Calif. Respiratory Care Board Attempting to Regulate Sleep Medicine
The American Academy of Sleep Medicine (AASM) recently obtained a legislative proposal drafted by the Respiratory Care Board of California (RCB) for the purpose of being introduced as a bill into the California State Assembly. Although the proposal has not yet been sponsored by a California legislator – a requirement for a bill to be introduced in California – AASM fully expects the RCB to secure a sponsor and introduce the proposal as a bill when the California State Assembly reconvenes on January 7, 2008.
The RCB proposal would require sleep technologists to obtain a license to practice certain sleep services. To obtain licensure, a sleep technologist would be required to fulfill one of the following criteria:
Possession of a current license to practice respiratory care in California.
Completion of an accredited respiratory care program as prescribed by the board and has an associated degree.
Completion of an accredited electroneurodiagnostics program as prescribed by the board and has an associated degree.
Completion of a polysomnography educational program prescribed by the board and has an associated degree.
Completion of an 18 months or 3,000 hours of full-time paid work experience as an applicant sleep technologist, including 1,000 hours in polysomnography-related respiratory care services as prescribed by the board and satisfactorily performed as verified by a physician or surgeon.
The RCB has also launched an aggressive campaign targeting sleep centers and laboratories across California.
According to its Fall 2007 newsletter, the RCB plans to increase its efforts to cite and fine individuals and sleep centers according to its interpretation of Section 3767 of the Respiratory Care Practice Act, which was signed into law in 1983.
The RCB plans to issue citations and fines, totaling up to $15,000 each, to individuals and facilities that do not have respiratory therapists assisting with services and therapies related to “maintenance of the natural airway” (e.g., CPAP BiPAP, and O2 titration) and employ sleep technologists to assist with these services and therapies for sleep disorders.
The AASM and American Association of Sleep Technologists (AAST) are closely monitoring the situation in California and addressing the issue. The AASM will keep members apprised as this process develops. Contact the AASM's Senior Health Policy and Government Affairs Analyst Ted Thurn at (708) 492-0930 or tthurn@aasmnet.org with questions and concerns.
New Definition of Direct Referral Accepted
At its October 2007 meeting, The Board of Directors approved a definition of a directly referred patient: A direct referral is a patient who is never seen in consultation by a sleep staff physician. The referring physician (PCP for purposes of this document although it is recognized physicians other than primary care providers may send patients as direct referrals) orders the sleep study, then treats and provides longitudinal care for this patient. A patient who is sent by the PCP for a sleep study and is seen in consultation by a sleep staff physician within 3 months of the sleep study is not a direct referral.
For more information on accreditation, visit www.aasmnet.org/SleepCentersLabs.aspx.
Registration Now Open for Two Popular AASM Courses
Registration is now open for the two popular courses offered by the American Academy of Sleep Medicine (AASM): Management of a Sleep Disorders Center: Administrative, Legal & Health Policy Practices and Advanced Sleep Medicine. Both courses will be held February 8–10, 2008, at the Hilton Clearwater Beach Resort in Clearwater, Florida. Download the brochures for both courses and register online at www.aasmnet.org/SleepEdSeries.aspx.
With an expert faculty led by Anitra Graves, MD, and Kelly Carden, MD, sleep medicine physicians, behavioral sleep medicine practitioners, administrative staff, sleep technologists and other sleep-related professionals attending Management of a Sleep Disorders Center: Administrative, Legal & Health Policy Practices will get a comprehensive overview of important issues related to business practices of running a sleep disorder center. The course addresses issues pertinent to the opening and operating of free-standing and hospital-based sleep disorders centers, presents new information essential to the operation of a sleep disorders center, provides perspectives on recruitment and retention of allied health staff, and reviews legislative and regulatory issues that affect practice.
The Advanced Sleep Medicine course is a timely, comprehensive review of relevant clinical topics in sleep medicine. Daily case-based meet-the-professor sessions and reviews of important topics will be delivered by an outstanding faculty, led by Chair Ruth Benca, MD, comprised of practicing and academic experts in sleep medicine. Discussions on topics such as sleep-related breathing disorders, narcolepsy, parasomnias and insomnia, focus on latest developments in diagnosis and treatment, recent research and publications, and future directions for the field.
Save the Date: 2008 Insomnia and Behavioral Sleep Medicine Course
Sleep medicine specialists looking to broaden their knowledge and understanding of insomnia and behavioral sleep medicine should mark their calendars for March 1 – 2, 2008, and join noted experts Jack Edinger, PhD and Dan Lewin, PhD, for the comprehensive course Insomnia and Behavioral Sleep Medicine.
