Sleep Medicine News and Updates
Sleep Medicine News and Updates
The American Academy of Sleep Medicine (AASM) thanks all of the members who cast a vote in the 2011 AASM election and congratulates the following members who were elected by the membership to the board of directors:
Sam Fleishman, MD, President-Elect
Amy Aronsky, DO, Director-at-Large
M. Safwan Badr, MD, Director-at-Large
Ilene Rosen, MD, Director-at-Large
Steven Shea, PhD, Director-at-Large
Board of directors terms commenced in June at SLEEP 2011, the 25th Anniversary Meeting of the Associated Professional Sleep Societies LLC, in Minneapolis, Minn.
Each year the AASM Awards recognize several leaders in sleep medicine who have made significant contributions to both the AASM and the sleep field. The AASM congratulates the following recipients of the 2011 AASM Awards:
Nathaniel Kleitman Distinguished Service Award: Ronald R. Grunstein, MD
William C. Dement Academic Achievement Award: Mark H. Sanders, MD
Mark O. Hatfield Public Policy Award: Mark R. Rosekind, PhD
Excellence in Education Award: Barbara Phillips, MD, MSPH
The 2011 AASM Awards Ceremony took place Monday, June 13, 2011, in Minneapolis, Minn., during the plenary session of SLEEP 2011.
Each year the AASM recognizes the outstanding efforts of a young investigator in the field of sleep research with the Young Investigator Award. The AASM congratulates the recipient of the 2011 AASM Young Investigator Award:
“Common variant in the PSY11 receptor gene is associated with narcolepsy and with higher susceptibility to ATP induced cell death in T lymphocytes”
The AASM also congratulates these four individuals who were recognized with the Young Investigator Honorable Mention Award:
Caris Fitzgerald, MD – University of Arkansas Medical Sciences
Norah Simpson, PhD – Beth Israel Deaconess Medical Center
Mauro Manconi, MD, PhD – Scientific Institute of San Raffaele
Rachel Markwald, PhD – University of Colorado
These award recipients were recognized Monday, June 13, 2011, in Minneapolis, Minn., during the AASM General Membership Meeting at SLEEP 2011.
The SLEEP 2011 abstract supplement, which contains all abstracts that were presented at the meeting in June, is now available as an online resource on the journal SLEEP website at www.journalsleep.org. For the last 25 years, the SLEEP meeting has linked the bench to the bedside with a robust scientific program involving basic, translational and clinical sleep research, and practical studies on the care of patients with sleep disorders. SLEEP 2011 continued in this tradition. More than 1,000 abstracts were presented this year in Minneapolis as scientific oral presentations and poster presentations. Each of these abstracts is included in the abstract supplement, which is only available online.
The American Board of Anesthesiology (ABA) announced that the American Board of Medical Specialties (ABMS) has approved the ABA's application for sponsorship of subspecialty certification in sleep medicine. The 2011 ABMS sleep medicine certification exam will be offered Nov. 10, 2011, by six member boards of the ABMS:
American Board of Anesthesiology (ABA)
American Board of Family Medicine (ABFM)
American Board of Internal Medicine (ABIM)
American Board of Otolaryngology (ABOto)
American Board of Pediatrics (ABP)
American Board of Psychiatry and Neurology (ABPN)
The 2011 ABMS sleep medicine exam is the final opportunity for physicians to apply under the Practice Pathway. Therefore, the AASM recommends that all eligible individuals sit for the 2011 exam. After this year, all first-time applicants will be required to complete a formal sleep medicine fellowship program before sitting for the exam.
To register for the 2011 sleep medicine exam, physicians must submit an application through the board in which they hold their primary certification. Please consult the website of the appropriate board for more details, including registration dates and requirements.
The average passing rate of the previous American Board of Medical Specialties (ABMS) sleep medicine certification exams is less than 75 percent. So the AASM recommends that exam applicants begin their preparations well in advance. In order to provide members with board preparation resources for this final Practice Pathway exam, the AASM will offer several Board Review for the Sleep Specialist courses leading up to the 2011 exam. The final courses scheduled for 2011 are:
Aug. 12–14, 2011, in Denver, Colo.
Sept. 9–11, 2011, in Reston, Va.
Additionally, on the Thursday before each course, two half-day companion courses will be held focusing on scoring and basic science. Get complete details on the AASM website at www.aasmnet.org/UpcomingCourses.aspx.
