Increasing prevalence of obstructive sleep apnea (OSA) is underlying growth in the market for sleep disorders/breathing care. For HME providers, the route to success combines high-quality products with an emphasis on patient care, says Jim Hollingshead, president, Americas, ResMed. “Treating sleep patients is extremely important to achieving a better quality of life and better health care outcomes, which is better for everybody and for the overall health care system,” he says. “There is a market side, a growth market from a business point of view, but there is also a human side for each individual patient that needs to be treated. From a health care system perspective, it also matters.”
“With a changing market, many of the old ways of doing business will no longer be in practice, although there will be many opportunities,” says Roberta Baron, president of CPAP Supplies Plus/Direct. “To be successful, a sleep program requires a concentration on patient care and education as well as effective marketing. Sleep management programs must be beneficial for the patient, profitable for the HME provider and valuable to referral sources and payers.”
Responding to Cost Pressures
Baron says Medicare reimbursement cuts and competitive bidding have changed the landscape. As patients lose access to their local dealers and immediate services because of competitive bidding, they are turning to online dealers for the products, services and pricing they were accustomed to, she says.
“Competitive bidding has caused many great home care companies to go out of business,” according to Bryan Vigna, national sales manager at Sunset Healthcare Solutions. Competitive bidding has also allowed large companies to become even larger by buying the patients of those who didn’t win bids or by purchasing entire HMEs and DMEs that won bids but couldn’t afford to stay in business at the lower reimbursement amounts, he adds. “It has affected pricing across the board, from manufacturers to patients. It has driven down the prices that HMEs and DMEs can afford to pay for masks and machines, and in the end the patients suffer. It is unfortunate to see top-of-the-line technologies and masks not available to patients because reimbursement is low.”
Hollingshead of ResMed warns HMEs not to get caught in the trap of supplying inferior products from lower-cost manufacturers. Although attractive at first glance, cheaper products can cost HMEs money, he says. For example, lower compliance rates—because the masks are less comfortable and do not perform—will appear in lower reimbursements within 90 days. Lower compliance also equates to lost resupply revenue for additional cushions and masks. Finally, providers could eventually lose favor with referral sources based on lower compliance numbers.
“The quality of the products you put on a patient has implications on the health of your business,” says Hollingshead. “Lower-cost products may be seductive, but you don’t get the revenue benefit of compliance by that patient. Don’t think your business can benefit from lower product costs. It’s a slippery slope and it will hurt you over time.”
Scott Frenz, senior director, North America field marketing, sleep and respiratory care, Philips Home Healthcare Solutions, points out that the cost of goods is only one component of an HME provider’s overall operational cost structure. More strategic approaches—rather than emphasizing low product cost—can help HMEs navigate through the changing reimbursement environment, and Philips Respironics is positioned to provide solutions to help HME providers manage their operational costs in areas such as patient setup, compliance management and resupply, Frenz says. “We see more opportunities for HME providers in offerings outside of traditional managed care settings, such as retail sales to their patients,” he says.
Philips Respironics is a leader in the areas of sleep management, respiratory care and non-invasive ventilation. It also provides a range of oxygen, ventilation and monitoring products for patients who suffer from chronic respiratory diseases.
Emphasis on Compliance
Compliance is required to get paid by Medicare, and the market for sleep disorder/breathing care products is offering many ways to achieve compliance. For example, ResMed’s QuattroAir CPAP mask promotes compliance by providing users a light and non-intrusive full-face mask. Designed with only four parts, the mask also simplifies stocking and inventory management for HME providers.
Software products serve another aspect of compliance. Hollingshead says he sees a trend in the market toward greater use of data to support patient care and to document compliance. ResMed’s U-Sleep software system is a comprehensive patient compliance management solution compatible with equipment from multiple manufacturers. “U-Sleep is a way to help HME providers take the pain and hassle out of the administrative costs of doing business,” he says. The system can also automatically contact patients to remind them to replenish their supplies.
ResMed is a leading provider of products for treatment of OSA, including CPAP, bi-level and auto-set devices, diagnostic equipment, accessories and software products. ResMed’s EasyCare Online provides easy access to patient compliance and efficacy details—anywhere with an Internet connection.