New SLEEP Web Site Launched
Log on to www.sleepmeeting.org for access to the new Web site for the SLEEP Annual Meeting of the Associated Professional Sleep Societies (APSS). The new site is a comprehensive resource for the SLEEP meeting and includes online registration, important dates and deadlines, and information about Baltimore, this year's host city.
First Sleep Medicine Certification Examination Offered Under ABMS Umbrella
During the week of November 12, the first sleep medicine certification examination was administered by the American Board of Internal Medicine (ABIM) under the auspices of the American Board of Medical Specialties (ABMS). The examination was offered by the ABIM, American Board of Psychiatry and Neurology (ABPN), American Board of Family Medicine (ABFM) and American Board of Otolaryngology (ABOto). According to ABIM, 1,921 candidates sat for its examination. Learn more about certification in sleep medicine by visiting www.aasmnet.org/Certification.aspx.
Mini-Fellowship Program for Behavioral Sleep Medicine: Application Deadline is January 15
Physicians, psychologists and advance practice nurses from the U.S. and Canada are invited to apply for the 2008 Mini-Fellowship Program for Behavioral Sleep Medicine that is sponsored by the American Academy of Sleep Medicine (AASM). The program is designed to help participants improve the quality of the behavioral sleep services that insomnia patients receive in primary care settings.
The four-week program provides practical training for individuals who currently deliver or have an interest in providing behavioral sleep medicine services. Participants in the program spend three weeks at an AASM-accredited sleep disorders center in the U.S. and then spend one week at the SLEEP Annual Meeting of the Associated Professional Sleep Societies.
The program overview, requirements and application are online at www.aasmnet.org/BSMMiniFellow.aspx. Interested candidates should note the application deadline for the 2008 Mini-Fellowship Program for Behavioral Sleep Medicine is January 15, 2008.
AASM Comments on Proposed Physician Fee Schedule
The American Academy of Sleep Medicine (AASM) provided formal comment regarding the Centers for Medicare & Medicaid Services' (CMS) proposed rule “Proposed Revisions to Payment Policies Under the Physician Fee Schedule, and Other Part B Payment Policies for CY 2008,” which was published July 12, 2007, in the Federal Register. According to the proposed rule, the scheduled reduction to physician payments is estimated at 10 percent for 2008, with projected cuts totaling 40 percent over the next eight years. During this same period, practice costs for physicians are expected to increase 20 percent.
In its comment the AASM strongly urged CMS to work with Congress and develop a fair and balanced rejoinder that enacts positive physician payments for 2008 and subsequent years and accurately reflects realistic medical practice costs incurred by physicians as indicated by the Medical Economic Index (MEI). Further, the AASM requested CMS and Congress assess the current sustainable growth rate (SGR) formula and replace it with a meaningful system that considers the continually increasing costs associated with care provided by physicians to Medicare beneficiaries.
Center for Medicare & Medicaid Services Updates
New Information on Important CMS Practice and Reimbursement Regulations
The Centers for Medicare & Medicaid Services (CMS) announced a number of rules and regulations that will have a sweeping impact on clinical practice and will directly affect sleep medicine practitioners.
CMS has posted on its Web site the final rule for 2008 Medicare physician payment schedule. The rule, which was published in the November 27, 2007, Federal Register, is available for download from www.cms.hhs.gov/physicianfeesched/downloads/CMS-1385-FC.pdf
The provisions of the final rule are effective January 1, 2008, with noted exceptions. There will be a 60-day open comment period that begins November 27, 2007. Comments can be remitted to CMS online at www.cms.hhs.gov/eRulemaking/. Click on the link, “Submit electronic comments on CMS regulations with an open comment period.”
The rule addresses several issues of importance to sleep medicine specialists.
Beginning January 1, 2008, a 10.1 percent cut in the Medicare conversion factor goes into effect as well as a 0.1 percent reduction for the sustainable growth rate; the 2008 conversion factor will be $34.0682. However, it should be noted that payment rates for specific services in certain localities may have different percentage payment cuts.
The rule addresses Independent Diagnostic Testing Facilities (IDTF) issues. Specifically, it clarifies CMS' interpretation of several of the existing performance standards related to existing performance standards, proposes new IDTF standards, and includes a new proposed IDTF provision. The section on IDTFs includes comments CMS received during its revision of the existing standards with a response as rationale for the changes.