If you are unable to attend the AASM's Board Review for the Sleep Specialist course, then you can order the course's full content on a CD-ROM archive that includes MP3 audio files of the speaker presentations from the March 17–20, 2011, courses, as well as PDFs of all course PowerPoint presentations for review on your computer. The MP3 files included on this CD-ROM allow you to download files to your MP3 player, listen to presentations at your convenience through the use of audio bookmarking, and burn files to CD for use on-the-go.
The CD-ROM includes content from the AASM Board Review for the Sleep Specialist course as well as the two half-day companion courses: the AASM Intensive Scoring Review course and the SRS Basic Science of Sleep for the Sleep Specialist course. Over 25 hours of material' Order your copy today by going to the AASM website at www.aasmnet.org/store/OrderboardReview.aspx.
This fall, the AASM will host several educational courses at the AASM national office in Darien, Illinois (a suburb of Chicago). Registration is now open for several of these courses and space is limited; with many courses expected to sell out as physicians prepare to take the November sleep medicine certification exam, be sure to register early to reserve your space and save on registration fees:
Interpreting Sleep Studies (Sept. 23–24 or Sept. 25–26)
Pharmacology and Sleep Medicine (Oct. 1–2)
Workshops in Sleep Medicine: Portable Monitoring (Oct. 15)
Workshops in Sleep Medicine: CPAP Adherence (Oct. 16)
Board Review Practice Exams (Oct. 29 or Oct. 30)
Get more information about these courses and register online at www.aasmnet.org/events.aspx. Questions may be directed to the AASM meeting department at firstname.lastname@example.org or 630-737-9700.
The Coding Page of the AASM website at www.aasmnet.org/coding.aspx has been expanded to include a new Medicare Physician Fee Schedule Search Guide. This illustrated guide includes step-by-step instructions for looking up pricing information for a single HCPCS code or a series of HCPCS codes. Payment can be searched by locality to find the variation in reimbursement from region to region. Additionally, searches can be performed with or without modifiers to help determine the exact reimbursement for a service provided.
Between now and Jan. 1, 2012, physicians can anticipate frequent speculation from industry analysts about how Congress will address the next scheduled reduction to physician Medicare payments. With the Medicare sustainable growth rate (SGR) formula scheduled to cut the 2012 payments by approximately 29.5 percent, Congress will have to impose another short-term fix or develop a permanent solution.
Either option has substantial budget implications. President Obama's proposed 2012 budget calls for another short-term fix by maintaining the current payment levels for 2012 and 2013 at an estimated cost of $62 billion. In March the AASM and 130 other state and specialty medical societies signed a letter urging Congress to find a permanent replacement for the current SGR payment formula before 2012. However, replacing the current payment formula with modest increases in physician payments would cost a projected $350 to $370 billion over the next 10 years.
Although the federal Medicare Payment Advisory Commission (MedPAC) has the issue on its agenda, it isn't scheduled to make recommendations to Congress until October. The bottom line is that an atmosphere of uncertainty will continue to prevail while physicians await Congressional action that is unlikely to occur until the end of the year.
In response to the identification in the Office of Inspector General (OIG) 2010 and 2011 Work Plans of a rapid expansion of sleep study services, a Centers for Medicare & Medicaid Services (CMS) contractor has performed an analysis of billing practices for nine sleep study services. This analysis will be used to provide individual physicians with a Comparative Billing Report (CBR), which will address the services identified by the following CPT codes: 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399, and G0400.
It is the AASM's understanding that each of the top 5,000 billers of these services nationally will receive a document that identifies his or her specific billing practices in comparison with his or her peers on a local and national basis. There will be a preliminary release of the comparative information to identified physicians in New Jersey. Physicians in other states should expect to see a report by the first week of June.
The stated purpose of the CBR is to “inform sleep study providers of billing data for selected services billed to Medicare and to help prevent improper payments.” The CBR is an educational tool that compares an individual physician's provision of specific patient services. As noted in the report, “A statistically significant difference from your peers may be an indication of improper usage.” Please note that the emphasis (may be) is included in the report, and improper usage could be under- or over-use.
The AASM encourages each sleep center to develop and maintain a compliance program, and perform self audits to ensure that your center's documentation supports the services it has billed.
