Benefits of an Integrated Cardiology and Sleep Clinic in Reductions of Health-care Costs

Abstract

Background: Cardiovascular diseases (CVDs) account for a large percentage of emergency room visits (ERVs), hospital admissions (HAs), and subsequent cardiac Intensive Care Unit admissions (CICUAs). CVD is still the number one killer in the Western and emerging countries and consumes the majority of health-care dollars. According to a recent report, the USA will reach $818.1 billion a year in CVD care by the year 2030; this is triple of spending for 2013–2014. We analyzed two types of cardiology care (CC) over a 20-year period: strictly CC and compared this to combined, integrated cardiology and sleep medicine (ICSM) care and looked at clinic-based costs of health-care delivery. In 2002, Chanwell Clinic with the assistance of Stanford Sleep Medicine built one of the America's first ICSM under one roof. The consequences of undiagnosed, untreated sleep-disordered breathing (SDB), obstructive sleep apnea (OSA) to worsening CVD, sudden cardiac deaths, and malignancies of all kinds have been published. Methods: We retrospectively reviewed 4550 patients under strict CC for the number of ERVs, HAs, CICUAs, and invasive cardiac surgical procedures (ICS) from 1993 to 2002 and prospectively tracked 8426 patients of HAs, ERV, CICUA, and ICS under ICSM for the years 2004–2013. Results: A single CC practice that transitions to ICSM resulted in over $21 million or 73% reduction of CV health-care over a 10-year period. Diagnosis and treatment of SDB, OSA common, in CVD resulted in marked reductions of ERV, HA, CICUA, and ICS; all are drivers of an ever-escalating financial burden of CV care. Conclusion: A single CC practice that transitions to ICSM resulted in over $21 million or 73% reduction of CV health-care cost over a 10-year period. The ICSM practice model when implemented on 27,000 cardiologists and cardiology practices nationwide could drastically slow down the rising cost of health care even with the enactment of Affordable Care Act and could make Medicare sustainable over a longer period beyond 2029; the year when Medicare is projected to be insolvent (Congressional Research Service, July 2013).