Author: Michael Kelley
ASBA Helping Promote Arrowhead Koala With NFL Legends
“Dr. Rod Willey who is an American Sleep and Breathing Academy Diplomate/Board Member and founded Koala Centers for Sleep Disorders, has been my largest account since he started doing dental sleep medicine four years ago. In one amazing month he started 106 cases! Month in and month out, Dr. Willey’s practice is starting 60 cases. He has this proven track record and I believe it is because he knows how to market,” says David Gergen, CEO of Gergen’s Orthodontic Lab. All Koala franchise owners are members of the ASBA, giving them access to a full library of expertise that come direct from doctors like Dr. Willey as well as the opportunity to work with current/former NFL players locally. For example, the Koala of Arrowhead is close to the Arizona Cardinals stadium and is working to connect that aspect of marketing by centering TV and radio ads around this demographic. The proven marketing plan will be mornings on KTAR with David Gergen, Executive Director of the ASBA, Cardinals great Ron Wolfley, voice of the Arizona Cardinals and Roy Green who was just announced by the Cardinals that he will be joining 15 other former players in the Ring of Honor. He is also considered by many to be the greatest Cardinals player of all time; he played defense, offense and ran back kick and punt returns. Wolfley, who was using CPAP prior, says he is “excited for the next time he travels because he won’t have to carry around all of his CPAP equipment.” Before Roy Green received his appliance, he had three heart attacks and two strokes. Since being treated, Green hasn’t had any serious health complications. This makes for two perfect examples of people who publicly support the cause and will aide immensely in the effort to spread awareness of sleep apnea throughout the community. For more information on Koala Centers or the opportunity to market with NFL greats in your community, email info@myasba.com or call 602-478-9713.
Obstructive Sleep Apnea Linked To Cardiovascular Disease
There are several types of sleep apnea that exist, but the most frequently diagnosed is obstructive sleep apnea (OSA) which occurs when muscles relax in the throat causing an airway blockage. The blockage causes people to snore and/or wake up during the night multiple times. A victim to this disorder becomes sleepy during the day, turning it into the source of poor performance at work and even car crashes. While day time sleepiness and fatigue are largely reported as the most common symptoms by patients, OSA can have a bad effect on the cardiovascular system that often goes unnoticed. “The evidence is very strong for the relationship between sleep apnea and hypertension and cardiovascular disease generally, so people really need to know that,” said Donna Arnett, Ph.D., chair and professor of epidemiology at the School of Public Health at the University of Alabama at Birmingham and the president of the American Heart Association. According to an American Thoracic Society study of people with hypertension, about 30% have obstructive sleep apnea. If they have obstructive sleep apnea, there is a 50% chance they also have hypertension. Why does blood pressure rise due to sleep apnea? When someone who suffers from sleep apnea stops breathing during the night, their oxygen levels fall drastically. The effects of this is that the brain will tell the blood vessels to increase pressure by narrowing or tightening up so that the body can receive more oxygen flow. In a sleep study, a sleep doctor can measure the severity of the sleep apnea and determine whether the patient has mild sleep apnea, characterized by five to 15 episodes per hour; moderate sleep apnea, defined by 15 to 30 per hour; or severe sleep apnea, meaning more than 30 each hour. Oral appliance therapy can help control the symptoms of sleep apnea and prevent heart-related problems associated with sleep apnea. “The good news is treatment that keeps the breathing passages open and oxygen flowing can yield fast results,” Dr. Arnett said. “Blood pressure comes down really quite quickly.” Reference sleepfoundation.org, heart.org, thoracic.org, harvard.edu
ASBA Is The Only Academy Fighting For Dental Rights In The Sleep Apnea Arena-ASBA Receives Support From Congresswoman Anna G. Eshoo
