As telemedicine has evolved over the years, sleep medicine has advanced accordingly to incorporate the growing technologies into the field. As described by Barry Fields, MD, MSEd, an assistant professor of medicine at Emory University School of Medicine and a sleep physician at the Atlanta VA Medical Center in a recent interview with Pulmonology Consultant, sleep telemedicine first began as telephone calls between the patient and provider. Now, anyone with a smartphone and the appropriate app can participate in synchronous (real-time) sleep telemedicine. This development provides much-needed relief to an industry hampered by a significant shortage of board-certified sleep physicians, especially for patients who live in rural areas or who are homebound. Thus far, research indicates that the quality of care provided through sleep telemedicine rivals that of in-person visits.
With the technologies currently available, providers can perform initial evaluations and follow-up visits, interpret sleep studies, order treatment, and monitor adherence—all with synchronous or asynchronous telemedicine. The introduction of smartphone apps has brought video visits into the patient’s home, rather than requiring a trip to a local clinic. Fields and other physicians have noted that most of the tasks accomplished during an office visit can be addressed via telemedicine; sleep telemedicine is a tool being used more frequently to deliver care. The unique benefits of telemedicine include saving both the patient’s and provider’s time, which allows the physician to see more patients, and offering more flexibility in scheduling the patient’s consultation.
What if a sleep test or CPAP is needed? Some companies, such as Singular Sleep in Florida, work with a durable medical equipment arm that mails equipment to patients as needed. Troubleshooting and desensitizing are performed the same way as in a traditional practice—except over videoconferencing. In fact, says founder Joseph Krainin, MD, FAASM, it’s revolutionary because data can be downloaded by the physician remotely, and machine settings can be adjusted remotely as well.
Despite the growing acceptance of sleep telemedicine, Fields worries about reimbursement paradigms. In particular, Medicare has stringent rules that dictate which types of visits qualify for reimbursement, and some states do not have parity laws—in other words, they do not require telemedicine visits to be reimbursed at the same rate as the corresponding office visits. Until these issues are addressed adequately, explains Fields, sleep telemedicine will remain in limited locations with unequal payments for telemedicine and office visits.
Hopefully, as they consider payments for telemedicine, Medicare and our lawmakers won’t sleep on it too long.