My favorite acronym for training dental practices in the best methods for improving their dental sleep medicine programs is SETUP. This stands for Screen, Educate, Test, Understand, and Present.
In our May newsletter, we covered S and E when we talked about screening patients and educating staff on the best ways to initiate conversations about sleep health. This month we’ll look at the finer points to keep in mind when improving your sleep testing procedures.
S – Screen – Screen patients for sleep breathing disorders.
E – Educate – Educate staff about sleep health conversations with patients and, in turn, educate patients.
T – Test – Initiate sleep testing or obtain a copy of a pre-existing sleep study.
U – Understand – Discuss the implications of the study with the patient and make them understand the risks and benefits of treatment.
P – Present – Present an alternative to physician-recommended sleep health solutions.
Educating staff and screening patients is an important first step, but our ability to help our patients can hit a brick wall if a patient does not follow through and get tested. Patients who have never been sleep tested require your team having the right strategies and protocols in place, as many patients will be in denial that any problem exists. Patients with a prior diagnosis who are not complying with physician recommended treatments can be a different story, however, and may have some prior awareness that can help as we continue the conversation and education.
Patients with a Prior Sleep Study
From a billing perspective, at least, patients who come to us already having done a sleep study tend to be an easier situation. When a sleep study is conducted, most insurers consider that study a life-long diagnosis. Very few insurers will ask for a second study to be conducted, even if it’s many years old. Medicare is sometimes a different story, and requires the patient have a Medicare covered sleep study. For the most part, even an old sleep study is a valid sleep study in the eyes of the private insurance carriers.
As health care providers, we know that an old diagnosis is not going to show us an accurate picture of the condition of the patient in front of us—but even an old study can give us a starting point for understanding the severity and symptoms of a patient’s sleep breathing disorder. For example, if a patient presents us with a 10-year-old perio chart full of 8s and 9s, we can anticipate what his or her present condition will be before we even conduct an examination. The same can be true for sleep studies; an old study can at least give us an idea of what we may be dealing with.
Combined with a patient’s medical history and current state of overall health, an old sleep study can help us identify patients who are in critical need of effective treatments they may be willing to comply with.
One of the most important protocols to have in place for patients such as these, is having an easy-to-grab copy of a medical records release form that will allow us to access a copy of the patient’s previous sleep study. We recommend never asking a patient to physically get a copy of an old study for you. It’s inconvenient and in most cases, will never happen. Having medical records release forms ready to use provides an easy path so the patient can sign the form before they leave the appointment and your team can call and fax to get a copy of the study in a day or two.
Once you have a copy of the sleep study, you will need to gather more information before you can move on to the U in SETUP: understand. You will have to use your best judgment to determine how well you think the study may reflect the current situation. The best source of information for this is the patient. Use the sleep study to initiate a conversation; ask the patient if they are fully compliant with treatment that was recommended after the initial study. Ask the patient if symptoms that first led to testing are still happening. If symptoms persist or have worsened. This is the time to discuss the health risks associated with sleep apnea and also the risks of diagnosed sleep apnea going untreated. The average medical appointment today is under five minutes in length—we cannot assume that medical treatment means the patient has been properly educated on the health risks of sleep breathing disorders.
Patients without a Sleep Study – The Good Neighbor Policy
For patients who report symptoms that may point toward a sleep breathing disorder, the best protocol to have in place is what we call the good neighbor policy. Having a good relationship with an oral appliance friendly nearby sleep physician or sleep clinic gives you the opportunity to refer patients for testing directly. If you can even call and assist patients with scheduling before they leave your office, there are much better odds he or she will follow through. Leaving a patient with a vague “you really should get sleep tested” will leave him with no clear steps to follow, and slim odds of actually getting the test completed.
Ultimately, successfully referring patients to a cooperating sleep physician is another situation in which the quality of the conversation is key. It’s about helping patients understand why they need to pay more attention to the quality of their rest at night, and making sure they know the risks to their health if they don’t. Again, remember the under-five-minute medical appointment that is now our national standard; you may be the first health care provider to adequately educate a patient about the connection between sleep apnea and whole-body health. Don’t let that conversation go to waste.
A Word About Home Sleep Testing
Some dental practices are in states in which dental practice act and medical practice act guidelines may make home sleep testing, at your direction, an impossibility. If you are in a location that allows home sleep testing, consider the benefits of a patient’s sleep study taking place in his own home and his own bed. Many dental teams find that they can achieve a much higher level of follow through when they are offering home sleep testing as part of their sleep health program.
We believe that all home sleep studies should be read by a Board Certified Sleep Physician. This gives us the medical diagnosis and treatment recommendations from the certified medical specialist which we can then review with the patient. Home testing presents a great opportunity only if we follow medical protocol and have a physician read the data and make the diagnosis.
Testing Opens the Door to Treatment
As practitioners of dental sleep medicine, we are all passionate about helping patients improve their health and extend their lives. We are so passionate that we are pushing beyond the traditional scope of dentistry, even when convention and insurers don’t always make it easy for us!
Testing and diagnosis are the critical steps to being able to help our patients with sleep breathing disorders. Patient conversations and evaluations determine which next appropriate steps will be taken. It’s important we give forethought to those conversations and find the best “visual” words that will help our at risk patients get tested and diagnosed.
In next month’s SnoozeLetter, we’ll focus on the U in SETUP: understand. We’ll look at ways to help patients understand the health implications of sleep apnea, why they should be treated, and what their options are, so we can give them the path of least resistance for treatment solutions.
If you would like to learn more about sleep testing protocols, and see scripts and other information to help you integrate these protocols into your practice, call me, Dr. Marty Lipsey, at 209-527-1995.
You are in the business of improving and saving lives. This is a noble calling, and I’m here to help you succeed!