Board of Registered Polysomnographic Technologists President, Cindra L. Altman, on the BRPT’s relationship with the American Academy of Sleep Medicine.

Cindra “Cindy” L. Altman, RPSGT, R.EEG/EP T, president of the Board of Directors of the Board of Registered Polysomnographic Technologists (BRPT), began her 2-year term as president in January of this year. Altman, the technical director for the Creighton University Sleep Disorders Center in Omaha, Neb, has been a member of the BRPT Board since 2010, serving as chair of the Website Development Committee, an active participant on the Exam Development Committee, and president-elect.

This past May, Sleep Review asked readers to submit their questions for Altman. Now, Altman responds to your questions about what she hopes to achieve as BRPT president, how the BRPT will help credential holders, and what developments led to the rocky relationship between the BRPT and the American Academy of Sleep Medicine (AASM).

Sleep Review: What do you hope to achieve while serving as BRPT president?

Altman: My goal is to make sure the RPSGT and CPSGT credentials retain their value and, more importantly, continue to grow in respect and importance over time. I want to see BRPT offer specialty credentials and certifications as a natural evolution to the changes and growth we are seeing in the profession. I’d like BRPT to become more involved and proactive in gaining insurance and government recognition for its credential holders. My personal mission is to delve into the mounds of data BRPT collects to better understand and communicate exam strengths and weaknesses, and to develop a profile of the successful—and unsuccessful—exam candidate.

Sleep Review: What is the greatest need of RPSGT and CPSGT credential holders today? How will the BRPT help to meet those needs?

Altman: BRPT credential holders are worried about their jobs. As technology and insurance regulations impact the delivery of services to sleep patients, the roles of some technologists, not all, are changing. The use of out-of-center testing and auto-PAP is on the rise, in part due to recognition and regulation by third-party payors, but also due to improved technology and documented outcomes. The BRPT can help its credential holders by keeping its existing credentials valid, making sure its credentials give technologists the edge over the competition, promoting professional excellence, and developing new and specialty certifications to recognize the changing scope of sleep technologists. As we see a move from a primarily diagnostic-based profession to one that promotes a more integrated model of chronic care, new opportunities will become apparent.

As an example, technologists are already functioning as clinical sleep educators, which is a relatively new role that is similar in nature to asthma and diabetes educators. The BRPT is responding by offering a new competency-based certificate program for clinical sleep educators, which has been met with an overwhelmingly positive response, and even a plea for a new credential. People want recognition and identity through certification.

As BRPT President, Cindy Altman will help technologists hone their skills while preparing for a more integrated model of chronic care. Here, she prepares a patient for a CPAP titration study.

Sleep Review: Tell me about the upcoming BRPT symposium. What presentation are you personally looking forward to most? Why?

Altman: The BRPT Symposium is an education program for individuals who have the RPSGT credential. It was started 6 years ago as a way for RPSGTs to network with each other, earn continuing education credits, learn about BRPT volunteer opportunities, and interact with vendors on a smaller scale than some of the larger meetings. The program content is designed for the experienced technologist with a desire for advanced or management topics. The 2012 Symposium is in Reno, Nev, on September 21 and 22. Topics this year include sleep forensics; evidence-based sleep medicine; primary care and dental roles in sleep; best practices and outcomes; patient advocacy; advanced PAP; shift work; legislative issues; LEAN techniques; night versus day scoring; and the value of volunteering. I’m looking forward to all of the presentations, but I am especially interested in hearing the comments and positions from the panel and audience during the night versus daytime scoring discussion. I should also add that BRPT will offer a clinical sleep educator program for licensed or certified health care workers, not just RPSGTs, on September 20, the day before the official start of the symposium.

Sleep Review: In the midst of rising tensions, the Associated Professional Sleep Societies, LLC (APSS) notified the BRPT that the contract to exhibit at Sleep 2012 in Boston had been canceled. When did relations between AASM (the physicians) and BRPT (technologist credentialing body) begin to break down? Why?

Altman: I can tell you the exact date when the relationship between the AASM and BRPT fell apart. On December 17, 2010, BRPT received notice that the AASM Board of Directors voted to develop a Sleep Technologist Certification Examination to be administered by the American Board of Sleep Medicine (ABSM). The reasons given for establishing a new exam were highly critical of the BRPT and the RPSGT exam, but to date have never been substantiated by objective data. I would describe the AASM relationship with the BRPT in the last decade as more authoritative than collegial, with BRPT striving to maintain an independent voice for technologists, but after receiving the notice of the new exam, the AASM clearly set the tone to end its relationship with the BRPT.

Sleep Review: Has the relationship between the BRPT and the AASM created friction within the American Association of Sleep Technologists (AAST) or the Committee on Accreditation for Polysomnographic Technologist Education (CoA PSG)?

Cindy Altman evaluates a sleep study with a coworker. Altman looks forward to the panel discussion about night versus daytime scoring, taking place at the 2012 BRPT Symposium.