The Georgia Law now says, “Depending on the diagnosis of the type and severity, one possible treatment option for obstructive apnea is the use of oral appliances. The design, fitting, and use of oral appliances and the maintenance of oral health related to the appliances falls within the scope of the practice of dentistry. The continuing evaluation of a person’s sleep apnea, the effect of the oral appliance on the apnea , and the need for, and type of, alternative treatment do not fall within the scope of dentistry. Therefore, the prescribing of sleep apnea appliances does not fall within the scope of the practice of dentistry. It is the position of the Board that a dentist may not order a sleep study. Home sleep studies should only be ordered and interpreted by a licensed physician. Therefore, only under the orders of a physician should a dentist fabricate a sleep apnea appliance for the designated patient and conduct only those tasks permitted under OCGA title 43, chapter 11. (Adopted 4/1/2016)” This is very disappointing for dentists in Georgia. Let’s look at the interpretation of this new law. Does it mean a dentist will no longer be able to titrate their appliance by using a home sleep test? It surely means a dentist cannot refer out to a sleep testing company such as Complete Sleep, Snap or Easy Sleep or hand out an HST to one of their patients and have a Board Certified physician do the read and diagnosis. To the ASBA this is horrible news and we will be fighting it with all of our resources. You will be pleased to know that just yesterday, ASBA Board Member and Diplomate Dr. Elliott Alpher was in Washington D.C. alongside Congresswoman Anna G. Eshoo discussing this very topic and transportation. Dr. Elliott J. Alpher, Diplomate to and representing the American Sleep and Breathing Academy and Congresswoman Anna G. Eshoo (DCalif.), Ranking Member of the Energy and Commerce Committee’s Subcommittee on Communications and Technology for the 114th Congress met today to ask her support on proposed rulemaking for screening, diagnosing, treating and tracking compliance of Obstructive Sleep Apnea (OSA) in individuals occupying sensitive positions in highway and rail transportation. The Federal Motor Carrier Safety Administration (FMCSA) and Federal Railroad Administration (FRA) have requested data and information concerning the prevalence of moderate-to-severe obstructive sleep apnea (OSA) among individuals occupying safety sensitive positions in highway and rail transportation, and on its potential consequences for the safety of rail and highway transportation. Many mental functions are reduced when an individual experiences fatigue and sleepiness. It is estimated that 20% of accidents are caused by drivers’ inattention and sleepiness, and the occurrence of drowsiness when driving is a major risk factor for dangerous accidents. Chronic excessive sleepiness and sleep-disordered breathing are common in commercial vehicles drivers. “OSA is a prevalent disorder among workers, which increases the risk of occupational accidents and has a significant impact on public safety. Fortunately, many of these accidents could be prevented by screening and treating sleep-disordered breathing with the resources and technology available…we are grateful to have Congresswoman Eshoo’s support on this matter,” says Dr. Alpher. Dr. Alpher, one of the District’s most experienced specialists for sleep and jaw disorders, on staff at George Washington University Hospital and Georgetown University Hospital, has been known as a leader in the treatment of sleep disorders and jaw pain for 25 years. Dr. Alpher has pioneered a conservative, non-invasive approach utilizing computerized and verifiable diagnostic methods to treat TMD, snoring and sleep apnea. This method of treatment has proven to be greatly successful and is highly regarded as the first method of choice by physicians and patients. Dr. Alpher was also responsible for heading a delegation to the Medical Advisory Board (MAB) to introduce the new technology of compliance chips in oral appliances to treat and monitor sleep apnea and snoring of truckers and other transportation personnel. In addition, he earned the status of Diplomate of the American Board of Craniofacial Pain & Dental Sleep Medicine in October 2013 and serves as a board member. Dr. Alpher is a Diplomate of the American Academy of Pain Management, Life Member of both the American Dental Association and the District of Columbia Dental Society. Dr. Elliott Alpher says, “The ASBA is the only academy fighting for the dentists’ rights in the sleep apnea arena and the efforts will become stronger as the American Sleep and Breathing Academy grows. The more members we have the more firepower we’ll have. I am so pleased that I have joined this academy because this is the only academy making a huge difference in my humble opinion. We are so blessed to have former Congressman Marty Russo as our ally.” Dr. Elliott Alpher was elected to the ASBA Hall of Fame for his lifetime achievements in the field of dental sleep medicine. If you are a concerned dentist about your rights, join the American Sleep and Breathing Academy at americansleepandbreathingacademy.com.