Another tool to boost compliance is Philips Respironics’ SleepMapper self-management system, a mobile and Web-based solution for OSA patients that combines feedback, education and troubleshooting. The system incorporates motivation enhancement therapy techniques to encourage adherence to sleep therapy.
SleepMapper is designed as a training tool, with videos and guides on OSA and on Philips Respironics’ devices and masks. HME providers can direct patients to SleepMapper as a resource to learn more about living with OSA and the importance of sleep therapy, and to view details and tips on therapy devices and masks. SleepMapper offers HME providers a retail sale opportunity through introduction of the optional Bluetooth accessory module.
Frenz of Philips says an efficient resupply program can help HME providers identify and contact patients who are in need of new masks or other replacement supplies, and also to identify and manage patients who are struggling with their therapy. An HME provider can also generate incremental cash sales from sleep apnea patients with retail offerings such as accessory items (hose covers, additional cushions) and even additional CPAP devices for patients who travel.
Cloud-based compliance reporting capabilities have opened up Pandora’s Box, according to Fisher and Paykel (F&P), now allowing multiple stakeholders to access compliance data. Longer compliance reporting is used to determine ongoing needs for CPAP resupply, and authorizations may be based on the data. “These changes seem to contribute to more accountability for CPAP providers in the short term,” says Andrew Hull, one of the company’s sleep product managers. F&P’s InfoSmart Web cloud-based compliance monitoring solution provides modem capability (InfoGSM). Also available is InfoUSB, including free patient reminders via text, voicemail and/or email.
Changing Equipment Trends
Roberta Baron of CPAP Supplies Plus/Direct has seen major changes in the field of sleep in the last six years. CPAP machines have been downsized, and have become extremely quiet and more lightweight. Comfort settings now slowly increase to the patient’s prescribed pressure upon starting therapy for better adjustment, and pressure relief upon exhalation adds to the comfort and encourages long-term compliance.
Remote access to a patient’s machine allows providers and clinicians the ability to adjust patient therapy without making additional trips to the patient’s home or having them bring in their machine. The market has also seen innovative alternatives to traditional CPAP, which has been the gold standard. Oral appliances and EPAP (Expiratory Positive Airway Pressure) have entered the market as new ways of delivering therapy.
CPAP Supplies Plus/Direct is a nationwide distributor of CPAP, auto-set and bi-pap machines from major manufacturers, masks, filters, tubing, accessories, including its own branded line of masks and accessories. The company warehouses the products on site, sells online and has a facility in Orland Park, Ill., where patients can try out several masks and machines.
The company also carries products beyond the basics, such as CPAP Comfort and Care products, CPAP essentials and a bed partner kit, which includes mask wipes, “mask friendly” bed pillows, CPAP tube covers, wash bags and books to educate patients on OSA. CPAP Supplies Plus/Direct also offers home sleep testing, replenishment programs and follow-ups. For local patients they offer a “CPAP Tune Up,” in which they check pressure, filters, tubing for leaks and address mask concerns.
CPAP Supplies’ new Whisper Soft nasal and full-face mask features easy-to-use multi-positioning forehead clips and a soft, silicone forehead pad to allow a proper cushion fit for a quick and easy setup. The design eliminates uncomfortable pressure points on the face. A cushion provides comfort and stability while reducing air leakage. The patented SilentVent Elbow has a mesh exhalation diffuser.
In addition to becoming smaller and quieter, devices are also becoming easier to set up and use, says Frenz of Philips. LCD screens with simple instructions and easy-to-read displays enable a patient to operate his or her device with less input from the HME proivder. This saves time at setup and reduces the need for troubleshooting.
There have also been advances in terms of patient comfort, with features such as flex pressure relief and enhanced humidification with heated tubing to make CPAP therapy more comfortable for patients. Masks are also becoming smaller, lighter, easier to fit and more comfortable.
