Update from The Quality Task Force April 2012

As you know, Dr. Sandra Horowitz has been working tirelessly on behalf of sleep professionals and patients to ensure that the rapid adoption of home sleep testing has not resulted in a loss of quality in patient care. She provided the following update for members in April of 2012.


The task force was formed in 2010 due to member concern about the implementation of mandatory  home sleep testing with exclusive providers by individual insurance companies.

As sleep physicians, our concern was and always will be the timely delivery of the highest quality of care to our patients. To this end a resolution was drafted in December 2010 and presented at the interim meeting of the Massachusetts Medical Society and highlights were:

—  1. RESOLVED, That the MMS support continued delivery of high-quality care for patients with sleep disorders in Massachusetts; and, be it further  (HP)


—  2. RESOLVED, That the MMS support incorporation of new diagnostic tools and therapies to treat sleep disorders utilizing evidence-based clinical guidelines and accreditation standards; and, be it further  (HP)


—  3. RESOLVED, That the MMS support the principle that management of chronic sleep disorders requires programs that incorporate comprehensive sleep evaluations, access to appropriate testing, evidence-based treatment protocols, and collaboration between primary care providers and sleep specialists.  (HP)


The resolution was adopted and has been supported by the MA Medical Society. They provided contact with  Elaine Kirshenbaum, VP policy, planning and member services, and she has helped guide the task force and facilitated meetings with Insurance Company Medical Directors. She has helped keep us on track in our mission is to preserve the Guidelines for sleep evaluation from the AASM:

—  Reviewed AASM guidelines Portable Sleep Studies:  2007

¡  Comprehensive sleep evaluation certified sleep doc

¡  Airflow, effort, 02

¡  High pretest probability and no comorbid sleep or medical disorder

¡  RDI is apnea plus hypopnea over all recording time

¡  Studies scored by qualified technician not computer

¡  Inadequate or negative with high pretest probability generates in lab

¡  Review results with Sleep specialist  offer CPAP among other treatments following test

Comprehensive Sleep Evaluation by a Board Certified Sleep Physician, as recommended by the AASM, is the cornerstone of the distribution of high quality patient care in Sleep Medicine.

We further support patient care that is not fragmented, is timely, reliable, and appropriate.

We feel care that is managed by a Utilization Management Entity, must use AASM approved criteria and have a rapid turn around and available appeals mechanism with sleep physicians in decision-making roles.

Positions have evolved, as the inevitability of management of testing in sleep medicine has become widespread in Massachusetts and is now starting to extend outside the state, and will likely be national in the near future.  We will see changes in the various utilization management companies as they compete with each other for contracts, but we must be advocates for our patient’s best medical care first and foremost in this time of transition.

Please be well versed in the AASM clinical guidelines for the use of unattended portable monitors (home sleep testing ) in the diagnosis of obstructive sleep apnea in adult patients, and the Practice Parameters for the use of auto-titrating  continuous positive pressure devices for the  treatment of Adult Obstructive Sleep Apnea Syndrome. Studies to date have been done in academic centers with comprehensive sleep evaluations and we still need community acquired data to make sure the paradigm works in a different environment.

I think the task force has succeeded in making the MA Sleep Society a force in the community, and a place where experts in sleep and third-party payers will look when they need guidance.  We have benefitted from member input representing multiple institutions and various practice models. As a task force our work is nearing its end but as a community of sleep physicians we will continue with support of our members to foster communication among sleep physicians and preservation of high quality care and the doctor patient relationship.

Thank you for entrusting me with leadership of the task force.

Sandra Horowitz MD FRCP(C)


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