In May the AASM submitted comments to the Federal Railroad Administration on the proposed modification of duty hours for train employees who provide commuter and intercity rail passenger transportation. The AASM cautioned that hours of duty limitations also are necessary for other train employees; fatigue from inadequate sleep can affect the performance of personnel who provide critical maintenance and oversight, which also increases the risk of accidents. The AASM also advised that the regulations should be more specific in recommending that train employees have at least eight hours of off-duty “sleep time.”
On May 2, the Board of Medicine (Board) of the District of Columbia finalized its regulations for the practice of sleep technology. Previously, in March 2009, the District of Columbia City Council unanimously approved Bill 18-33, the “Practice of Polysomnography Amendment Act of 2009.” The bill establishes a scope of practice for sleep technology and establishes the licensure and registration requirements for a sleep technologist, technician and trainee in the District of Columbia. The Board, along with the newly created Advisory Committee on Polysomnography comprised of physicians and sleep technologists, was directed to develop the education and training standards for regulating the practice. View a summary of the new regulations on the AASM website at www.aasmnet.org/articles.aspx?id=2254.
The AASM conducted a successful Congressional Forum on Sleep Medicine in Washington, D.C., on May 4. The Forum was sponsored by Congresswoman Judy Biggert (R-IL), whose district includes the AASM national office, and it was attended by Congressional Health Policy staffers. The Forum educated lawmakers and their staff in the U.S. House of Representatives on the importance of effective sleep and the essential role of the sleep medicine and sleep research communities.
Presentations were by provided by five sleep experts:
Patrick Strollo, MD: What it takes to be a sleep medicine specialist and the role of the AASM
Nancy Collop, MD: The relationship between sleep and comorbid medical conditions, public health issues, and learning ability for school children
Sheri G Katz, DDS: Sleep apnea and oral appliance therapy
James Walsh, PhD: The importance of sleep related research
David Dinges, PhD: Fatigue management
The AASM thanks Congresswoman Judy Biggert for sponsoring this important program and appreciates the involvement of members who contacted your representatives and urged their attendance.
On May 10, Maryland Governor Martin O'Malley signed House Bill 560 (HB 560) and Senate Bill 641 (SB 641) into law. The bills, which have identical language, delay the licensing of sleep technologists until Oct. 1, 2013.
Existing statutory language required that after Oct. 1, 2011, individuals applying for sleep technologist licensure must first complete a CAAHEP program. Currently, there is only one CAAHEP-approved educational program in the state. HB 560 and SB 641 were passed to avoid a significant decrease in the availability of sleep studies in Maryland or having a large pool of unlicensed personnel practicing in spite of the law. The AASM and the American Association of Sleep Technologists (AAST) worked closely with the Maryland Sleep Society (MSS) on this important issue. The AASM and AAST provided written and oral testimony and attended hearings in the Maryland House Committee on Health and Government Operations and the Senate Committee Education, Health and Environmental Affairs. Find sleep technology policy and statutory language for all 50 U.S. states in the Legislation section of the AASM website at www.aasmnet.org/legislation.aspx.
The AASM congratulates medical director Richard A. Ferber, MD, and all of the staff at The Center for Pediatric Sleep Disorders at Children's Hospital Boston, which was recently recognized as the fifth AASM Comprehensive Academic Sleep Program of Distinction. This program recognizes academic sleep programs that have demonstrated excellence though compliance with rigorous standards in the areas of clinical service, educational mission and research accomplishments. Learn more about the program on the AASM website at www.aasmnet.org/programofdistinction.aspx.
Fellow status in the AASM is a unique honor that recognizes special competency in sleep medicine and significant contributions to the field. The AASM is pleased to welcome the following new Fellow Members:
Sabin R. Bista, MD, FAASM
Jasvinder P. Singh, MD, FAASM
If you are interested in becoming a Fellow member of the AASM, please review the requirements on the AASM website at http://www.aasmnet.org/Articles.aspx?id=292. All required documentation should be submitted to email@example.com. Please contact the AASM National Office at 630-737-9700 if you have any questions regarding your membership status.
