Is there a Ratio?

Discussion in 'Sleep Medicine' started by Lowell, Jun 1, 2008.

  1. Lowell

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    to number of physicians to number of sleep beds?

    More specifically, if one were to open a comprehensive sleep center (not a diagnostic center), where the sleep physician saw the patient first and performed the consult, before deciding the PSG was needed.

    In this model of care - how many full time docs per sleep beds do you need keep the beds FULL 6 nights per week?

    Thanks!
     
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  3. neurologist

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    All depends on how many beds.

    There are no mandated ratios for docs:beds (unlike for tech coverage, which is 2:1). Depends on how big a center and how the doc plans to work. You have to look at how many daytime new consults and followups the doc(s) can realistically see. You can probably figure realistically 40 minutes for a new consult and 15-20 for a followup. Each overnight patient will need a followup to discuss results, plus you will need f/u slots for established patients, so your ratio of new:f/u will probably be roughly 1:2. You can do the patients/hour math because it's too early in the morning for me. ;) And don't forget to block out time to actually review the studies -- at a "comprehensive sleep center" you're going to be expected to actually review the PSG and not just rubber stamp the tech's scoring report.

    There are some other practice models wereby established patients are seen by a nurse or NP -- i.e., stable patients who just need a CPAP f/u or med refill. That adds some ability for the MD to see new patients or PSG returns for results.


    I'd say realistically one doc could manage up to a 4-6 bed lab, depending on how busy they want to be. And don't forget that if you're running 6 nites a week, Mondays will be killer because you have 2 nites of studies to review (Friday + Sat/Sun), unless you plan to work every weekend. And of course, your planning would need to account for the fact that not every consult to a "comprehensive sleep center" will need a PSG (insomnia, restless leg, etc).

    Would be interested to hear from Michealrack on this, since he's running his own center, I think.
     
  4. michaelrack

    michaelrack All In at the wrong time
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    6-8 beds, assuming the doctor is only practicing sleep medicine and not his underlying specialty. Since you are planning on seeing most patients before the initial psg, probably 6 beds would be reasonable to start off with but I would make sure there is room in the building to add another couple of beds. By the way, if you buy 6 or 7 psg systems, the company will usually throw in another system for free. You might be even able to get this deal for 5.
     
  5. michaelrack

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    Since the doc will be seeing most of the pts prior to the psg, the sleep center will need to be organized as an extension of a physician practice, rather than as an IDTF.
     
  6. Lowell

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    Thank you.

    1:6 sound like a consensus.

    What does IDTF stand for?

    Also, would you agree that sleep centers should embrace CMS decision and invest in multiple ambulatory PSG units to offer in it cadre of services?

    Esp. of is a significant proportion of the patients wil be medicare or military (Tricor?).

    One could envision screening large #'s of appropriate patients with home studies, and reserving lab PSG's for other situations.

    What are your are you prationers doing out there with home studies?

    Much thanks.
     
  7. michaelrack

    michaelrack All In at the wrong time
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    IDTF stands for independent diagnostic and testing facility. Physicians have strict limits on the # of patients they can refer to an IDTF that they have ownership interest in. Unless the physician working for an IDTF has no ownership of it, he needs to see a majority of patients after the first psg, not before.
     
    #6 michaelrack, Jun 2, 2008
    Last edited: Jun 2, 2008
  8. michaelrack

    michaelrack All In at the wrong time
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    What's your background, Lowell? You're obviously not a physician or you would know that Tricor is an anti-lipidemic medication and Tricare is the insurance.

    Are you a business man? respiratory tech? medical student?
     
  9. Lowell

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    Michael,

    Apologies for my current and future typos. I am a very hasty and terrible at the keyboard. I am a physician. I am just not familiar whatsoever with military patients and heard the name if their insurance very briefly, and could recall what it was called....

    Do you have any advice regarding the usage of home studies?

    If not, thanks for all you have shared thus far.
     
  10. neurologist

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    My 2 cents:

    Ambulatory studies will be useful for patients with high pre-test probability of straightforward OSA: otherwise not-too-unhealthy fat guy who snores, is sleepy, and has a tight airway on exam and maybe has already had an abnormal overnight oximetry. I don't think they'll be helpful looking at patients with "OSA-plus," i.e., OSA plus maybe periodic limb movements, REM or non-REM parasomnias or other nocturnal "spells" or patients with more complex cardiopulmonary comorbidities (COPD, various hypoventilation problems, etc). They clearly won't be helpful at all for people who have no flavor of OSA on presentation.

    The other question is this: say you do an ambulatory study that is + for OSA . . . then what? You still either have to bring them in for a titration or just slap an autotitrating device on them. Then what? What if you give them an auto and they don't do well? Well, at that point you have to wonder if they have some other problem (complex apnea, something other than sleep apnea, etc) and . . . you end up having to bring them in for an attended study anyway in the end to sort it out.

    I think the ambulatory studies will reduce attended studies for some of the "slam dunk" OSA patients, but I don't think it's going to cut down on lab business all that much in the end -- you'll just see the more "difficult" patients in the lab sooner.
     
  11. michaelrack

    michaelrack All In at the wrong time
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    no problem, sorry for accusing you; just like to have some sense of who I am corresponding with. Everything is still up in the air with home studies. Insurance coverage guidelines are still being written. Everyone is talking about home studies, but no one I know is actually using them yet.

    The sleep lab I am a part-owner of is expanding from 6 to 12 beds and we are getting a free type 3 device with the psg systems we ordered. The type 3 device should arrive in the middle of the month; so far I have no experience with home testing.
     
  12. cathyz

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    That would be great if that is the case because the hospital may give much better service to their client specially those poor places.
     
  13. Lowell

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    for the responses.

    Comitted apathist: The approach you outline seems like the way it will go.

    Michael: It will be interesting to hear about you experience with home studies as it you begin get some under your belt.

    Now I will begin a new thread: To discuss the place of home studies in the modern practice of sleep medicine.
     

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