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Volume 07 No. 05
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Sleep Medicine News and Updates

Sleep Medicine News and Updates

The AASM Standards for Accreditation of Sleep Disorders Centers have been revised and updated to reflect several changes as of August 2011:

  • Standard B-8 – Registered Sleep Technologist: This standard now states that registry examinations accepted by the AASM are those that are offered by the American Board of Sleep Medicine (ABSM), the National Board of Respiratory Care (NBRC), and the Board of Registered Polysomnographic Technologists (BRPT). The standard still requires that the registered sleep technologist be present at the facility for a minimum of 30 hours per week. However, for sleep centers that are open fewer than 40 hours per week, the standard now states that the registered sleep technologist must be present at the facility 75 percent of the time.

  • Standard B-9 – Non-registered Sleep Technologist: This standard also has been updated to reflect the AASM’s acceptance of the registry exams offered by the ABSM, NBRC and BRPT.

  • Standard B-11 – Sleep Technician and Technologist Additional Certification: This standard no longer names specific providers of cardiopulmonary resuscitation (CPR) certification. This change allows medical directors to select the local CPR certification program that is most appropriate for their staff.

  • Standards F-6, F-7, F-8, and F-9 – Inter-scorer Reliability: These standards now indicate that the requirement is fulfilled by use of the AASM Inter-scorer Reliability program.

The revised AASM Standards for Accreditation of Sleep Disorders Centers are available for download on the AASM website at www.aasmnet.org. Contact the Accreditation Department at accreditation@aasmnet.org or 630-737-9700 if you have any questions about AASM accreditation.


The Journal of Clinical Sleep Medicine (JCSM), the official peer-reviewed publication of the American Academy of Sleep Medicine (AASM), is a free benefit of AASM membership and a valuable educational tool for individuals interested in the clinical practice of sleep medicine. Published bimonthly, each issue includes original manuscripts including clinical trials and reviews, commentary and debate, medical economic/practice perspectives and case reports.

The JCSM Editorial Board remains committed to publishing relevant science for its readers, but must also address increasing printing and postage costs. Starting with the 2012 volume year, JCSM will transition to an online-only resource. AASM members will enjoy full access to the current online issue and journal archives and may choose to purchase Kindle versions or printed copies of the journal at www.aasmnet.org/jcsm.


On Tuesday, Aug. 9, the AASM sent a comment letter to the Centers for Medicare – Medicaid Services (CMS) outlining concerns regarding the 2012 Physician Fee Schedule Proposed Rule. The AASM comment letter focuses on the following four issues:

  • Decrease in RVUs for Home Sleep Testing: The Proposed Rule suggests that the practice expense (PE) relative value units (RVUs) for codes 95800 and 95801 will be cut significantly. The proposed cuts are close to 27 percent and 18 percent. Following conversations with CMS and American Medical Association (AMA) staff, it is the understanding of the AASM that these cuts are a result of CMS using an inappropriate specialty blend to calculate the new practice expense figures. The AASM comment letter outlines these concerns and suggests an alternative calculation that would result in a far less drastic cut.

  • Decrease in RVUs for code 95810: The Proposed Rule indicates that the PE RVUs for code 95810 may decrease by 6 percent. This change would result in the total RVUs for code 95808 being higher than the total RVUs for code 95810, which is inappropriate because code 95810 reflects a service that requires more labor and equipment than code 95808. The AASM comment letter requests that CMS increase the PE RVUs for code 95810 so that the total RVUs for 95810 are greater than the total RVUs for code 95808.

  • Changes to the Conversion Factor: The Proposed Rule indicates that the conversion factor is expected to be cut by 29.5 percent in 2012. This proposed cut is mandated by law as a result of the sustainable growth rate (SGR) formula. The AASM comment letter stresses the catastrophic strain that such a cut would put on AASM membership and urges CMS to push for a long-term solution.

  • Inclusion of the Sleep Apnea Measures Group in the 2012 PQRS Program: The Proposed Rule reflects inclusion of a sleep apnea measure group in the 2012 Physician Quality Reporting System (PQRS) Program. The AASM comment letter thanks CMS for including sleep measures in this program.

The AASM will continue to update members regarding further communication with CMS.


In January, the AASM announced that the Centers for Medicare – Medicaid Services (CMS) approved the establishment of a physician specialty code for sleep medicine. The original approval letter from CMS indicated that the code would be established after October 2011.

In an email received Sept. 8, staff from the CMS Provider Enrollment Operations Group notified the AASM that the establishment of the specialty code has been delayed. CMS staff cited system implementation issues, which will prevent the code from being established until April 2012. The AASM will continue to keep members updated regarding this important issue. Once the specialty code has been established, members will be provided information about how to change their specialty information with CMS.