Medicare and Private Insurers Raise Rates For Sleep Apnea Dentistry
Sleep therapy continues to receive scrutiny by regulators and payors. Centers for Medicare and Medicaid have been monitoring patient outcomes and clinical yield for patients. There has been no formal announcement as to their findings however CPAP reimbursement continues to be cut while Oral Appliance Therapy reimbursement has officially been increased by Medicare. Revenue from code E0486 has doubled in recent months according to reports by ASBA members, Industry leaders predict that private insurance will follow Medicare reimbursement guidelines. Supporting this trend is the recent announcement by Cigna the first private insurer to develop a national policy for Oral Appliance Therapy, settling on $2500 as a bundled fee. In other regions fees have increased by 25 to 100%. Jurisdiction “D” reimbursement rates has remained unchanged. Insurers are expected to work with industry to monitor outcomes data to balance revenue and patient care expectations. It is also very significant and important to note that evidence of post graduate training and Diplomacy has become a method that some insurers use to deny insurance claims (this is new and bears watching). The American Sleep And Breathing Academy continues to monitor insurance reimbursement, and policies through its relationships with Washington DC insiders like Congressman Marty Russo and others. “In June of 2015 the ASBA was the first organization to warn Dentists of the risk to using the “S” code for billing TMJ Splints. Advance notice of this change saved ASBA members thousands of dollars in hard costs associated with billing errors and uncollected revenue.” – David GergenCDT The latest opportunity identified by the American Sleep And Breathing Academy team of lobbyists is a new government protocol for chronic care management. CCM has the potential to contribute a strong revenue stream for sleep apnea dentists in 2016. The physician who developed the Chronic Care Program spoke at the Sleep and Wellness conference in Scottsdale AZ April 15 and 16. CMS Bets on Oral Appliance Therapy a blog post Gergensortho.com A running discussion for the last 6 years here at Gergens Orthodontic Lab has been the CPAP as Gold standard of sleep therapy vs Oral Appliance therapy debate. These discussions usually go for hours and have gone on for years. The strongest debate has been between David Gergen President of Gergens Orthodontic Lab and Executive Director of American Sleep and Breathing Academy (ASBA) and Randy Clare who supports CPAP. Gergen knows CPAP has its place and time in the sleep world, but strongly feels that the oral appliance will surpass CPAP as the go-to treatment within 10 years. Clare would debate if that’s the case, respiratory techs will be managing the oral appliance patients not the dentists. Back and forth compliance vs treatment efficacy. David Gergen has been back and forth to Washington working with congressman Marty Russo trying to get some traction within the federal government on this issue. The key point of distinction of course is what drives medical care in the United States is reimbursement. The story for CPAP in the reimbursment arena since competitive bidding became an issue has slowly restricted access to care and fed a consolidation of providers. Fewer providers to provide care and the care they can afford to provide is less personal which results in lower compliance rates which results in lower reimbursement. January 1 2016 CMS cut CPAP reimbursement by 25%. Will this affect a diagnosed OSA patients ability to get great care of course it will. On the other side of the ledger Oral Appliance therapy has not been a focus for CMS. The OAT program has been way underfunded. This has made access to oral devices for sleep apnea difficult for medicare patients. Dentists were not finding it easy to provide care for these patients because reimbursement was so low. January 1 2016 CMS raised reimbursement for OAT to $3700 in jurisdiction B (see attached EOB) If you don’t know your jurisdiction for medicare we have also added a map for your use. I expect that this will increase access to care significantly. I feel it indicates a trend and perhaps insurers are ready to consider higher compliance rates and better return on sleep therapy dollars. After all the dental team sees the patient at minimum every six months which is a much better way to manage a lifelong condition with severe health implications.
