Reimbursements for sleep medicine

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kumar28

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Hey all,
I heard that due to home sleep tests being mostly covered by insurance companies that reimbursements for sleep medicine has reduced. Is this true?? Anyone able to expand on this..Im not too familiar with reimbursements for sleep medicine.

Much appreciated in advance
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kumar28 said:
Hey all,
I heard that due to home sleep tests being mostly covered by insurance companies that reimbursements for sleep medicine has reduced. Is this true?? Anyone able to expand on this..Im not too familiar with reimbursements for sleep medicine.

Much appreciated in advance
Click to expand...

2 things are going on:

1) home sleep testing is expanding (more in the NE parts of the country) and reimbursement is low for this- $40-50 for the physician interpretation and approx $150 for the technical component, on average, for a total reimbursement of approx $200.
Some insurance companies are requiring home testing for a majority of patients.

and

2) the reimbursement for in-lab sleep tests (both physician interp and technical component) is declining. There are a number of explanations including Obamacare, home sleep testing, etc. This started with Medicare but other insurers are now doing the same.
 
Not sure if it is b/o Obamacare .... obviously hospitals are overcharging for PSGs, my hospital charges BCBS about 7K..!! No wonder why insurances are pening their eyes and opt for a home test (? 300$). Obviously a PSG is a simple procedure (few sensors,,,O2 and a software and paying a tech to watch 2 pts per night), obsviously it cannot cost 7000$!
 
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sleepmeddoc said:
Not sure if it is b/o Obamacare .... obviously hospitals are overcharging for PSGs, my hospital charges BCBS about 7K..!! No wonder why insurances are pening their eyes and opt for a home test (? 300$). Obviously a PSG is a simple procedure (few sensors,,,O2 and a software and paying a tech to watch 2 pts per night), obsviously it cannot cost 7000$!
Click to expand...

It's typical to, on average, get about 30-35% of your charges. Hospitals do get more $ than IDTF's or physician-owned sleep labs.
 
anyone wanna take a crack at what they think the future holds for sleep medicine. Im very interested in the fellowship but want to know if its worth it a full years salary
 
More than likely the apnea mills will die off, but those who are actively involved with the treatment of sleep disorders will be ok.
 
Shikima said:
More than likely the apnea mills will die off, but those who are actively involved with the treatment of sleep disorders will be ok.
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Maybe. I will personally be ok, but it is generally going to get harder to be an independent sleep doc (solo practice, practicing primarily sleep medicine). There will still be opportunities to have a side sleep practice or to work as part of an integrated system (as part of a hospital or large group practice or a Kaiser-type organization)
 
michaelrack said:
Maybe. I will personally be ok, but it is generally going to get harder to be an independent sleep doc (solo practice, practicing primarily sleep medicine). There will still be opportunities to have a side sleep practice or to work as part of an integrated system (as part of a hospital or large group practice or a Kaiser-type organization)
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You've always demonstrated a genuine concern for looking at the business pragmatics and combining it with good 'ol fashioned doctoring.
An inspiration!
 
http://www.aasmnet.org/articles.aspx?id=4088

What does this bode for the specialty in terms of sustaining a private practice and maintaining revenue for solo/ small group providers. How bad of a hit will this be to sleep medicine providers and how will it impact delivery of care? Anyone care to elucidate. Will appreciate your thoughts on these developments. Thanks.
 
" If implemented, a proposed cut to the practice expense relative value units (RVUs) will result in decreased payment for sleep services that are billed globally. When billed separately, reimbursement for the technical component of the service also will be decreased while payment for the physician component of the service will be increased slightly"

The effect is minor for sleep docs- slightly negative if your income depends on the financial health of the sleep lab, slightly positive if it doesn't and you bill for your own interps. Overall, this development is slightly negative for the sleep industry.
 
Dr. Rack is welcome to correct me - To me, this reads as physicians will be better compensated for interpreting studies while those who have developed a fly-by-night mill type system will be hurt. It speaks to me that good doctoring will be rewarded.
 
Any further opinions on the above comment?
 
michaelrack said:
" If implemented, a proposed cut to the practice expense relative value units (RVUs) will result in decreased payment for sleep services that are billed globally. When billed separately, reimbursement for the technical component of the service also will be decreased while payment for the physician component of the service will be increased slightly"

The effect is minor for sleep docs- slightly negative if your income depends on the financial health of the sleep lab, slightly positive if it doesn't and you bill for your own interps. Overall, this development is slightly negative for the sleep industry.
Click to expand...

Update: Insurers are decreasing both the technical (lab) and interpretation reimbursements for sleep studies. One private insurer in MS reduced both by 25% earlier this year.
 
michaelrack said:
Update: Insurers are decreasing both the technical (lab) and interpretation reimbursements for sleep studies. One private insurer in MS reduced both by 25% earlier this year.
Click to expand...

So in the vein of this thread, I am wondering how it's possible that the mean salaries for sleep docs is 400k while the 90 percentile is above 500k if reimbursements are so crappy?
 
Chickenandwaffles said:
So in the vein of this thread, I am wondering how it's possible that the mean salaries for sleep docs is 400k while the 90 percentile is above 500k if reimbursements are so crappy?
Click to expand...

I am wondering what ranges of starting salary one can expect in sleep coming from neurology. I was discouraged by my sleep attending from applying due to the poor future projection in her view. Your experienced input will be greatly appreciated.
 
Speaking for myself, and what I know and where my interests lie - if I were to have completed neurology residency, I'd have done an epilepsy or neurophysiology fellowship and then complete a sleep fellowship. The marketability will be tremendous. You won't find any sleep medicine only positions out there.
 
So is sleep medicine still a feasible life style for typical IM graduate, even with only home tests. Any of you still want to go?
 
I heard of a few FM docs doing sleep fellowships... Whats your guys take on it?
 
Shikima said:
They do and incorporate this into their practice. Few people out there doing Sleep only these days.
Click to expand...

Being a PCP would it incorporate itself better into a practice than other specialists? Let says vs psych,neuro maybe even pulm sleep docs?
 
Hard to tell. Depends on the health system and community needs. Sleep integrates itself similarly respective to the primary board.
 
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