On Friday, Aug. 19, the Centers for Medicare – Medicaid Services (CMS) announced that it will expand the durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) competitive bidding program, which is used to set prices for DME. Among the product categories for Round Two are continuous positive airway pressure (CPAP) devices and respiratory assist devices (RADs) and related supplies and accessories. Bidding for Round Two, which will expand the program from nine cities to 91 areas, will begin this fall.

Pricing based on Round One of the program was implemented Jan. 1, 2011. According to CMS, this revised pricing has yielded a savings of 35 percent to date. Round Two bidding will result in changes to pricing that will be implemented July 1, 2013. CMS anticipates that the competitive bidding program will result in savings of $28 billion. Round Two bidding may result in decreases to reimbursement for CPAP and related supplies and accessories. However, any estimation of the exact amount of the decrease would be speculative at this time.

Specific information about the competitive bidding process, including a list of the 91 areas participating in Round Two, can be found at www.dmecompetitivebid.com.


In the Sept. 6 Federal Register, the Centers for Medicare and Medicaid Services (CSM) published a final rule describing changes to the eRx Incentive Program. Beginning in 2012, providers who do not successfully prescribe electronically per CMS requirements will receive a penalty, also known as a payment adjustment, of −1 percent of allowable charges. This adjustment is projected to increase to −1.5 percent in 2013 and −2 percent in 2014.

Providers who believe they cannot meet the requirements of the eRx incentive program due to hardship can apply for exemption from the eRx program. Major changes to the eRx program, as outlined in the final rule, include the addition of new hardship exemption categories as well as an extension of the deadline to submit a hardship exemption request. The exemption deadline is now Nov. 1, 2011.

Based on feedback that the AASM has received, many members plan to apply for a hardship exemption in one or more of the six categories that are described in the final rule, which also outlines the Web-based system that will be used for submission of exemption requests. The AASM will continue to monitor the CMS website and will notify the membership once the system is available.


A new pocket-sized supplement to the AASM’s International Classification of Sleep Disorders—Second Edition (ICSD-2) is now available through the AASM. The Coding Supplement provides facilities with a user-friendly crosswalk between the diagnoses in the ICSD-2 and the billing codes found in the International Classification of Diseases, Ninth Revision, Clinical Modifications (ICD-9-CM). Physicians and coding staff will find this resource to be indispensable as a quick reference when billing sleep medicine services.

The 25-page Coding Supplement mirrors the content of the ICSD-2 and includes a table of ICD-9-CM codes with references to the ICSD-2. For more information about this new product, and to order, visit the AASM Online Store at www.aasmnet.org/store. Questions about this product may be directed to the AASM by sending an e-mail to orders@aasmnet.org or by calling 630-737-9700.


Order the full content of the AASM’s Board Review for the Sleep Specialist course 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 Online Store at www.aasmnet.org/store.


From 2007 through 2009, the AASM hosted several live, online webinar series covering topics related to the blueprint of the American Board of Medical Specialties (ABMS) sleep medicine certification exam. Several of these presentations have been remastered to improve audio quality and compatibility with the AASM Online Learning Modules, which allow members to stream multimedia presentations on demand from the AASM website. The presentations were led by experts in the field and are grouped into several series of related topics:

  • Board Review Study Sessions

  • Board Review for the Nonspecialist

  • Board Review Trouble Spots

  • Case-Based Board Review

The board review webinars are now available for purchase through the AASM Online Store at www.aasmnet.org/store. Members may purchase the presentations for 3-day, 30-day or 1-year access.


View and discuss nearly 250 of the top scientific abstracts presented as posters at SLEEP 2011, the 25th Anniversary Meeting of the Associated Professional Sleep Societies LLC (APSS), through the SLEEP 2011 Online Poster Viewing Website at www.sleepmeeting.org/PosterViewing.aspx. Each poster on this site is viewable in PDF format, and a comments area allows for interactive discussion of the science presented at the meeting. Access to the online posters is FREE for AASM and Sleep Research Society (SRS) members who attended SLEEP 2011. All other individuals may purchase access to view the posters for $25, providing unlimited access to the site until Nov. 30, 2011.


Visit the American Sleep Medicine Foundation website at www.discoversleep.org to read about how the ASMF is making a difference through research, education and humanitarian aid. The new “Success Stories” highlight individuals and organizations that have received an ASMF grant or award. For more than a decade, the ASMF has been enhancing sleep health for all, awarding nearly $5 million in grants since its inception. These stories are just a few examples of how the ASMF is advancing the fields of sleep medicine and sleep research. Look for additional stories to be posted on the website in the near future.


