cms.hhs.gov/ContractorLearningResources/downloads/JA6048.pdf.
4. American Academy of Sleep Medicine, accreditation requirements: http://www.aasmnet.org/Resources/PDF/AccreditationBrochure.pdf.