Sleep Disorders and Sleep Deprivation: An Unmet Public

Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem
http://www.nap.edu/catalog/11617.html
BUILDING SLEEP PROGRAMS IN ACADEMIC HEALTH CENTERS 307
any conclusions drawn from the analysis may be limited and may not transcend
every medical center.
Specific Questions and Methodology
The analysis addresses three specific questions: (1) Can sleep programs
generate revenue in excess of their costs? (2) Which revenue streams produce
the largest net revenue available for program development? (3) What
organizational structure maximizes control over resources for program
development? Parametric analysis applying the principles of operations
research was used to examine these three questions. Semistructured interviews
were conducted at five academic sleep programs with varying organizational
structures: Emory University, George Washington University,
Stanford University, University Hospital of Cleveland, and University of
Pennsylvania. The interviews dealt with the topics in Box 9-2. Financial data
were obtained from each program, and direct observations were performed,
including the provision of clinical services and the effect of teaching on
patient throughput. Major priorities of the analysis were to develop an
operational framework to categorize organizational structures, to delineate
specific constraints affecting sleep programs, to identify major cost structures
and major funding streams, and to develop a “business plan” for each
major organizational variant most likely to sustain or expand its program.
Direct Costs
The analysis identified three major direct costs: clinical services, teaching,
and research. Clinical services consist of obtaining a reliable clinical
history from a patient, determining what studies to conduct and, based on
findings, establishing a diagnosis and developing a treatment plan. Diagnostic
sleep studies are constrained by the fact that a sleep technician simultaneously
can run, at best, two studies. “Reading” of studies requires frequent
technician and clinician “calibration” for quality assurance purposes.
Most programs are able to generate approximately 30 readings a week per
full-time equivalent. Incorrect staffing ratios (e.g., medical assistant to provider
ratios lower than 2 to 1) often produce longer patient wait times,
which negatively affect patient throughput. No-show rates typically increase
beyond a 2-week “next appointment” wait time. The direct costs of performing
a sleep study are rising rapidly, primarily as a result of personnel
costs. The changes in direct service costs between 1994, 2000, and 2005 are
depicted in Figure 9-3.
The programs in the study taught medical students, residents, doctoral
students, sleep fellows, and postdoctoral fellows. Though many faculty
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