Growth in Home Sleep Testing
Awareness of sleep apnea has increased in the last five years, but many people still report feeling uncomfortable talking about it with their doctor because they don’t want to have to spend the night in a sleep lab. Home sleep testing is eliminating this concern. As home testing becomes more readily available and more accurate, Vigna of Sunset Healthcare predicts a huge increase in the number of sleep apnea patients across the country.
Home sleep studies are a growing phenomenon in the sector—almost a third of sleep studies are now done at home in lieu of lab testing, says Hollingshead of ResMed. Commercial payers, in particular, are driving the increase in home sleep studies and many require pre-authorization on a polysomnography (PSG).
Increasingly, lab sleep studies are being used only when there is a co-morbidity to justify the added expense. Home sleep studies are fueling a big shift toward auto-set devices, which automatically titrate the required pressure based on a patient’s breathing. (Titration is generally part of lab sleep studies but not home sleep studies.)
Frenz says there is a place for both in-lab and out-of-lab sleep testing. Using both leads to more undiagnosed patients being identified and treated. “For the HME provider, there is opportunity here, as they may now consider adding home sleep testing services—in house or outsourced—to their list of offerings,” he says. “In that respect, home sleep testing is an additional business growth opportunity.”
New Opportunity: Aromatherapy
The industry is constantly improving to provide end users with a better night’s sleep, says Vigna of Sunset. In addition to smaller machines that make less noise, new products such as RemZzz’s (mask liners), CPAP aromatherapy and RoEzIt (skin moisturizer) demonstrate how the industry is moving beyond mask and machine to increase consideration of patients’ comfort.
Sunset Healthcare Solutions carries a full line of CPAP products including filters, tubes, masks, cleaning supplies, pillows, gels and aromatherapy. Sunset’s complete line of filters for every CPAP machine on the market makes it easy for DME providers to get filters to their patients, even those who are using older or unique machines.
Sunset’s new line of CPAP aromatherapy products allows patients to experience a calming scent during therapy, making it more enjoyable and therefore increasing compliance. Placed on the back of the machine by the intake filter, the product supplies aromas that can be pushed through the machine and out through the mask. For dealers, it meets both the need for greater compliance and the need for cash-sale products.
A mistake some HME providers make is not ensuring every patient receives a new mask, filter and/or tube at each of the allowed intervals throughout the year, says Vigna. In addition to costing the HME provider revenue, the failure can impact a patient’s health and eventually compliance. “It is important that a patient on CPAP therapy have a clean filter and tube as well as a new mask that can create and keep a seal,” says Vigna.
To boost opportunities for cash sales, Sunset Healthcare has expanded its cash item line three-fold to accommodate requests from larger accounts. Starting in July, Sunset Healthcare is offering multiple CPAP pillows, CPAP aromatherapy, CPAP moisture therapy and several lines of CPAP-specific cleaning products.
The company is also offering additional comfort products such as RemZzz’s and tubing wraps, as well as a tube hanger. “Promotion and sale of comfort and cleaning products, especially those that require replacement, like cleaning and aromatherapy products, will be critical to supplementing the income for HME providers struggling to keep their revenue up,” says Vigna.
Vigna urges HME providers to negotiate pricing on masks and other supplies, and to find lower-cost alternatives when possible. Beyond the top two or three providers, there are other great masks available at reasonable prices, such as Circadiance (all-cloth masks), Sunset, Tap Pap and Fisher and Paykel.
Emphasis on Choice
Roberta Baron says she sees lack of education as an immense shortcoming among DME providers addressing the sleep disorder/breathing care market. “The patients feel as if the main concern of the DME provider was to further their profit growth,” she says. “The patient is rarely given multiple choices of different manufacturers’ machines and masks that will address their specific therapy needs.” She adds that providing wider choices to their patients is one way online DME providers can offer more.
“All the patients want is someone to guide and direct them, to answer their questions, and they want to know that someone will be available to address their concerns and possible problems with their equipment in the future,” she says.
Support Sites
CPAP Supplies Plus/Direct
www.cpapplus.com
Philips Respironics
www.respironics.com
ResMed
www.resmed.com
Sunset Healthcare Solutions
www.sunsethcs.com