Trucking, Railroad Regulators Hearing at Sleep Apnea Listening Session May 12 Highlights
FMCSA and FRA announced three public listening sessions to be held on May 12, 17, and 25, 2016, to solicit information on the prevalence of moderate-to-severe obstructive sleep apnea (OSA) among individuals occupying safety sensitive positions in highway and rail transportation, and of its potential consequences for the safety of rail and highway transportation. FMCSA and FRA (collectively “the Agencies”) also request information on potential costs and benefits from possible regulatory actions that address the safety risks associated with motor carrier and rail transportation workers in safety sensitive positions who have OSA. The listening sessions will provide interested parties an opportunity to share their views and any data or analysis on this topic with representatives of both Agencies. Highly prioritized concerns during the May 12 session included the cost of sleep studies for drivers and locomotive engineers, the failure of most safety-sensitive transportation employees with apnea to use their CPAP machines and ensuring that any apnea mandates consider safety benefits over costs and driver health. Megan Bush, manager of safety policy for American Trucking Associations told regulators, “Though OSA treatment holds promise to improve driver health, the agency should be reminded its role is to improve safety, and not driver health.” “FMCSA is prohibited from imposing rules that would have a deleterious impact on driver health, but the role is not to promulgate rules that improve it.” James Edwards who is a Washington-based representative of the National Association of Small Trucking Companies said, “The process [of getting treated for OSA] is inconvenient, costly, intrusive and disrupts a driver’s livelihood.” As ASBA members, we need to provide input on how it is important to driver and public safety to be treated for OSA. If you are unable to attend the hearings, a great opportunity to weigh in and share your expertise with influential policy makers is to go to www.regulations.gov. Search separately for docket numbers FMCSA-2015-0419 and FRA-2015-0111. Present your credentials and relevant experience. Be concise and support your claims. Use scientific evidence from dental sleep medicine. Include scientific studies on oral appliance therapy and your own experience as an expert. There is the ability to upload documents that support your position. Address trade-offs and opposing views. Include the costs and benefits to patients of your approach. It is especially important for oral appliance therapy to address costs and compliance. Do not attempt any perceived commercialization for your product of services Comments are not votes, but one well supported comment is more influential than a thousand form letters.DEADINE FOR COMMENTS IS JUNE 8, 2016, 11:59 pm ET.DO NOT let this opportunity pass us by. If we don’t impress our views on the rule-makers, years will pass before we can have this chance again. The May 17, 2016, session will be held at the Marriott Courtyard Chicago Downtown/River North, 30 E. Hubbard Street, Chicago, IL 60611. The final session will be held on May 25, 2016, at the Westin Bonaventure Hotel and Suites, 404 S. Figueroa Street, Los Angeles, CA 90071. Learn more about the sessions at at www.fmcsa.dot.gov/calendar and www.fra.dot.gov/.
Department Of Transportation Holds Meeting on OSA and Travel Safety
Dr. Richard Klien DDS, Diplomat ASBA I was in Washington DC yesterday speaking about the deaths and accidents on American roads and railways related to drowsiness caused by OSA. I mentioned recently published articles related to this topic. The ASBA would like to thank Congressman Marty Russo for leading the Academy and prompting us attend the meeting. Published in Primary Care on March 22, 2016 “results show that the rate of serious, preventable crashes was 5 times higher among truck drivers with sleep apnea who failed to adhere to PAP therapy”. On April 4, 2016, The Huffington Post stated, “drowsy driving may be responsible for 1.2 million car accidents every year according to the National Highway Traffic Safety Administration”. At the meeting, the owners of truck and railroad transportation were understandably concerned about the time lost and the cost of OSA screenings, doctor visits, and compliancy follow up appointments. They were desirous of streamlining the process so their employees did not lose as much time not performing the duties they were being paid for. The Federal Motor Carrier Safety Administration is sincerely attempting to help the roads and rails be safe. In 2013, I met with the DOT to discuss OSA in truck drivers. The meeting yesterday included safety on the railways as well. I am pleased to help my country and the people who live in it. The American Sleep and Breathing Academy is a passion is an exhilarating and I am blessed to be able to assist in OSA education. Join the fastest growing academy in Dentistry www.americansleepandbreathingacademy.com Dr. Richard Klien DDS, Diplomat ASBA Show less
Reflection On Cardinals Legend Roy Green Entering Ring Of Honor
