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 315
One of the board’s major goals was realized in 2005, when it was accorded
recognition as a bona fide subspecialty by the American Board of Medical
Specialties. The timetable calls for a 6-year transition period. By 2011, board
certification in sleep medicine will become available under the auspices of
the American Boards of Internal Medicine, Pediatrics, Otolaryngology, and
Psychiatry and Neurology. However, as discussed in Chapter 5, not all
clinicians will be eligible to sit for the exam. The ACGME only permits
accreditation of medical doctors; thus nurses, dentists, and doctorally prepared
sleep specialists (e.g., psychologists and behavioral health specialists)
in other fields will require alternative means of credentialing. It is possible
that this may continue to be performed through the American Board of
Sleep Medicine. Alternatively, other appropriate professional organizations
may wish develop their own standards.
Health Insurance Role in Improving Quality
Health insurance, whether private or public (e.g., Medicare or Medicaid),
is a driving force in health care delivery. Health insurance coverage
drives the types of services that are offered and the incentives under which
physicians operate. Health insurance coverage also influences who has access
to services and how consumers select and use them (Hillman, 1991;
Miller and Luft, 1994).
Health insurance coverage also influences the quality of care, often in
unintentional ways. For example, fee-for-service health insurance may promote
overuse of services—ones may not be necessary or that may expose
patients to greater harm than benefit. Conversely, managed care may promote
potential underuse of services from which patients might benefit (IOM,
2001). A major recommendation of the IOM report, Crossing the Quality
Chasm, was to use health insurance as a means to ensure development of
programs in quality improvement. Payment policies, the report recommended,
should be used to reward higher quality of care.
The concept of using payment methods to reward better quality of care
already has taken hold in many areas of medicine. It also is occurring in
sleep medicine. In several regions, private health insurers require as a condition
of reimbursement that sleep studies be conducted in accredited laboratories
or centers (AASM, 2006a).
NEXT STEPS
Continued clinical advances and growth of the field depends on the
appropriate emphasis and organization of academic sleep programs. These
structures require special attention, not only to diagnosis, but also to longterm
patient care that recognizes the need for chronic disease management
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