Understanding our market and the competition within our market is critical to stemming the many influences, which may erode our success as providers. As well, daily we face many factors which impact the growth of our program. Reimbursement changes, regulatory standards, changing referral alliances, technologic innovations, and outcome based quality monitoring all yield their influences. Measuring effective outcomes for our patients is an expectation. Coupled with these factors, is the need for us as practitioners to be recognized by our patients, peers, third party payers, and the community as providing evidence based care. When we add the expectation for documenting and trending defined quality measures, it becomes necessary to have a matrix to coordinate the many facets of a sleep center. Therefore, each day we have to carefully define, implement, and monitor strategic variables of the successful sleep medicine program. The key to survival is scrutinizing your business, identifying changing alliances, and marketing the strengths of your program. We will identify how Home Sleep Testing can be a conduit to enhancing market presence.