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Volume 07 No. 04
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Editorial

President's Message

http://dx.doi.org/10.5664/jcsm.1180

Nancy A. Collop, M.D., F.A.A.S.M.
The Emory Clinic Sleep Disorders Center, Atlanta, GA

It is an incredible honor to be nominated and elected as the 26th president of the American Academy of Sleep Medicine. When I became an AASM member more than 20 years ago, the field of sleep medicine was on the cusp of two decades of remarkable growth that would take place in the 1990s and 2000s. The AASM was at the forefront of that progress, setting the clinical standards for the field and garnering recognition for sleep medicine as a medical subspecialty.

Today, the AASM continues to advance the field as the leader in setting standards and promoting excellence in sleep medicine health care, education and research. As a result, there has never been a better time to be a sleep specialist. Public education initiatives have dramatically increased our patient base by increasing awareness of sleep disorders and the negative health effects of sleep loss, and technological advances have improved the diagnostic and therapeutic tools that we can use to provide quality medical care for these patients. Although I personally experience the challenges of practicing medicine on a daily basis, I am grateful for the abundance of opportunities that I enjoy as a sleep clinician. The satisfaction of helping patients who have sleep disorders, teaching younger students and colleagues, and continuing to see the growth of our specialty all make each day worthwhile.

The other members of the AASM board of directors and I are truly committed to advancing the field of sleep medicine in the year ahead, and we are already working on a variety of initiatives related to the three pillars of the AASM vision: health care, education, and research. Several task forces have already been convened, and projects are underway that will have a significant influence on the practice of sleep medicine.

The AASM accredited a sleep disorders center for the first time in 1977, and today there are more than 2,250 AASM-accredited sleep disorders centers that are providing the highest quality of medical care for patients with disorders of sleep and daytime alertness. The AASM standards for accreditation have raised the bar for patient care at sleep centers in the U.S. and abroad, and many insurers have adopted AASM accreditation as their “gold standard” for reimbursement. However, as medicine in general—and sleep medicine in particular—has evolved, the goals of what these standards represent have changed. The health-care system is adopting a philosophy of clinical care that emphasizes measurable “quality” and “outcomes.” Therefore, the AASM will be taking a critical look at our standards to ensure that they reflect these changes. A task force led by President-elect Dr. Sam Fleishman will make recommendations to the board of directors for a process that will help us periodically review and revise the standards for accreditation to keep them in line with the ongoing push toward quality, safety, and outcomes.

In addition to seeing tremendous growth in the number of AASM-accredited sleep centers, the AASM also has expanded its accreditation programs. In the past year the AASM launched new accreditation programs for both non-Medicare DME suppliers and out of center sleep testing. Additionally, the American Academy of Dental Sleep Medicine recently launched a dental sleep medicine facility accreditation program. Together these programs give patients with sleep disorders confidence that they will receive the highest quality of care in virtually every aspect of their diagnosis and treatment. The programs also have sparked the interest of the Centers for Medicare – Medicaid Services (CMS) in the potential of an accreditation model that would integrate these programs together. As a result, we are currently working on a proposal for a partnership between the AASM and the Center for Medicare and Medicaid Innovation to test the effectiveness of an integrated delivery model for the treatment of sleep disorders. The recently established Innovation Center has the resources and flexibility to rapidly test innovative care and payment models while also encouraging widespread adoption of practices that deliver better health care at lower cost.

Another important way in which the AASM sets the clinical standards for the field is through the development of evidence-based practice parameters and consensus-based recommendations. Our Standards of Practice committee has produced dozens of practice parameters papers, clinical guidelines, and best practice guides that provide clear recommendations for the practice of sleep medicine. However, the process of developing these papers is incredibly resource intensive. It is an ongoing challenge to produce papers that are not conflicted by industry, have a sound base of evidence, and can be completed in an expeditious manner. Some of our papers have taken years to be finalized, which is frustrating to everyone who is involved. There are additional challenges related to “commissioning” authors on a volunteer basis; the experts in the field are usually senior clinicians who have very little free time to devote to such projects. Therefore, I have asked Dr. Tim Morgenthaler to head up a task force to bring recommendations to the board of directors on how to prioritize and develop practice parameters going forward. This analysis will help ensure that we continue to develop timely, relevant, and practical clinical standards for the field.

