Health care in the United States has transformed rapidly over the last several years as the model for care has shifted to a patient-centered medical home where provider reimbursement is tied to quality metrics. The evolution of clinical care will escalate as the Patient Protection and Affordable Care Act (PPACA) forces additional changes to the U.S. health-care system, many of which are mandated for implementation in the coming year. These important changes to health care will have a significant impact on the clinical practice of sleep medicine.
In anticipation of these changes, the AASM’s Board of Directors has engaged in several forward-thinking initiatives to define a strategy and vision for the future of the sleep medicine field. As part of this strategy, the Board of Directors has proactively devised a new paradigm for care of patients with OSA. This new model provides increased access to quality and cost-effective diagnostic and treatment services for OSA while also improving outcomes through tracking, managing and educating patients with OSA and related co-morbidities.
As part of this paradigm, the AASM submitted an application to the Centers for Medicare and Medicaid Services (CMS) Center for Innovation for a new pilot program called the Integrated Care Delivery and Management Program for Patients with OSA (ICDMPPO). A copy of the complete ICDMPPO proposal can be viewed on the program’s website, www.innovatesleep.org. I encourage you to review it at your earliest convenience. We expect a decision on our application in late March 2012 and, if accepted, the program will begin on or about September 1, 2012.
The pilot program represents a significant change in the testing algorithm for OSA as well as care delivery for patients with OSA, and serves as the foundation for the future of clinical care. This marks the beginning of an exciting chapter for sleep medicine, and I invite you as an AASM-accredited center to be a participating site for the Integrated Care Delivery and Management Program for Patients with OSA during its three-year pilot. As a participating site, your center, staff and patients have a unique opportunity to play an integral role in shaping our field by demonstrating the effectiveness and cost benefit of new diagnostic and care delivery models as well as long-term patient management through collaboration and outcome data. Download the ICDMPPO application and submit it by email to email@example.com to apply.
- Participating patients will be evaluated using a standardized assessment tool that aids the board-certified sleep medicine physician in determining the appropriate diagnostic test.
- Through a collaborative patient-physician relationship, an individualized care plan will be developed that includes utilization of DME that you are able to prescribe and dispense to the patient.
- Working with your staff, the long-term management of the patient’s care is coordinated by your sleep center in consultation with the primary care physician and other specialists.
- At each intervention with the patient, required data and survey information are collected and entered into a database for the tracking of quality metrics and cost outcomes. This information is valuable in showing you that the treatment plan is successful or that it needs retooling. The data also demonstrate cost savings to Medicare and insurance carriers.
- Sleep center staff provide all education, training and adherence assistance to the patient, eliminating fragmentation of care.
- Physician payments for the initial 90 days of care will be bundled under a newly created G code. All services provided after the 90 days will be billed separately according to the appropriate CPT code.
This pilot program, if accepted by the CMS Center for Innovation, will enroll a minimum of 50 and a maximum of 75 participating sites based on facility type and geographic location. Each participating center is required to enroll 100 patients each year for the three-year duration of the pilot program. Following is a basic outline of the essential design of the program:
Interested centers should complete the ICDMPPO application and submit it via e-mail to firstname.lastname@example.org to indicate your interest in becoming a participating center for this exciting new initiative. We appreciate your response by March 1, 2012, to ensure time for training and education of participating sites.
As an organization we have witnessed the rapid growth of our field, with the AASM membership reaching 10,000 since its inception. We have also transitioned our field to a place of formal recognition in organized medicine with the establishment of fellowship training programs accredited by the ACGME and the certification examination administered by the ABMS. Redefining our practice model for diagnostic, therapeutic and management services for our patients and moving to outcome-based care are natural next steps and will guide sleep medicine as we enter a new era of health care. I look forward to your participation in the Integrated Care Delivery and Management Program for Patients with OSA and look forward to working with you.
Nancy Collop, MD