empowering physicians to treat sleep apnea the md home sleep program presented by dr. avi ishaaya,...

Empower ing Phys ic ians to Trea t S leep Apnea

The MD Home Sleep Program

Presented by Dr. Avi Ishaaya, MD

Medical Director

http://www.aviisha.com/

Aviisha Medical Institute, LLC | www.aviisha.com


Overview• Background: OSA

• Prevalence of Sleep Apnea• Consequences &

Comorbidities• Program Goals

• How MDHSP Works• A Brief Overview

• Billing & Financials

• Closing• Physician’s Responsibilities• MDHSP Achievements• Free Tools & Resources• Where To Go From Here

• Q&A

http://www.aviisha.com/mdhsp


Aviisha Medical Institute, LLC | www.aviisha.comAviisha Medical Institute, LLC | www.aviisha.com

Obstructive Sleep Apnea & the MD Home Sleep Program



The Prevalence of Sleep Apnea• At least 1 in 5 Americans has mild OSA

and 1 in 15 has moderate-to-severe OSA (Young et al. 2007).

• It is the second most common sleep disorder (Lettieri 2009).

• About 9% of middle-aged women and 24% of middle-aged men are affected (Young et al. 1993).

• OSA remains undiagnosed in approximately 92% of affected women and 80% of affected men (Young et al. 1997). Unaffected

79%

Mild61,401,310

16%Moderate-Severe

20,467,1035%

Sleep Apnea Prevalence (United States)




The Severity of Untreated Sleep Apnea• Recurrent arousals disrupt sleep, resulting in

chronic sleepiness, poor concentration, mood disturbance, loss of motivation

• Low levels of oxygen place stress on the heart, leading to heart failure, hypertension, and stroke

• Metabolic changes can influence insulin and trigger obesity

• Loud snoring creates marital discord• Apneas can be fatal in and of themselves• Diminished alertness raises risk of repeated

vehicular accidents by a factor of 6





Comorbidities Associated with OSA

DISEASE PREVALENCEAsthma 17%Atrial fibrillation 49%Congestive heart failure 76%Depression 58%Drug-resistant hypertension 83%Dysrhythmias 58%Gastroesophageal reflux disease 60%Hypertension 30%Ischemic heart disease 38%Morbid obesity, female 50%Morbid obesity, male 90%Nocturia 48%Stroke 90%Type 2 diabetes mellitus 15%Source: Medscape.com

The US Department of Health and Human Services, in cooperation with other federal agencies launched the HealthyPeope.gov initiative whose #1 sleep objective is to “Increase the proportion of persons with symptoms of obstructive sleep apnea who seek medical evaluation.”





The MD Home Sleep Program’s Goals1. Empower physicians from all specialties

to feel confident in diagnosing and treating sleep apnea.

2. Streamline the process as much as possible by

• Avoiding expense, discomfort, and inconvenience of lab testing by using home sleep tests;

• Using technology to simplify diagnosis and treatment;

• Absorbing logistical responsibilities so physicians can focus on medicine while earning revenue.




How MDHSP Works


Physician screens patients using

screening tools

Physician prescribes a home sleep test (HST)

online

Aviisha coordinates shipping with

Patient, administers and scores the test

Physician receives HST Scoring Report

with test results

Physician prescribes

AutoCPAP online

Physician receives quarterly treatment compliance reports prepared by Aviisha

HST

AutoCPAP

How MDHSP Works




How MDHSP Works Physician Screens Patient

Patient completes Medical Information form when entering

clinic

Physician reviews form (screening

tool) and inquires about sleep

How are you sleeping?

Patient completes HST Lease

Agreement before leaving

clinic




How MDHSP Works

Screening tools provided:

1. Patient Medical Information form• Given to patients to complete at clinic• Incorporates Epworth Sleepiness Scale

• Score ≥10 indicates excessive daytime sleepiness and requires testing

• Even scores below 10 can require testing if other symptoms are present

• Universally recognized by medical professionals and insurance companies

• Incorporates Berlin Questionnaire (comes with quick scoring key)

2. OSA Symptoms Guide• Simple checklist of symptoms

Physician Screens Patient (continued)




Physician Orders a Home Sleep Test

How MDHSP Works

Clinic completes order information

online

Clinic submits Medical

Information form and signed

Lease Agreement

Physician prescribes

Home Sleep Test online

HST




Aviisha Administers Home Sleep TestHow MDHSP Works

Philips Alice PDx Portable Monitoring

Device

• Aviisha ships the patient the HST, administers, and scores it

• Aviisha follows up with a phone call to patient when device is received

• Device comes with Step-by-Step Instructional Guide

• 21 channels measuring airflow, breathing effort, heart rate, SpO2, body position

