Use case · Sleep medicine group

Sleep Vigil: the first ninety days decide everything

In obstructive sleep apnea, adherence is the entire clinical outcome, and the payer decides coverage on it inside a fixed compliance window. A sleep group that watches PAP data daily is not doing surveillance — it is doing the only intervention that changes the outcome, at the only time it can change it.

The problem

Abandonment happens in week two. The portal gets checked in month two.

Most PAP abandonment is a solvable problem — mask fit, pressure intolerance, claustrophobia — occurring in the first fourteen nights. The data proving it sits in a manufacturer portal that a busy practice checks when the compliance report is due, which is weeks after the patient has already quit. The entire use case is moving that data into a threshold engine while the rescue is still possible.

Direct manufacturer PAP feeds
Usage · residual AHI · mask leak
Not an aggregator. PAP therapy data comes through direct manufacturer interfaces, nightly, with residual AHI and leak alongside hours — because four hours of use with a leaking mask is not therapy, and hours alone will not tell you that.
Week-two rescue thresholds
Named owner · 48h clock
Two nights under two hours, rising leak trend, or residual AHI above target fires to a respiratory therapist with a mask-refit protocol. The intervention is a phone call and a fitting appointment — cheap, boring, and the whole ballgame.
The compliance window, watched
Payer usage criteria · day 1-90
The platform tracks each start against the payer's usage criteria in real time, so the practice knows on day 20 — not day 85 — which patients will miss documentation without intervention. Daytime sleepiness PROs ride alongside as the clinical counterweight.

The DME boundary, stated plainly

A PAP device supplied by a DME provider is billed by that provider. If the practice is not supplying the monitoring device, the device-supply code does not belong to the practice — management time (98980 and 98981, plus the 10-minute 98979) is where the practice's legitimate revenue lives. Getting this wrong is the most common structural error in sleep RTM, and the platform refuses the claim line rather than warning about it. Full logic on the OSA program page.

What to measure

The numbers this program should be judged on

Percentage of new starts meeting payer compliance criteria. Week-two rescue rate — interventions fired versus abandonments prevented. Residual AHI distribution at day ninety, because usage without efficacy is a false victory. A sleep program that reports those three numbers honestly will keep every referral source it has.

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