Also detailed in the final rule are refinements to resource-based practice expense relative value units (RVUs); geographic practice cost indices (GPCI) changes; physician self-referral issues; and a durable medical equipment (DME) update. The rule includes the final list of quality measurers for the 2008 Physician Quality Reporting Initiative. Full specifications for each measure in the initiative will be posted on the CMS Web site in the near future.
Medicare Premiums will rise in 2008
According to the October 29 issue of the American Medical News, Medicare premiums for outpatient services will rise 3.1 percent next year, marking the smallest percentage increase in seven years. The standard Medicare Part B monthly premium will be $96.40 in 2008, an increase of $2.90 from the current level.
Though the increase is the lowest in several years, the monthly charges have nearly doubled since 2001 and are approaching the $100 threshold.
Medicare officials offered several factors for next year's nearly $3 increase in beneficiaries' monthly premiums. Estimated spending growth on physician-administered drugs, physicians' office laboratory services and ambulatory surgery center services each was a contributing cause along with the growth in the home health and durable medical equipment sectors.
To read the full article, please visit http://www.ama-assn.org/amednews/2007/10/22/gvl11022.htm.
Medicare Rejecting Claims with NPI Discrepancies
American Academy of Sleep Medicine (AASM) members should be aware that Medicare must be able to match a physician's appropriate PIN to his or her correct National Provider Identifier (NPI) or risk the possibility of a claim rejection if a match can't be made.
Prior to September 4, 2007, most Medicare carriers permitted claims to process through their computer systems even if an appropriate match between the physician's NPI number and their old legacy billing number(s) couldn't be made. However, effective September 4, 2007, Medicare has activated the edits that previously allowed these claims to process.
The AASM and American Medical Association strongly encourage all members to immediately check with their billing office to determine what, if any, error reason codes have been returned over the summer and rectify these discrepancies. Members who use a clearinghouse should check to ensure that the NPI or these reason codes are not being stripped off of their claims.
NOTE: Medicare must be able to match single, incorporated physicians-those who have an LLC or other incorporated business arrangement. These physicians must have two NPIs-one for themselves and one for their corporation. In some cases Medicare may have originally assigned these physicians one PIN rather than the two that are now needed to match a physician to his or her correct NPI number. In these cases, re-enrollment in Medicare is required. In addition, physicians in large group practices who may have multiple Medicare PINs could also experience claims interruptions if there are matching problems.
MedCAC Evaluates OSA NCD
The Medicare Evidence Development and Coverage Advisory Committee (MedCAC) met September 12, 2007, to evaluate national coverage determination (NCD) 240.4 continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA). Alex Chediak, MD, president, and Mary Susan Esther, MD, president-elect, represented the American Academy of Sleep Medicine (AASM). As communicated to AASM members via the Weekly Update, Dr. Chediak presented official testimony, completely based on available published evidence and data, on behalf of the AASM. Download his testimony by visiting www.aasmnet.org/resources/pdf/testimony.pdf.
CMS has posted on its Web site the full transcript of the September 12, 2007, meeting of the MedCAC regarding NCD 240.4. Download the transcript and official meeting minutes from the CMS Web site www.cms.hhs.gov/mcd/viewmcac.asp?where=index&mid=40#speaker.
According its Web site, the Centers for Medicare and Medicaid Services (CMS) has until December 14, 2007, to issue a preliminary decision memo, which will be followed by a 60-day public comment period. CMS expects to publish the final NCD by March 14, 2008.
Legislative Updates: Prescription Bill, Mental Health Parity Act
On Monday, October 1, 2007, President Bush signed HR 3668, which delays for six months the implementation of a mandate that requires pharmacists and physicians to write prescriptions on tamper-resistant paper. The original mandate was scheduled to take effect October 1, 2007, and pharmacists and physicians now have until April 1, 2008, to comply with the new mandate.
Senate Bill 558, the Mental Health Parity Act, which provides coverage parity for mental health and substance-related disorders along with medical and surgical benefits in large group health plans, was passed by the United States Senate on September 18, 2007. The bill also prohibits treatment limits or the imposition of financial requirements on mental health and substance-related disorder benefits in large group health plans that are not imposed on medical and surgical benefits.
In the United States House of Representatives, there are three different version of the bill. The three versions of the House bill must now be reconciled before it can be voted on by the full House.