Altman: This is an interesting question. Obviously, there was emotion on the part of technologists when BRPT announced the AASM’s decision to develop a new exam. The AAST elected to remain neutral in the matter and to recognize all credentials, although some members of the AAST Board of Directors have been actively
supporting the ABSM credential and serve on the exam committee, making me question the AAST’s neutral position. While the response to the ABSM exam by the AAST was of concern to some, I cannot tell you if this had a direct impact on the AAST. What I can tell you is that there was, and continues to be, tremendous support for the BRPT. Our exam volumes are solid, and the BRPT has expanded its vision and mission to make sure it remains a viable entity in technologist certification.

Regarding the CoA PSG, the BRPT is a strong supporter and sponsor of the CoA. The ABSM was recently recommended for sponsor consideration, and the BRPT opposed this action while the AASM and AAST approved it. Members of the CoA PSG, who function independent of their respective sponsor organizations, considered the ABSM request for sponsorship on more than one occasion and seriously evaluated and debated the addition of another sponsor. In the end, the CoA PSG did not approve the ABSM as a sponsor but did not exclude the possibility of doing so in the future. The ABSM subsequently withdrew its request. The BRPT questioned the process and criteria used to approve new sponsors, but did not make the final decision.

Sleep Review: Do you feel the AASM has been willing to have a good professional working relationship with the BRPT? Why or why not?

Altman: I would say no based on my personal experiences. During my first year as a BRPT director, in 2010, it appeared that the BRPT, AASM, and AAST were working together to develop and launch the CPSGT exam. I’ve seen communications in the BRPT archives from AASM and AAST, supporting and even approving, the direction of the CPSGT exam. However, I know that there was concern about the pass rate for the RPSGT exam, and there was an expectation that the pass rate for the CPSGT exam would be high, which it is.

From BRPT’s standpoint, we believed there was positive collaboration taking place with the AASM. Then in December 2010, quite literally out of the blue, the AASM notified the BRPT that it was establishing a new credential for sleep technologists. BRPT was told that there was no opportunity for discussion; the decision was final. This was after the BRPT met with the AAST and the AASM executive director in September at the AASM headquarters in Illinois to discuss their concerns about the RPSGT pass rate and the exam development process. The BRPT included an examination expert from its internationally recognized testing agency, Pearson VUE, in the meeting to help explain the processes used, the differences in testing measurements, and how BRPT was meeting or exceeding testing best practices for the RPSGT exam.

Another example pointing to a poor relationship between the BRPT and AASM was in a communication from the AASM to the BRPT expressing “serious reservations” about BRPT’s consideration to develop specialty credentials for sleep technologists, despite surveys of sleep technologists that repeatedly showed a strong interest in the development and delivery of specialty credentials for technologists as a means and opportunity for professional growth. So no, my personal experiences with the AASM have not been positive nor did they support a good professional working relationship.

Sleep Review: How are the goals of the BRPT different from the AASM? Do the organizations have different legislative goals?

Altman: Both organizations share a broad commitment to strengthening the field of sleep medicine and to patient care, but the primary interests of sleep physicians and the interests of sleep technologists are likely not the same. In addition, the goals of a membership organization (AASM) are different from a credentialing organization (BRPT). This is not unique to our field. I recently attended a conference that included a panel presentation on the relationships that work or don’t work between certification, accreditation, and membership organizations. The message from the different representatives was that relationships can be difficult to manage, even antagonistic at times, and require a lot of work to maintain. Each organization needs to have a level of respect for the other, and agree to disagree in certain situations. What is unique to sleep is that an organization of physicians, and not technologists, wants to direct technologist credentialing.

Legislative tensions between the AASM and BRPT are ongoing as the BRPT works to counter the ABSM efforts to have the new credential recognized as equivalent to the RPSGT. At this time, the ABSM exam has been given one time in November of last year to 19 people. It has not been objectively evaluated or independently assessed by a nationally recognized accrediting body. The exams are NOT equivalent. The BRPT also does not support legislative activity that restricts the technologist’s choice of alternative education to A-STEP (which is AASM’s technologist education program). The BRPT believes technologists should have a choice in their education and recognizes a variety of alternative education programs to meet exam eligibility pathways if this is an option for technologists in the various states.

Sleep Review: Could you explain why the BRPT is not under the umbrella and control of the AASM?

Altman: In 2004, the AASM proposed that the BRPT become part of a management umbrella that also included the ABSM, AAST, and Sleep Research Society. The BRPT declined the proposal and voted to remain physically, as well as organizationally, independent. Independence is an expectation of NCCA (National Commission for Certifying Agencies) accreditation, and BRPT was concerned that the lines of independence could become muddied by the overlap in services, staff, and mutual interests. Even today, the management relationship between the AASM, AAST, and ABSM raises serious questions about the true autonomy of each group.

Sleep Review: Do you feel fences can be mended enough to reestablish a professional relationship between BRPT and AASM?

Altman: Time will tell if the AASM and BRPT can reestablish a professional relationship. It would certainly benefit the field to have a unified voice in sleep. Our numbers are small compared to other professions, making it even more important for us to work together. People come and go, relationships change, so yes, I am hopeful we can move forward some day despite different goals and directions.