Turning your nights from ZZZZs to $$$$
Turning your nights from ZZZZs to $$$$
ASC finds overnight success with sleep program
How can you make money in the dead of night when your ORs are shut down and your staff are at home asleep? Create a sleep center as an adjunct to your surgery center, advises Gerald Mazzola, administrator of North Shore Surgi-Center in Smithtown, NY.
Sleep disorders and surgery may seem like an unusual combination, concedes Mazzola. But in fact, they fit together well, both in clinical and practical ways, he says. The center will be profitable in its first year -- and is expected to eventually produce a gross profit even greater than the surgery center, he says.
"At 5 o'clock at night, we go home and our facilities are not used," he says. "Why not use the facility more efficiently and provide a need that's not met?"
Mazzola's interest in sleep began when physicians at the center began performing laser-assisted uvula palatoplasty (LAUP) to treat snoring. (For more information on LAUP, see Same-Day Surgery, September 1994, p. 122.) With the LAUP, otolaryngologists remove tissue from the uvula and soft palate, which reduces the vibration and resonance that causes the snoring.
"That was only one piece of what was a real complicated problem [of sleep disorders]," says Mazzola.
Mazzola saw an opportunity to provide a needed service in the community, as well as an after-hours revenue source. The potential patient base is huge. An estimated 40 million adults suffer from chronic sleep disorders, and another 20 million have intermittent sleep problems.1 That category includes insomnia, narcolepsy, and obstructive sleep apnea, in which people momentarily stop breathing.
"A lot of people suffer from sleep disorders, and there are very few places available to treat them," says Raymond P. Walsh, CRTT, executive director of the sleep center.
Sleep center requires small staff
In creating the Long Island Sleep Center, Mazzola took a comprehensive approach to treating sleep disorders. But such an effort need not be difficult or expensive, he says.
The sleep center has a small staff of an executive director who is a respiratory therapist specializing in sleep disorders and an executive secretary. Sleep technicians, who are registered nurses or respiratory therapists, work on a per-case basis, Mazzola says. Patients are referred to otolaryngologists, pulmonary specialists, dentists, and other physicians for consultations and treatment, he says.
Patients often become acquainted with the sleep center through free seminars that are offered about two evenings a month in the center's marbled lobby. The seminars are led by a sleep specialist associated with the center and are advertised in local newspapers and radio spots. They attract as many as 40 to 50 people. Sometimes the sleep center brings the free seminars to area businesses, Walsh says.
Walsh provides attendees with brochures about the center, and he follows up with a phone call to see if they need further information or assistance.
Many patients at the seminars may have minor problems; they may receive enough information to solve their own sleep problems without further intervention, Mazzola says. For example, sleep problems may be the result of stress or weight problems.
"If you lose 10 pounds, that could be the difference between snoring and not snoring," he says.
For many others, though, the problem is not so simple. The sleep center provides patients with referrals to a physician trained in handling sleep problems. For example, an otolaryngologist may perform an upper airway exam to check the patient's nose and sinuses.
Patients then may be referred back to the sleep center for a study called a polysomnogram. That nightlong computerized test measures 12 to 16 parameters, including respiration, muscular activity, oxygen level, and EKG. The test determines, for example, whether the patients are getting REM sleep or are suffering from sleep apnea.
"It's at that point that we really begin to understand how to treat the patient," says Mazzola.
The patient falls asleep at night in the center and is observed and monitored by the technician. The analysis is submitted to a specialist knowledgeable about sleep problems, usually either a pulmonologist or otolaryngologist. The sleep center charges $1,200 for each polysomnogram.
Some need dental, respiratory devices
The types of treatment required to resolve the snoring or sleep problems varies greatly. Some patients will need a dental device to eliminate the noise. Others need a specially fitted device called a C-PAP (continuous positive airway pressure) to provide oxygen throughout the night.
The sleep center has a dental director who can provide the oral appliances some patients need. And the center provides the C-PAPs, although Mazzola notes that some sleep centers could contract with a home health agency to provide the device.
"It's a team approach," says Walsh. "That's what makes the center very unique. Sleep is a very complex problem, but we've developed a good comprehensive solution to it with a wide variety of physicians."
About 10% to 20% of patients have otolaryngological or pulmonary problems for which surgery is appropriate, Mazzola says. That aspect makes the sleep center a good match for an ambulatory surgery center, he says.
"You're feeding into your basic business," he says. "You're making referrals to your ENT physicians."
ASCs can open a sleep center with minimal capital investment, Mazzola says. Mazzola initially thought he could use his recovery room beds for sleep patients, but he determined that those patients need a home-like environment in order to fall asleep.
His solution: a Murphy bed that folds into the wall during the day. "We create a very attractive bedroom in our step-down unit," he says. "We bring in a VCR and television set. All of our patients have been able to fall asleep."
Mazzola spent $2,000 for the bed and construction to fold it into the wall, and $75,000 for the polysomnography equipment. Mazzola says he was able to cover his investment within six months.
"After six months, I'm putting in a second bed because there's more business than I can handle," he says.
For centers that want even less risk, "there are companies that will provide equipment at no cost to the surgery center and will share revenues," he says. Or surgery centers can arrange to lease rather than purchase the equipment. The sleep center was formed as a new corporation, Long Island Sleep Associates, with ownership divided among surgery center partners and area sleep specialists. The sleep center maintains a contractual agreement with the surgery center for facility rental, billing, marketing, and administrative support. Keeping a distinct ownership insulates the surgery center from liability, profit/loss, and quality-of-care issues, Mazzola says.
Mazzola and Walsh have met with representatives of managed care organizations and have been able to arrange for coverage of the services. Again, relationships with the surgery center helped forge important links for the sleep center, Mazzola says. Many of the managed care companies were willing to add the CPT codes for sleep disorders as an addendum to the surgery center's contract, Walsh says. Managed care companies also have become more interested in providing coverage as the field has gotten attention from consumers and employers, Walsh says.
In addition to marketing its services through the seminars, the sleep center also has advertised on the radio.
"Our motto is that we provide a comprehensive solution to a complex but common problem," Mazzola says. "It really is a major commitment to sleep and the patient."
Reference
1. National Commission on Sleep Disorders Research. Wake Up America: A National Sleep Alert. Submitted to the United States Congress and to the Secretary of the U.S. Department of Health and Human Services. Washington, DC; 1993. *
For more information about creating a sleep center, contact:
* Gerald Mazzola, Administrator, North Shore Surgi-Center, 989 W. Jericho Turnpike, Smithtown, NY 11787. Telephone: (516) 864-7100. Fax: (516) 864-7129.
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