Cardiovascular Business - March/April 2008 - (Page 37) get a daily dose of Cardiovascular business News, visit Cardiovascularbusiness.com, or sign-up for the weekly newsletter @ Subs.CardiovascularBusiness.com s cardiologists watch their reimbursement and volume decline, many are eying sleep disorder programs as an attractive option to supplement their bottom line. Cardiologists can house the program within their practice, farming out the reading of sleep studies, or they can become board certified and read their own. To become certified, the American Board of Internal Medicine requires, among other things, a minimum evaluation A á Cardiologists eye sleep disorders as way to AWAKEN REVENUE cardiologists enter the sleep disorder market. Cardiologists can expect 61 percent of heart failure patients, 49 percent of patients with atrial fibrillation, and between 35 and 40 percent of those with hypertension to have sleep apnea or some type of sleep disorder, said Weisfogel, one of the few U.S. cardiologists certified in sleep disorders. Most cardiologists have not been trained to look for sleep disorders, despite the plethora of studies that link sleep apnea 2003;348:1233-41). Additionally, researchers at the Mayo Clinic in Rochester, Minn., found an association between obstructive sleep apnea and elevated levels of C-reactive protein (Circulation 2002;105:2462-2464). The Heart Failure Society of America guidelines in 2006 for the first time listed sleep-disordered breathing as an indicator for heart failure risk evaluation. Regular cardiology patients are screened by nurses, nurse practitioners or other adjunct staff members, who ask appropriate questions, measure the neck circumference and examine the throat. A certified cardiologist then examines the results for any likelihood of problems and, if so, usually refers patients for an overnight evaluation at a sleep center. If sleep apnea is then suspected, a CPAP (continuous positive airway pressure) titration is required during another overnight stay. Cardiology practices that establish sleep labs within their practices can earn about $800 gross per study, netting about $300 after expenses, Weisfogel said. In the last decade, Roger Shell, MD, president of Cardiology Associates of New Brunswick in New Jersey, has noticed a shift in sleep apnea research being driven by cardiologists rather than pulmonoligsts. Two years ago he opened a sleep lab in his practice. He said his group was concerned that the pulmonologists who share the building would disapprove of the sleep lab. In fact, the pulmonary physicians often refer patients and two physicians, who are certified in sleep studies, read the exams. All other sleep studies are read by Weisfogel, who serves as medical director of the lab. “My role,” said Shell, “is to recognize the possibility of sleep apnea being present in my patient from a pattern of cardiac diseases or symptoms, direct them to testing, and encourage them to follow the recommended treatment.” Maintaining two studies per night—the lab’s full capacity—is profitable. A larger facility would allow more studies per night, generating more revenue because staff requirements would remain the same. The practice hired a firm to manage the lab and its revenue is relatively small compared to the overall practice. “For us, it’s not a big money maker, but you need to have it to practice cardiology appropriately, and you need to have it in the same building for the convenience of the patients,” Shell said. By Chris Kaiser EKG shows molecular oxygen (O2) saturation as a result of sleep apnea. (source: G. Weisfogel, Md) of 400 patients per year. That number is easily maintained as sleep disorders are prevalent in patients who have significant cardiology diseases, according to Gerald Weisfogel, MD, medical director of Brockton, Mass.based Healthy Heart Sleep Programs, a company that helps with heart problems. T. Douglas Bradley, MD, and colleagues at the University of Toronto, for example, showed that medically treated patients with heart failure who are also treated for obstructive sleep apnea experience improved left ventricular systolic function (N Engl J Med CardiovascularBusiness.com Cardiovascular Business 37 http://www.cardiovascularbusiness.com http://Subs.CardiovascularBusiness.com http://CardiovascularBusiness.com
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