HHS Appeals Checkbook Decision
In late 2006, Consumer's Checkbook filed a lawsuit against the U.S. Department of Health and Humans Services (HHS) in Federal District Court seeking an order compelling HHS to release Medicare claims data, including individual physician identifiers, under the Freedom of Information Act (FOIA). The judge in Consumer's Checkbook vs. HHS on August 22, 2007, ruled against HHS and stated the FOIA exemption does not apply to Medicare claims data. Last week HHS filed an appeal with the U.S. Court of Appeals Circuit. The American Medical Association (AMA) is planning to jointly file an amicus brief urging appellate court review and reversal of the August 2007 ruling.
Without an appeal of the decision in Consumer's Checkbook vs. HHS, the agency would have been required to disclose Medicare data under FOIA and the Privacy Act would no longer provide any protection against disclosure of physician identifiable Medicare information. Information on the outcome of the appeal will be released by HHS when the outcome is revealed.
New Fellow Designation for AASM Members
In July 2006 the American Academy of Sleep (AASM) defined new requirements for the Fellow membership category, which are effective with the 2007 membership calendar year. All members with Fellow membership status before the new requirements were grandfathered in to the new Fellow category. The AASM recently announced a new designation – FAASM – to signify status as a Fellow member. The AASM encourages all current members with Fellow status to use this designation to signify their professional achievement. Information on membership categories is online at www.aasmnet.org/AboutMembership.aspx.
NIH Launches Extensive Open-access Dataset of Genetic and Clinical Data
The National Institutes of Health (NIH) has launched one of the most extensive collections of genetic and clinical data ever made freely available to researchers worldwide. Called SHARe (SNP Health Association Resource), the Web-based dataset enables qualified researchers to access a wealth of data from large population-based studies, starting with the landmark Framingham Heart Study. The goal of SHARe is to accelerate discoveries linking genes and health, thereby advancing scientists' understanding of the causes and prevention of cardiovascular disease and other disorders.
Framingham SHARe includes data on more than 9,300 participants spanning three generations, including over 900 families, who had their DNA tested for 550,000 genetic variations (single nucleotide polymorphisms, or SNPs). In addition, the participants' clinical data gathered during the study, such as test results or weight, are included. SHARe will enable researchers to relate study participants' genetic variations with their clinical and laboratory test results.
SHARe is accessed through dbGaP, or the database of Genotypes and Phenotypes http://view.ncbi.nlm.nih.gov/dbgap, a Web-based resource for archiving and distributing data from genome-wide association studies (GWAS). Researchers interested in applying for access to individual-level Framingham SHARe data should follow the directions at www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/study.cgi?id=phs000007.
NIH Announces 2008 Application Cycles for NIH Director's Pioneer and New Innovator Award
The National Institutes of Health (NIH) is calling for applications for 2008 NIH Director's Pioneer and New Innovator Awards. Both programs support exceptionally creative scientists who take highly innovative -- and often unconventional -- approaches to major challenges in biomedical or behavioral research. The programs, part of the NIH Roadmap for Medical Research, complement other NIH efforts to fund innovative research and support scientists in the early stages of their independent research careers.
Pioneer Award applications will be accepted from Dec. 16, 2007, to Jan. 16, 2008. Application instructions are at http://grants.nih.gov/grants/guide/rfa-files/RFA-RM-08-013.html.
The New Innovator Award application period is from March 3 to 31, 2008. See http://grants.nih.gov/grants/guide/rfa-files/RFA-RM-08-014.html for application instructions.
More information on the programs is available at http://nihroadmap.nih.gov/pioneer and http://grants.nih.gov/grants/new_investigators/innovator_award.
Sleep Apnea Included in WHO Report
The World Health Organization (WHO) has published a report on respiratory diseases that includes a comprehensive section on sleep apnea. According to “Global Surveillance, Prevention and Control of Chronic Respiratory Diseases: A Comprehensive Approach,” the WHO concludes sleep apnea, which it estimates affects 100 million people world-wide, is preventable, a chronic respiratory disease and the most common organic sleep disorder. Further, the report includes estimates on the global economic cost of untreated sleep apnea, prevalence of sleep apnea, and impact on morbidity and mortality. Log on to www.who.int/gard/publications/GARD%20Book%202007.pdf to download the report.
New Resources Available for Teenage Patients
The American Academy of Sleep Medicine's public education Web site www.sleepeducation.com has new information and resources about sleep disorders and the effects of sleep deprivation for teens. Among the new resources your teenage patients can download is the Cleveland Adolescent Sleepiness Questionnaire, developed by Drs. James Spilsbury, Dennis Drotar, Carol Rosen and Susan Redline and published in the October 15 issue of the Journal of Clinical Sleep Medicine, a self-completed instrument to measure excessive daytime sleepiness in ages 11–17.