Taking Care of Business

Tips for starting a successful sleep scoring outsourcing service

By Kristen Ziegler

A sleep diagnostic center's success greatly depends on how quickly it can generate accurate results. As the demand for sleep testing rises, often so does the backlog of studies

to score.

This presents an enticing opportunity to well-trained polysomnographic technologists interested in launching an independent company that provides sleep scoring services. However, it will take much more than a computer and an entrepreneurial spirit to get started.

The first step is to clearly understand your clients' needs and expectations. When sleep centers choose an outsourcing service, they are paying for someone else to handle personnel concerns such as managing and retaining sleep technologists, said Christopher P. Mathews, LRCP, president and chief executive officer of NorthStar Associates, PLLC, which has a sleep disorders center in Bellingham, Wash. What they expect, though, is quality service customized to their individual needs.

Some sleep centers want scoring services to function as flexible staffing, filling in when the center receives an influx of patients. Others want a partner that can process a consistent amount of studies. Either way, identifying what type of clients your business will serve should be paramount.

"If you are going to do this long term and both sides are going to be happy, there has to be a compelling fit," Mathews said.

Customizing services

Next, you should have a lengthy discussion with any potential client about your scoring criteria. While the American Academy of Sleep Medicine's scoring guidelines have streamlined many standards, variances still exist — even among sleep technologists practicing in the same center. Be sure to ask about the nuances desired by the sleep center's physicians.

At the Sleep Disorders Center at University of New Mexico, Albuquerque, for example, physicians who specialize in neurology may focus more on the electroencephalography criteria, said Nancy L. Polnaszek, MBA, unit director at the facility. Scorers must learn how physicians like to have studies scored and adjust accordingly.

Any discrepancies can be resolved by following the new AASM scoring guideline requiring scorers to document the rules used to score a study, said Natalie Morin, RPSGT, president and chief

executive officer of a sleep scoring company. That helps interpreting physicians understand the criteria used on a patient study.

A scoring service also should inquire about the center's desired level of oversight, Mathews said. "Does the medical director want the ability to overscore and look over the whole study, or does he just typically want to look over the high points of the study and have a certain trust in the study? That is really up to the discretion of the medical director."

A matter of trust

Building your company's credibility and trustworthiness is vital. When Mathews contracted with a sleep scoring service five years ago, he asked about the company's financial stability, size, and what practices they used for accounting and legal purposes. Then he reviewed their business operating agreements.

Be prepared to provide at least three references who can attest to your company's expertise, professionalism, and responsiveness to concerns, Mathews said. "These are all elements that come into play in business expertise and longevity that separate someone who is going to be there five, 10, 15 years down the road and will continue to evolve with your practice."

Also be ready to validate your staff's level of proficiency. During her interviews with freelance scorers, Polnaszek always asks about their experience working with other high acuity academic institutions.

"The skill level and depth of experience is obviously not universal," she said. "You have to be very, very careful to find people who are as experienced as you need."

If the center contracted with a scoring service, Polnaszek said she would want to speak with physicians at other high acuity institutions to determine their level of satisfaction with the scoring service's expertise.

Technical considerations

Once you have determined that your outsourcing service and the sleep facility will make a great duo, you need to ensure the software programs and security features you will be using are just as compatible.

"Even if you have two clients with the same application, they may actually use the software slightly differently," Morin said. Most centers tailor the configuration of files through types of tags, events, labels, and custom reports. "We are an extension of their team, so we need to ensure that we are performing the analysis exactly the same way as it is performed in house."

Dedicating a specific team of scorers to each facility can help ensure that they receive properly customized reports. Your scoring service can determine the number of technologists who should be dedicated to each facility by asking about the expected volume and complexity of studies, and about the required turnaround time. Morin's company tracks technologists' study productivity to assist in this process.

Sleep centers will want to know which manufacturers' software the scoring service is familiar with, Mathews said. "Having a broad array assures that you have options in the future as well. Should you decide to change and shift, you are not locked in, and you don't have a lot of barriers to remaining flexible in your business model."

A sleep scoring company that wants to stand out from the competition could offer additional resources such as on-site training that can help a sleep center's in-house technologists adapt to new software and equipment.

Mathews values his scoring company because of its assistance in adopting the new AASM guidelines. "They are watching that we are meeting specific and evolving standardization," he said. "They know the guidelines and are helping our staff, medical directors, and technicians to make sure we are meeting them as effectively as possible."

Kristen Ziegler is assistant editor of ADVANCE. She can be reached at kziegler@advanceweb.com.