• Meets standards of Type II, III and IV diagnostics• “Good Study Indicator” help track success of study• Aviisha available for customer support 8:30-

midnight PST




Physician Receives HST Scoring Report

How MDHSP Works

The Home Sleep Test Scoring Report

• Aviisha scores and interprets the test and emails the physician a report

• Report has diagnosis and recommendations from sleep-boarded physician

• Narrative portion• Demographics, Procedure, Definitions• Indications (symptoms, BMI)• Conclusions (key study conclusions) • Recommendations (confirmed by board-certified sleep

physician)

• Technical portion• Respiratory Events, Snoring, Heart Rate, Oximetry• Body-Position Summary (may indicate positional apnea)• Hypnogram




Physician Prescribes APAPHow MDHSP Works

• Sent directly to patient with instructional setup video and modem

• Aviisha follows up with telephone call when device received

• Modem hooks up to Aviisha compliance system• APAP can record data on SD card for patients

without internet access• PAP therapy is the “Gold Standard” in treating OSA• APAP reduces unnecessary air pressure by up to

40% compared to CPAP• No titration needed

System One REMstar AutoCPAP Machine with A-Flex




Treatment Compliance Reports

How MDHSP Works

• APAP connects to Aviisha compliance system via modem

• APAP records data on SD card in case modem unavailable

• Aviisha manages treatment compliance and generates progress reports

• Progress reports shared with MD• MD bills for compliance calls

Aviisha’s Compliance Management System





Physician’s Duties1. Screen patients using screening tools

2. Prescribe HST

3. Send Aviisha Patient Medical Information form and signed HST Lease Agreement (Clinic duty)

4. Review report and prescribe APAP if needed




Billing & FinancialsPatients Accepted, Reimbursement



Patients Accepted• Out-of-network (preferred)• Cash patients• In-network• Medicare (HST only)

MDHSP is available for all patients

Billing options: Physicians can bill on their own or have Aviisha bill for them.





ReimbursementAmount depends on whether physicians bill on their own or elect Aviisha to bill for them (for out-of-network only)

Aviisha-Bill Self-Bill

For Home Sleep Test MD paid $200MD pays Aviisha’s fee

and keeps remainder of reimbursement

For AutoCPAP MD paid $500MD pays Aviisha’s fee

and keeps remainder of reimbursement

Medicare (HST only) N/AAbout $135 directly from

Medicare




Closing



[email protected]

Learn more: www.aviisha.com/mdhsp

Screening Tools

• Epworth Sleepiness Scale (Key)

• Berlin Questionnaire (Key)

• OSA Symptoms Guide• OSA Risk Factors

• OSA Education webinars every month

• Presented by Dr. Avi Ishaaya, MD

• http://www.aviisha.com/mdhsp/webinars.php

WebinarsContact Information

Free Tools & Resources

http://www.aviisha.com/mdhsp/education/tools/MDHSP-EpworthSleepinessScale.pdf

http://www.aviisha.com/mdhsp/education/tools/MDHSP-EpworthSleepinessScale.pdf

http://www.aviisha.com/mdhsp/education/tools/MDHSP-BerlinQuestionnaireScoringGuide.pdf

http://www.aviisha.com/mdhsp/education/tools/MDHSP-BerlinQuestionnaire.pdf

http://www.aviisha.com/mdhsp/education/tools/MDHSP-EpworthSleepinessScaleScoring%20Guide.pdf

http://www.aviisha.com/mdhsp/education/tools/MDHSP-OSASymptomsGuide.pdf

http://www.aviisha.com/mdhsp/osa-risk-factors.php

http://www.aviisha.com/mdhsp/webinars.php






MDHSP AchievementsMDHSP has already signed up over

600 physicians and has about 3,500 in progress.

MDHSP physicians have reached an 85% conversion ratio from home sleep

test to positive diagnosis using our screening tools.

Our current treatment compliance rate is over 74%, almost twice the industry

average.





Where To Go From HereContact Aviisha or Merritt Hawkins to sign up.

There is no fee to join or participate, and there are no obligations at any point in time.

[email protected]

Learn more: www.aviisha.com/mdhsp

Taylor Bonham

[email protected]



http://www.aviisha.com/sleep-well/quiz

empowering physicians to treat sleep apnea the md home sleep program presented by dr. avi ishaaya,...

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