The AASM thanks all members who voted in the Membership Section Chair Election and congratulates the following members who were elected as 2011-2012 section chairs:
Childhood Sleep Disorders & Development: Sanjeev Kothare, MD
Circadian Rhythms: James Wyatt, PhD
Insomnia: Don Townsend, PhD, LP, CBSM
Movement Disorders: Arthur Walters, MD
Narcolepsy: Eve Rogers, MD
Parasomnias: Milena Pavlova, MD
Sleep Deprivation: Siobhan Banks, PhD
Sleep Related Breathing Disorders: Kannan Ramar, MD
To encourage an interest in sleep medicine and sleep research at the high school level, the American Sleep Medicine Foundation (ASMF) sponsors an annual High School Topical Review in Sleep Science Contest. The contest recognizes excellence in the understanding of scientific research and in the preparation of a topical review paper related to sleep. The AASM congratulates the following winners of the 2011 contest:
Julia Deutsch, Scarsdale, N.Y.: 1st place – The effect of time of day on cognitive function in adolescents
Tailer Hensley, Utica, Ohio: 2nd place
Emily Mancini, Smithtown, N.Y.: 2nd place
Shana Zucker, Deerfield, IL: 2nd place
Camille Finn, Ossining, N.Y.: 3rd place
Tyler Senjem, Pine Island, Minn.: 3rd place
As the first-place prize winner, Ms. Deutsch received a $1,000 U.S. savings bond and a trip for her and a parent to Minneapolis, Minn., to attend SLEEP 2011. There she was recognized during the AASM General Membership Meeting. All of the contest entries have been published online in conjunction with this issue of the Journal of Clinical Sleep Medicine at www.aasmnet.org/jcsm.
The American Academy of Dental Sleep Medicine (AADSM) is accepting applications for its new Dental Sleep Medicine Facility Accreditation program. Facility accreditation is a voluntary process created to evaluate and recognize competency and delivery of optimal care to dental sleep medicine patients. Facilities that achieve accreditation illustrate to their patients, medical professionals and reimbursement decision-makers that they meet the high standards required to provide quality patient care.
Dental sleep medicine facilities that seek to earn accreditation through the AADSM must meet the quality measures outlined in the Standards for Accreditation of Dental Sleep Medicine Facilities, which aim to ensure that an accredited facility demonstrates proficiency, practice and professionalism regarding the treatment of patients with sleep-related breathing disorders. Application details and FAQ answers are available on the AADSM website at http://aadsm.org/DSMAccred.aspx.
In April the U.S. Food and Drug Administration announced the approval of Horizant Extended Release Tablets (gabapentin enacarbil), a once-daily treatment for moderate to severe restless legs syndrome (RLS). The effectiveness of Horizant was studied in two 12-week clinical trials in adults. The drug may cause drowsiness and dizziness and can impair a person's ability to drive or operate complex machinery. Horizant is the third drug approved by the FDA for the treatment of moderate to severe RLS, joining Requip (ropinirole) and Mirapex (pramipexole).
In December 2010 the U.S. Department of Health and Human Services included four sleep health objectives in “Healthy People 2020.” The new 10-year plan covers 42 topics and nearly 600 objectives for health promotion and disease prevention.
In March 2011 the Institute of Medicine of the National Academies (IOM) announced that it had identified one of these sleep health objectives as one of the 24 key objectives in the plan. In its “Leading Health Indicators for Healthy People 2020 – Letter Report,” the IOM chose the objective to “Increase the proportion of adults who get sufficient sleep” as one that warrants priority attention in the plan's implementation.
Annually, the Office of the Inspector General (OIG) publishes a work plan for the fiscal year. The 2011 plan, which can be downloaded in PDF format on the OIG website at http://oig.hhs.gov/publications/workplan/2011/, describes audits and evaluations underway and under development. The plan provides readers with insight into the main areas under investigation by the OIG and outlines the OIG's enforcement and compliance activities.
The work plan for 2011 includes a number of sleep-related initiatives:
Appropriateness of Medicare Payments for Polysomnography (Page I-17)
Medicare Payments for Sleep Testing (Page I-17)
Excessive Payments for Diagnostic Tests (Page I-17)
Geographic Areas With a High Density of Independent Diagnostic Testing Facilities (Page I-18)
Independence Diagnostic Testing Facilities' Compliance with Medicare Standards (Page I-19)
Life expectancy at birth increased to 78.2 years in 2009, up slightly from 78.0 years in 2008, according to preliminary 2009 death statistics reported by the CDC's National Center for Health Statistics in the March 16 issue of National Vital Statistics Reports. Women continued to have a higher life expectancy (80.6 years) than men (75.7 years).