“I was bawling like a baby”, Roy Green said as he spoke of the moment he was first notified that the Arizona Cardinals would be inducting him in to the Ring of Honor. That is a respectable reaction considering what Michael Bidwell, President of the Arizona Cardinals, said about a place where only 15 other Cardinals players have managed to seal their names to in Cardinals franchise history since 1920. “Look at that Ring of Honor as a special place and you want to put special players in there,” he said. “And you look at Roy’s complete body of work and offense, defense; back in the day when we had a 45-man roster limit, he was our emergency quarterback and also ran the scout team as the quarterback in practice. Green, in 12 seasons with the St. Louis and Phoenix Cardinals, caught 522 passes for 8,496 yards and 66 touchdowns; those receiving statistics coming from only 10 of the 12 years spent as a Cardinal due to the first two years playing exclusively as a defensive back. He added another 1,932 yards and one touchdown as a kick returner and intercepted four passes. As of now Roy is second in total receiving yardage as well as touchdown catches. He ranks fourth in career receptions and is third in individual combined yardage. John Madden honored Green in his annual All-Madden Team, stating that at one point, he regarded Green as not the best wide receiver in the game, but the best player. Green still holds the cardinals record yards per reception 21.5 and yards per touchdown at 48.5. The press conference was said by the Bidwells to be “one of the most fun press conferences” they’ve had as Roy Green was full of laughter, memories and jokes. As a guy who teammates declare to be one of the hardest working guys on the field, Green continues to live up to the reputation off the field. Not only is he part of the broadcast team for the Arizona Cardinals, he has a dedicated schedule allocated to lending aide to other current/former players across the country regarding their overall health. In 2012, Roy Green was diagnosed with kidney disease due to the long-term use of anti-inflammatories during his playing career in the NFL. Following a year of dialysis three days a week, his daughters, Miyosha, 30, and Candace, 26, both offered to donate a kidney to their father. Both daughters were matches, but Miyosha was chosen to donate. Green had successful surgery on Nov. 14 at the Mayo Clinic. Roy’s player health initiative was a result of the three heart attacks and two strokes he suffered in addition to the kidney failure that had occurred prior. Since being retired from the NFL, Roy Green has shifted his focus to helping improve the well-being of current and former professional athletes through promoting sleep apnea awareness across the country. He has teamed up with David Gergen, Executive Director of the American Sleep and Breathing Academy, and a company called Pro Player Health Alliance to hold free public awareness events and private player health screenings in communities all over the nation. After becoming a member of Pro Player Health Alliance and using his extensive amount of connections to players, he has helped get over 1,600 former players successfully tested and/or treated for obstructive sleep apnea. What he’s done on the football field pales in comparison to what he’s done for players’ health.
Miami Dolphins Coaching Legend Treated For Fluid Retention, Sleep Apnea
Miami Dolphins coaching legend Don Shula was hospitalized overnight May 3, 2016 after suffering from fluid retention and sleep apnea, according to his wife in a statement released by the team. It was confirmed to NFL Media that the 86 year old was treated and discharged by the Aventura Hospital and Medical Center Tuesday. “Coach Shula has been admitted to the hospital due to fluid retention and sleep apnea,” Mary Anne Shula stated. “The family is looking for a speedy recovery.” Shula is considered the most successful coach in NFL history with countless accolades. He won two Super Bowls with the Dolphins and won six NFL Coach of the Year honors during his 33-year head coaching career. Inducted into the Pro Football Hall of Fame in 1997, Shula holds coaching records for most regular-season wins, most career wins and Super Bowl appearances. He is also the owner of a successful chain of steakhouses throughout the country named “Shula’s Steakhouse”. . Dr. Rod Willey, an American Sleep and Breathing Academy Diplomate and the largest stand-alone dental practitioner in the US who screens and treats patients for snoring and sleep apnea says, “I am pleased to hear his sleep apnea treatment went well. I remember a few years ago when the Pro Player Health Alliance, lead by David Gergen and an NFL great Roy Green, educated the Dolphins on the effects of untreated sleep apnea. Their efforts to educate the players are certainly being heard and are echoing throughout the communities that follow them. Nearly 25 million people remain undiagnosed with sleep apnea. The Pro Player Health Alliance and the American Sleep and Breathing Academy are working hard to change that. Sleep apnea contributed to the premature death of star Green Bay Packers defensive end Reggie White in 2004 as well.”