The International Classification of Sleep Disorders, Second Edition, which was published by the AASM in 2005, is the essential diagnostic and coding manual for the sleep field. It is hard to believe that the ICSD-2 is already six years old, and it is remarkable to consider how much new research has been added to the body of literature related to the diagnosis of sleep disorders during this time. To ensure that the manual remains current with recent findings and changes in the sleep field, I have asked Dr. Michael Sateia to coordinate a third edition. The ICSD-3 will reflect the new research in the sleep field, and it also will synchronize the sleep disorders diagnoses with the codes found in The International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). This is a critical part of the revision process, because the ICD-10 codes soon will have to be used by everyone who is covered by the Health Insurance Portability and Accountability Act (HIPAA) on all HIPAA transactions, including outpatient claims with dates of service and inpatient claims with dates of discharge on and after Oct. 1, 2013.

The coordination of an ICSD revision is a massive undertaking that involves a comprehensive literature review, multiple task forces, and scores of sleep experts. Dr. Sateia did an extraordinary job of navigating this complex process and pulling together the ICSD-2, and I am confident that he will be equally successful as the editor of the ICSD-3. Already he is organizing the expert subgroups that will revise and review the content for the new manual, and he has set an initial timeline that will hopefully lead to publication in 2013.

Other AASM task forces also are addressing current issues of importance to the field. I was the chair of a task force that performed a literature assessment and technology evaluation of obstructive sleep apnea (OSA) devices for out of center sleep testing. The resulting paper is undergoing final review and soon should be ready for publication. The Sleep Apnea Definitions task force, which is led by Dr. Richard Berry, is examining current respiratory definitions and will propose recommendations to clarify some of the rules in The AASM Manual for the Scoring of Sleep and Associated Events. Finally, a task force that will be led by Dr. Safwan Badr is developing a new clinical guideline for diagnostic testing for adult OSA, which will combine recommendations for both overnight polysomnography in a sleep laboratory and out of center sleep testing into one document.

In the next year the AASM also will build on the recent work of the AASM Presidential Task Force on the Future of Sleep Medicine. Under the leadership of my predecessor Patrick J. Strollo Jr., M.D., the task force and workgroups of thought leaders in the sleep field have been examining how changes in health-care delivery might impact the evaluation, management, and treatment of patients with sleep disorders. Their reports were compiled in an AASM white paper that addresses three key topics: frameworks for health-care delivery such as the patient-centered medical home (PCMH), patient registries, and new outcomes measures and tools for the diagnosis and treatment of sleep disorders. A draft of the paper was made available online for member comment, and the final version will be published soon.

Another issue of critical importance to the future of sleep medicine is the workforce. At the end of this year, the number of board-certified sleep specialists in the U.S. is likely to be higher than it will ever be again. The sleep medicine certification exam that will be offered in November by member boards of the American Board of Medical Specialties (ABMS) is the final opportunity for physicians to apply for the exam under the practice pathway, which allows candidates to take the exam without having completed a sleep medicine fellowship. Because there are less than 180 slots available in sleep medicine fellowship programs, the continued entry of physicians into the field will slow down considerably. At the next meeting of the AASM board of directors, we will be addressing this issue and considering a workforce survey to evaluate the real needs of the field and determine what the AASM should be doing to intervene. I also have begun to organize another task force to examine the potential for advanced practice nurses and physician assistants to play a greater role in the field of sleep medicine.

The future of sleep medicine is also dependent on scientific research, which advances our understanding of sleep and improves our ability to accurately diagnose and effectively treat sleep disorders. The AASM has invested about $10.5 million in the American Sleep Medicine Foundation (ASMF) since it was established in 1998, providing the funding for all of the foundation's administrative costs and most of the ASMF grants. Under the leadership of ASMF president Dr. Steven Shea and with the support of the AASM board of directors, the ASMF will continue to provide critical grant support for strategic research that will have a lasting impact on the sleep field.

Finally, I intend to work closely with our colleagues in other sleep societies—including the Sleep Research Society, the American Academy of Dental Sleep Medicine, the Society of Behavioral Sleep Medicine, and the American Association of Sleep Technologists—to collaborate on projects that will be mutually beneficial. I value these close working relationships, and I hope that all of us can work together to continue moving sleep medicine forward in the year ahead.

With so many projects and initiatives running concurrently, it is important to keep AASM members informed about all that is happening. As I meet with leaders from CMS, the National Institutes of Health (NIH), and other organizations and societies, I will try to update you regularly about what is taking place and where we are heading. I also am providing regular updates, thoughts and commentary in HypnoGram, a blog that is available to members on the AASM website at www.aasmnet.org. I hope to serve you well as AASM president and encourage you to provide feedback by emailing me at ncollop@aasmnet.org.