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Blog Feature

By: AAST Editor on September 6th, 2018

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Matthew Anastasi on Management of Complex Patients in the Sleep Lab

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Outlook best July 2015Matthew Anastasi, BS, RST, RPSGT, is presenting the breakout session "Management of Complex Patients in the Sleep Lab: The Implications of Severe Obesity” at the AAST 2018 Annual Meeting, Sept. 28-30, 2018, in Indianapolis. We caught up with Anastasi to discuss his background and the future of sleep medicine.

What is your background, and how did you get involved in the sleep field?

I was lucky to have completed a psychology program at Mount St. Mary's University that strongly emphasized experimental and clinical approaches to science through a capstone research project and counseling internship, respectively. In retrospect, this undergraduate background was the ideal setup for my first position in the sleep field as a clinical research technologist at the University of Pennsylvania. 

Over the following 20 years, the research-based understanding I gained would serve as a basis for each of the roles I have held in the field, including lab manager, clinical coordinator and chief technologist, as well as the volunteer leadership roles at the Pennsylvania Sleep Society, Committee on Accreditation for Polysomnographic Technologist Education (CoA PSG), and, of course, AAST.

What is the topic of your session? What will attendees take away from it?

"Management of Complex Patients in the Sleep Lab: The Implications of Severe Obesity," is a breakout session scheduled for the final morning of the conference. By highlighting obesity as the comorbid patient condition, due to the prevalence of the disorder, the presentation follows the cascading effects of the disease on the clinical preparations, practical lab operations and financial opportunities that impact the sleep disorders center.

The objective is for our conference attendees to develop a more complete picture of how presenting patient complexities, which we all agree are on the rise among the populations that we serve, call for a more robust model of care for the intake, preparation and accommodation of patients. The hope is that the talk will provide strategies, spur discussion and a sharing of ideas that will allow sleep professionals to hit the ground running upon returning to their labs and clinics to address a latent need for enhanced care team "touch points" using this model.

What is the biggest challenge you see sleep professionals facing currently?

This is very related to the topic of complex patients. Changes in healthcare delivery have created an urgency in the field of sleep technology to evolve in some predictable and unpredictable ways: It was expected that the trend toward insurance pre-authorizations would slash reimbursement and push in-lab tasks to the in-home setting. This trend has had a similar effect in other fields; however, we have also seen dramatic increases in a) the diversification of sleep technologist roles; b) the acuity of patients that are contraindicated for in-home care; c) the need for a multidisciplinary approach to referrals and treatment of sleep disorders; d) regulatory oversight; and e) collaboration required among in-lab, industry, inpatient, clinic, physician practice and home care DME staff to "close the loop" on an increasingly complex clinical care pathway. These are downstream effects of the changes and present a big challenge, indeed!

How do you see the field changing in the next few years? 10 years?

In order to negotiate these challenges, an expanded set of risks, skills and roles to face these challenges should become formalized over the next few years. Much of this can be addressed by increasing the level of competency of the average tech through prior education and credentialing. There are 40 and growing CAAHEP-accredited post-baccalaureate programs in polysomnography. Meanwhile, state licensures, employers, as well as provider requirements are settling on RPSGT as the gold standard credential for sleep techs. Moreover, there is a call for the field to support more specialized roles and move from a "trade" to a "profession" approach to staffing.

Within the next 10 years, the diagnostic testing model as we know it will have been replaced by a model that rewards solely based on patient outcomes: We will be reimbursed for patients that get healthy and penalized for patients that do not.