The age-adjusted death rate for the U.S. population fell by 2.3 percent to an all-time low in 2009, marking the 10th year in a row that U.S. deaths rates have declined. Age-adjusted death rates dropped by 3.7 percent for heart disease, which remained the leading cause of death, and declined 4.1 percent for diabetes and 4.2 percent for stroke.
Results of a poll commissioned by Research'America show that 78 percent of Americans think federal funding for health research is important for job creation and the economy, and 83 percent agree that basic scientific research should be funded by the federal government. Now Research'America and more than a dozen partner organizations have joined forces for the 2011 launch of “Your Congress–Your Health,” a non-partisan constituent education initiative that asks members of the 112th Congress to share their positions on research and related issues. Learn more at http://www.yourcongressyourhealth.org/.
In April the National Heart, Lung, and Blood Institute (NHLBI) posted an executive summary of the workshop, “Defining Molecular Pathways and Mechanisms that Predict Cardiovascular Disease (CVD) Risk Associated with Sleep Disordered Breathing (SDB),” which was held in September 2010. It outlines specific scientific priorities in the areas of sleep, circadian and neuroendocrine mechanisms of energy metabolism; cardiovascular and SDB pathophysiology; and intermediate molecular markers of CVD and SDB. The summary also indicates that there is a need for training and re-specialization opportunities for established investigators in sleep and circadian biology. Learn more on the NHLBI website at www.nhlbi.nih.gov/meetings/workshops/.
In April the National Institutes of Health (NIH) posted its NIH Fiscal Policy for Grant Awards for Fiscal Year 2011. The notice (NOT-OD-11-068) indicates that NIH has been allocated a budget of $30.9 billion, which is nearly one percent less than the total fiscal year (FY) 2010 budget authority level of $31.2 billion. As a result, NIH will implement reductions in commitment levels for non-competing research awards. Modular and non-modular research grants from all NIH Institutes and Centers, with the single exception of the National Cancer Institute, will be reduced to one percent below the FY 2010 award level. Awards that have already been made in FY 2011 which are impacted by this policy may be revised. Some awards are exempt from the policy, so a careful review of the notice is advised.
For competing research awards, each NIH Institute and Center will manage its competing portfolio using funds that have not been committed for non-competing awards. It is estimated that this will allow for the support of the NIH investigator pool with approximately 9,050 new and competing Research Project Grants. Additional details on fiscal operations, including specific funding strategies, will be posted on the NIH website at http://grants.nih.gov/grants/financial/index.htm.
In March the National Institutes of Health released a new Strategic Plan for NIH Obesity Research to combat the obesity epidemic by encouraging diverse scientific investigations. The plan emphasizes the development of practical solutions by moving science from the laboratory to clinical trials, and it is designed to help target efforts and resources in areas most likely to help. Of potential interest to sleep and circadian researchers, the plan includes sleep and sleep disorders among various factors that contribute to obesity and its consequences. “The importance of sleep and the circadian ‘clock’ in obesity development is increasingly recognized,” the report states.
A funding opportunity announcement (RFA-DK-11-010) from the National Institutes of Health (NIH) will utilize the NIH Clinical Trial Planning Grant (R34) to support the development of clinical trials in individuals with type 1 diabetes. These trials should be designed to improve glycemic control and/or treat or reduce diabetes complications. Applications can focus on sleep health issues for children with T1D and their parents, especially in relation to the management of nocturnal hypoglycemia, and subsequent impact on memory consolidation, learning and school performance, as well as on parental stress. The earliest submission date is Feb. 15, 2012, and the application due date is March 15, 2012.
A funding opportunity announcement (FOA) issued by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) encourages Research Project Grant (R01) applications (PA-11-178) and Exploratory/Developmental Grant (R21) applications (PA-11-179) that propose to conduct mechanistic studies of the circadian rhythms involved in alcohol-induced organ damage. Selected examples of potential interest to sleep and circadian researchers may include: molecular mechanisms of how central or peripheral circadian rhythms are involved in alcohol-induced tissue injury; the role of clock genes and clock-controlled genes in alcohol-induced oxidative stress; and the role of circadian rhythm on alcohol's effects at different stages of development. Standard application due dates apply.
Get complete details about these grant opportunities on the NIH website at www.grants.nih.gov.