Health Reform Hits Sleep: Speakers encourage specialists to get involved in initiatives

Both of these organizations reflect the evolving nature of medical practice, which is increasingly integrated and provides a more multidisciplinary approach to taking care of patients. From 2009-2010, more than 7,600 clinicians at more than 1,500 practices nationwide earned PCMH recognition by the National Committee for Quality Assurance, Dr. Coppola noted.

According to Dr. Coppola, specialists will likely become involved in PCMHs by assuming what he called a “neighbor role” (PCMH-N). This arrangement can take the form of a pre-consultation exchange with the PCMH in which the sleep specialist provides his or her expertise on the management of a patient, with no further involvement; a formal consultation with the PCMH in which the sleep specialist recommends diagnostic and treatment measures and co-manages the patient; or a relationship in which the sleep specialist acts as co-manager, diagnosing and treating a patient and then referring the patient for regular follow-up with a primary care physician while continuing to see the patient.

Dr. Coppola also encouraged sleep specialists to participate in ACOs, “as opposed to being a downstream vendor in the ACOs that are already in existence or developing in your area.” He cited examples of organizations that have adopted an ACO model, including Advocate Health Care, Geisinger Health System, Kaiser Permanente, Harvard Vanguard Medical Associates and Blue Cross Blue Shield of Massachusetts, which he said has converted over 25 percent of its commercial business to an ACO model.

Involvement in an ACO, he added, would allow sleep specialists to participate in the higher value delivered by an ACO through quality improvement of care with shared savings. However, he also pointed out the challenges to adapting to this new model of care. In this type of organization, the sleep specialist would no longer be an independent provider delivering fragmented care to a patient, but would instead act as an interdependent team provider who coordinates the care of a specific population, such as patients with obstructive sleep apnea. Payment would change from the current system of reward for volume to reward for value. According to Dr. Coppola, dollars spent on reducing the impact of negative medical conditions, such as diabetes, high blood pressure and heart diseases, would be valued the most.

“We need to get involved now,” he said, “and proactively redefine the field [of sleep medicine] in the next three years.”