The ASC setting creates opportunities to improve efficiency. Whereas a hospital may have a different surgical team for each patient undergoing the Inspire procedure, the ASC can provide the same team every time. That consistency means the surgical team is so familiar with the Inspire procedure that they can safely build efficiencies into the process to improve patient experiences.  

More than 80% of ENTTX procedures are done at Stonebridge, but some patients with complex comorbidities or conflicting insurance coverage may require a hospital setting. Because most OSA patients have comorbid health conditions, dedicated nurses at Stonebridge handle all pre-procedure clearances and work with schedulers at other practices to make sure all patients have had the right tests, so they can evaluate whether the ASC setting is right for each patient. 

Although a joint venture partnership with an ASC isn’t feasible or desirable for every provider organization, aligning organizational practices with each ASC’s interests can still be beneficial. Efficiencies, like shortening procedure time and decreasing time of pre-procedual clearance, will make it more likely for ASC administration to see the implant procedure as value-added.

Before launching the Inspire program, ENTTX worked with the ASC to ensure that the procedure would be clinically and financially viable in the long-term.

ENTTX and Stonebridge first assessed the clinical relevancy of the Inspire procedure for the region, including whether the procedure would help improve the quality of life for patients with OSA, who often go untreated or undertreated. Importantly, Stonebridge evaluated whether their patient base was vulnerable to intraoperative complications or complex post-operative care that goes beyond the capacity of most ASCs. On the business side, Stonebridge reviewed insurance coverage and reimbursement in relation to the cost of the Inspire device, pre-authorization requirements, and equipment needed for the procedure.

Once a case is made that Inspire therapy is a net benefit for surgeons, patients, and ASCs, it will become much easier for ASCs in different partnership configurations to decide whether offering the Inspire procedure is right for them. 

Clinical

Is the procedure clinically relevant to the patient population? Will it improve access to care and patient quality of life? 

• Stonebridge found that many OSA patients in their region couldn’t tolerate CPAP therapy and were undertreated due to a lack of alternatives. Inspire therapy now provides a safe, effective option that can improve those patients’ quality of life.

Are patients in the region good candidates for receiving the procedure at an ASC, accounting for age, comorbidities, and the potential for intraoperative or post-operative complications?

• Stonebridge found a strong base of OSA patients in their region who were both intolerant of CPAP-therapy and were candidates for the Inspire procedure in the ASC setting.

Are area surgeons interested in offering the procedure and willing to become credentialed in the Inspire skill set?

• ENTTX surgeons trained in Inspire therapy are near their max capacity for performing the procedure due to high patient demand. ENTTX plans to train and credential several interested surgeons on staff in the Inspire therapy. 

Has the procedure been successful and received positive patient feedback?

• Stonebridge found that the clinical data for Inspire therapy showed positive outcomes for most patients who choose the procedure. Subsequent feedback from their own patients about Inspire therapy has been overwhelmingly positive.

Administrative

Will the procedure be covered by insurance? Are there processes in place to obtain pre-authorization?

• Inspire therapy is broadly covered by most U.S. insurance providers. Inspire also has an in-house team dedicated to resolving issues with reimbursement and prior authorization.

Does the ASC have the right equipment for the procedure?

• Like most ASCs, Stonebridge already had most of the equipment needed for the Inspire procedure in-house, so they didn’t have to invest a lot of capital to do the procedure.

Is there industry partner-supplied training and support available for the program or procedure?

• An Inspire representative is always available to help Stonebridge access training and credentialing programs for the procedure, as well as insurance reimbursement and prior authorization support.

ENTTX took care to develop relationships with sleep medicine clinics based on mutual referral and trust. Sleep medicine clinics sometimes view surgical procedures like Inspire with skepticism, because they are concerned about losing patients. Surgeons from ENTTX visited sleep medicine clinics in person to emphasize that sleep medicine clinics are essential to the process — handling sleep studies, monitoring or adjusting the Inspire implant, and managing OSA patients who aren’t eligible for Inspire.

To help build a seamless referral process, ENTTX partnered with several private sleep clinics such as Dream Sleep Medicine. ENTTX refers patients who don’t already have a sleep provider to Dream Sleep for initial sleep studies, Inspire device adjustment and management, or further care when ineligible for Inspire. Also, although sleep medicine usually activates the Inspire device, ENTTX has chosen to activate the device before sending the patient back to sleep medicine for monitoring and adjustment. Due to this co-management process with Dream Sleep, ENTTX patients experience an efficient process and excellent outcomes.

Many other sleep medicine clinics also partner with ENTTX to evaluate their patients for Inspire therapy. When patients are already established at a sleep medicine clinic, ENTTX sends them to their original sleep care provider. In addition, Stonebridge pre-screens patients for all surgeries using the STOP-Bang score for OSA and refers patients who meet the criteria for OSA to a sleep medicine clinic for evaluation.

A consistent patient flow is beneficial for all parties involved, particularly for private practices that must generate their own referrals — unlike practices affiliated with larger health systems. 

With a high success rate at ENTTX, Inspire therapy has changed the sleep apnea treatment landscape. In addition to the following outcomes, ENTTX and Stonebridge have substantially increased patient access to the Inspire therapy and are in the process of expanding the number of available implant surgeons and ORs.

Inspire Medical Systems, Inc., is a medical innovation company committed to the safe, effective, and reliable treatment of obstructive sleep apnea in order to improve patient lives.

Inspire® therapy is a solution for people with obstructive sleep apnea who have tried and struggled with CPAP. The Inspire® implant works inside the body to treat the root cause of OSA, enabling patients to breathe regularly and sleep soundly. Learn more at inspiresleep.com.

This report is sponsored by Inspire, an Advisory Board member organization. Representatives of Inspire helped select the topics and issues addressed. Advisory Board experts wrote the report, maintained final editorial approval, and conducted the underlying research independently and objectively. Advisory Board does not endorse any company, organization, product or brand mentioned herein.

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