The new American Board of Sleep Medicine (ABSM) Sleep Technologist Registry Examination will be offered for the first time Nov. 11, 2011. All practicing sleep technologists who have passed the Board of Registered Polysomnographic Technologists (BRPT) examination prior to Dec. 31, 2011 - and are a Registered Polysomnographic Technologist (RPSGT) in good standing - are eligible to apply for equivalency status and receive the Registered Sleep Technologist (RST) certification by the ABSM. RPSGTs must submit an application for the Registered Sleep Technologist certificate to the ABSM before March 31, 2012. Get complete details on the ABSM website at www.absm.org/techcertification.aspx.


New York Assembly Bill 354 (AB 354), which establishes “authorization” for sleep technologists, was signed into law by Governor Andrew Cuomo on Aug. 4, 2011. The bill requires an individual performing sleep procedures to obtain an authorization certificate issued by the State Education Department.

The AASM has been working with the New York State Society of Sleep Medicine (NYSSSM) over the past 10 years to pass this licensure bill. Now that AB 354 has been enacted, the AASM will assist the NYSSSM on developing the regulatory language.


Recently the Agency for Healthcare Research and Quality released “Comparative Effectiveness Review of the Diagnosis and Treatment of Obstructive Sleep Apnea in Adults,” the latest report from AHRQ’s Effective Health Care Program. The systematic review included 234 clinical studies published through September 2010.

The report concluded that portable monitors can predict a diagnosis of OSA. However, additional studies are needed to prove their value compared with polysomnography (PSG). The effectiveness of continuous positive airway pressure (CPAP) therapy was backed by the strongest evidence. Although mandibular advancement devices (MADs) also were shown to be effective, CPAP was found to be superior to MAD in achieving an apnea-hypopnea index (AHI) of five events per hour or less.

The report did not find enough evidence to determine if surgery is more or less effective than non-surgical treatments. However, some individual studies do show that specific surgical interventions are effective.


In July the Agency for Healthcare Research and Quality reported that a recent study funded by the AHRQ revealed that very few primary care clinicians (PCCs) routinely screen for obstructive sleep apnea (OSA). The study, which was published in The Journal of the American Board of Family Medicine, gathered information from 44 randomly selected practices in five regional, practice-based research networks.

The study found that only 10 of the 44 PCCs (23 percent) who were interviewed said that they routinely screen patients for OSA. Only 14 of the 45 PCCs could identify 25 patients in their practices with OSA despite using multiple methods and having three months to do so. One PCC admitted to never having identified a patient with OSA, and four practices could not identify a single patient with a known diagnosis of OSA.


Due to new risk screening criteria required by the Affordable Care Act, providers/suppliers who enrolled in the Medicare program prior to March 25, 2011, will be required to revalidate their Medicare enrollment. Providers/suppliers who enrolled in Medicare after March 25, 2011, have already completed the risk screening process.

Medicare Administrative Contractors (MACs) will contact providers/suppliers between now and March 2013 with revalidation requests. Providers/suppliers are required to complete the revalidation process within 60 days from the date of the letter from their MAC. Medicare has asked that providers/suppliers do not revalidate until asked to do so by their MAC. Revalidation will require completion and submission of enrollment forms. Revalidation can be done using the Internet-based Provider Enrollment, Chain, and Ownership System (PECOS).


Recently the U.S. Department of Health and Human Services issued an updated Final Rule on conflict of interest, providing a framework for identifying, managing, and ultimately avoiding investigators’ financial conflicts of interest. Staff from the National Institutes of Health worked with others in HHS to revise the 1995 regulations to update and enhance the objectivity and integrity of the research process, according to an NIH press release. The rules follow a series of cases that involved a failure to disclose millions of dollars, The Washington Post reported.

Major changes to the regulations include the definition of significant financial interest (SFI), the extent of investigator disclosure, the information reported to the Public Health Service (PHS) awarding component, the information made accessible to the public, and investigator training. For example, the new regulations lower the monetary threshold at which significant financial interests require disclosure, generally from $10,000 to $5,000. The regulations will be implemented no later than 365 calendar days after the final rule is published in the Federal Register.


In July the U.S. Department of Health and Human Services announced that the federal government is contemplating various ways of enhancing the regulations overseeing research on human subjects. The regulations have been in place since 1991 and are often referred to as the Common Rule.

The changes under consideration can be found in an Advance Notice of Proposed Rulemaking (ANPRM), “Human Subjects Research Protections: Enhancing Protections for Research Subjects and Reducing Burden, Delay, and Ambiguity for Investigators,” published in the July 25 Federal Register.


