In the April 15 issue of the Journal of Clinical Sleep Medicine, an editorial by Stuart Quan, MD, and Lawrence Epstein, MD, discusses the implications of the recent closing of Sleep HealthCenters, one of the largest sleep medicine practices in the country.  In A Warning Shot Across the Bow: The Changing Face of Sleep Medicine, they address contributing factors such as an overall decline in reimbursement rates and changes in reimbursement policy, a simultaneous decline in the reimbursement for in-lab polysomnography, the protracted economic downturn, and the increasing adoption of out of center sleep testing (OCST) and autotitrating positive airway pressure devices.  They conclude that insurers across the country will expand the use of pre-authorization for OCST and in-lab PSG to reduce diagnostic expenses.  As a result, sleep medicine practices need to reevaluate their business plans, diversify their services, and emphasize the evaluation and management of patients.