Sleep Disorders and Sleep Deprivation: An Unmet Public

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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 Copyright © National Academy of Sciences. All rights reserved.
Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem http://www.nap.edu/catalog/11617.html 308 SLEEP DISORDERS AND SLEEP DEPRIVATION BOX 9-2 Areas Addressed in Semistructured Interviews 1. A description of the program’s revenue stream(s) a. Tests, including polysomnograms b. Treatment protocols c. Clinical consults d. Other services 2. Approximate operating budget for: a. Number of staff i. Administrative ii. Technical support b. lll. Practitioners Number of beds allocated to sleep c. Equipment maintenance and upgrades d. Training and continuing education e. Basic and clinical research f. The amount and source of discretionary funds controlled by the sleep center director 3. What percentage of the center’s revenue goes to its parent department or division? 4. What percentage of the center’s revenue goes to other departments through cost-sharing agreements? 5. What percentage of the center’s operating budget does your sleep center receive from its parent department or division? 6. What are the challenges in working under the current system—does this create any barriers in care or service? 7. Are changes in the infrastructure needed? If so, why and what? taught these medical students, there was not a formal mechanism for offsetting the expense through tuition revenue sharing. This is a more substantial problem in administrative structures in which the academic hospital is a separate legal entity from the university. Although there is generally a formal revenue sharing arrangement between the university and the hospital, there is seldom a similar arrangement between the university and the medical faculty. Direct observations of programs being profiled here are consistent with findings of other studies that “teaching moments” increase the time spent for each clinical encounter by 20 to 30 percent. All programs examined for this study participated in fellowship training. Funding, with the exception Copyright © National Academy of Sciences. All rights reserved.
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Sleep Disorders and Sleep Deprivation: An Unmet Public

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