Recently the National Heart, Lung, and Blood Institute (NHLBI) posted an executive summary of a Sept. 9, 2010, workshop on Pediatric Sleep Disturbances and their Contribution to Developmental Pathophysiology of Cardiometabolic Risk. Recommendations include targeting research to define the contribution of sleep-disordered breathing (SDB) to cardiovascular pathophysiology, validate cardiovascular biomarkers as surrogate endpoints for subsequent clinically significant disease in children with obstructive sleep apnea (OSA), and define the mechanistic links and test the direction of the causal association between SDB effects on pathological mechanisms of cardiometabolic disease (CMD). The summary also calls for research to evaluate developmental changes in sleep duration and timing from conception through adolescence and their links to a variety of pediatric health outcomes.


The National Heart, Lung, and Blood Institute (NHLBI) hosted a working group June 17, 2011, to discuss research areas that could be addressed by a possible continuation of the Coronary Artery Risk Development in Young Adults (CARDIA) Study. One high priority recommended by the group is, “An assessment of sleep disordered breathing with a non-invasive home-based monitor and the administration of sleep questionnaires.” A Future Research Opportunities in the CARDIA Study executive summary is available on the NHLBI website.


Recently the National Heart, Lung, and Blood Institute announced (NOT-HL-11-153) that it is no longer making new awards using the Method to Extend Research in Time (MERIT) Award (R37) funding mechanism. The decision was based on the unanimous recommendation of the National Heart, Lung, and Blood Advisory Council at its June 15, 2011, meeting. The NHLBI will maintain its commitment to existing R37 awardees. All active awards and requests for extensions will be processed in the usual manner.


Recently the National Heart, Lung, and Blood Institute (NHLBI) announced that it will no longer accept investigator-initiated, exploratory/developmental grant (R21) applications in response to the National Institutes of Health’s Parent Funding Opportunity Announcement (FOA), NIH Exploratory Developmental Research Grant Program (Parent R21). Investigator-initiated R21 applications will not be accepted for review and funding beyond Fiscal Year 2012. Therefore, the last receipt dates for NHLBI investigator-initiated R21 grant applications are Oct. 16, 2011, for new applications and Nov. 16, 2011, for resubmission (amended) applications. Individuals who submit a new investigator-initiated R21 application for the Oct. 16, 2011, receipt date will not be allowed to revise and resubmit their applications.


From 2000-2006, black applicants were 10 percentage points less likely than white applicants to be awarded research project grants from the National Institutes of Health after controlling for factors that influence the likelihood of a grant award, according to an NIH-commissioned study in the journal Science. In an accompanying commentary, NIH Director Francis Collins, MD, PhD, and Principal Deputy Director Lawrence Tabak, DDS, PhD, call the findings unacceptable and commit to immediate action by the NIH.

In response to the study, NIH has developed and is implementing a framework for action. To learn more about this study and to provide additional suggestions about causes and remedies, visit the NIH Director’s Page at www.nih.gov/about/director/index.htm and NIH Feedback website at http://feedback.nih.gov/.


The National Institutes of Health (NIH) announced a research project (R01) grant (PAR-11-314) and an exploratory/developmental (R21) research grant award (PAR-11-315) for “Systems Science and Health in the Behavioral and Social Sciences.” Both grants include numerous topics related to sleep and sleep disorders as potential areas of interest. Standard application due dates apply.

The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) issued a funding opportunity announcement (RFA-HD-12-209) for the Pediatric Scientist Development Program (K12). The program will be responsible for identifying pediatricians who have completed their clinical training and have promising research potential, and for matching them with established mentors with a strong record of research productivity. The application due date is Nov. 22, 2011.

The Basic Behavioral and Social Science Opportunity Network (OppNet) of the National Institutes of Health (NIH) issued a funding opportunity announcement (RFA-MH-12-130) for research that increases the understanding of basic cognitive, affective, motivational and social processes that influence decision making. “Basic Research on Decision Making: Cognitive, Affective and Development Perspectives” encourages researchers to explore the interactions among the psychological, neurobiological and behavioral processes in decision making and the mediating or moderating influences of genetics, physiology, the social environment and culture. Applications are due Jan. 18, 2012.

Other new funding opportunities recently announced by NIH include the 2012 NIH Director’s Pioneer Award Program (RFA-RM-11-004) and the 2012 NIH Director’s New Innovator Award Program (RFA-RM-11-005), as well as the Short-Term Research Education Program to Increase Diversity in Health-Related Research (RFA-HL-12-031) and the Global Health Program for Fellows and Scholars (RFA-TW-11-001).

Get complete details about these grant opportunities on the NIH website at www.grants.nih.gov.