If you are not currently participating in the sleep market, you
are most likely considering the prospect. There is good reason: The
market is growing at approximately 20 percent annually, and
opportunities abound for respiratory providers who offer clinically
sound and efficiently run programs.
“The sleep market is one of the areas that is growing
faster than any other area,” says Bob Messenger, RRT,
Invacare's clinical manager of respiratory products. “From
the perspective of evaluating a business going forward, you really
need to look at the fact that Medicare is cutting the legs out from
under providers in other areas. The one bastion of safety that is
left is sleep.”
With the growing need, manufacturers have responded with a new
generation of sleep-disordered breathing products designed not only
to improve patient compliance but also to enhance providers'
profits.
According to Gretchen Jezerc, respironics' director of U.S.
marketing, sleep-disordered breathing, the company's new technology
is “a way to help people be compliant and successful in their
therapy from the beginning, because that's what really drives
everything in terms of the success of a home care provider's
business and the success of the physicians and clinicians in
treating the patient.”
Manufacturers note that product enhancements are driven by
several factors, competition among them — and that's good for
patients, says Kristin Mastin, director of respiratory marketing
for the DeVilbiss Respiratory Products Division of Sunrise
Medical.
“The sleep market is a young market, so … each
manufacturer is continually trying to offer the latest and greatest
solution,” she says.
“Additionally, the industry as a whole is learning more
about sleep and sleep disorders, which encourages manufacturers to
push the envelope to develop more effective means of providing
sleep therapy. These advancements are furthered by continual
innovations in the components used in the manufacture of sleep
therapy equipment.”
Mastin and others say patient need has a huge impact on sleep
product design changes and improvements.
“What drives our newly designed masks and other
respiratory products is patient feedback with specific requirements
they have for the perfect mask to wear when sleeping,” says
Kelly Rudolph, marketing manager for Hans Rudolph.
“The sleep apnea market is a huge market that is growing
each day, so, therefore, there are various mask requirements. There
isn't one mask for everyone, so we continually strive to meet all
the requirements for a mask that seals better, is more comfortable,
more durable and more affordable.”
Messenger adds that consumers want portable systems that fit
their lifestyles. “Clearly, what we're seeing is a movement
toward a smaller, lighter, quieter and definitely more
aesthetically pleasing product that will fit into people's home
environment,” he says.
To meet patients' needs today, adds Jezerc, products must focus
on comfort, adjustability and “getting it right” the
first time.
Respironics' new My Life series, launched in January with its
OptiLife mask, was developed in part to help patients overcome the
initial difficulties of therapy. The series offers modular
components, simple designs and a wide range of fittings that make
it easy for patients — and therapists — to contend
with.
The OptiLife, for example, allows side-sleeping without
disrupting the seal, based on the premise that patients who are
more comfortable with their equipment will be more compliant with
their therapy. The mask features headgear with no buckles, and
instead of using the nose to support the seal, it uses a chin
support band to provide a foundation for the seal, eliminating
nasal irritation and pressure.
The flexible headgear and chin band allow the mask to be put on
and adjusted with little effort. The mask also comes with pillow
cushions in four sizes (petite, small, medium and large) to
accommodate a range of patients.
For home care providers, the company says the mask should
minimize patient call-backs and “can't-fit” scenarios,
which, in turn, should reduce costs and increase long-term
revenue.
Invacare's Messenger says a good design will allow the use of
fewer materials yet still maintain a good feel. “If it's
designed properly, a mask should almost be able to float on a
patient's face with minimum pressure,” he explains.
The company's Twilight II nasal mask “equally distributes
pressure completely around the head,” he says. “By
virtue of the way the cushion itself is designed, it does not
require the patient to utilize a lot of pressure. They get a
comfortable fit, and there are no telltale signs in the
morning.”
ResMed's Mirage Swift II nasal pillows mask, introduced last
year, is a lightweight mask that sits at the entrance of the
nostrils without covering the nose. The mask has few parts and is
designed for easy handling and cleaning.
Fisher & Paykel launched its new Opus nasal pillows mask in
February. According to Christian Kiely, the company's home care
product manager, the mask is small, quiet and comfortable, and
allows side-sleeping without mask displacement.
Kiely says the mask is designed with anatomical silicone pillows
and facially contoured, reinforced headgear. A
ball-and-socket-styled joint combines with its anchoring system to
give stability and freedom of movement, and the Opus comes fully
assembled with a variety of pillow sizes.
In other product areas, Mastin adds, the market is moving toward
small flow generators that look less like medical equipment and
more like small home electronics. “These units are also
feature-packed, focusing on patient comfort,” she says.
The new DeVilbiss PAP line, which will be launched later this
year, will provide the next generation of remote monitoring, Mastin
adds.
Meanwhile, ResMed has introduced its VPAP Adapt SV, an adaptive
servo-ventilator designed specifically to treat central sleep apnea
(CSA) in all its forms, including complex and mixed sleep
apnea.
Running an Efficient Business
Naturally, an HME market that is growing as rapidly as this one
spawns high-stakes competition among providers as well. As home
care companies increase their presence in the sleep market, experts
say they will have to differentiate themselves through efficiency
and stellar customer service.
There are a number of aspects of efficiency that must be
considered:
- Clinical efficacy
If patients are not compliant, a sleep therapy program will most
certainly be a disaster. Compliance is directly related to initial
success and immediate gratification. Patients whose therapy is
effective often feel benefits after the first night of use.
Messenger says 80 percent of patients report mask
incompatibility as the No. 1 reason for noncompliance. “It is
very important for providers to ferret out these issues early in
the therapy, because if the patient is non-compliant at the 30-day
mark, the window of opportunity has been closed,” he
says.
Providers will need to diversify their sleep business with both
payers and referral sources. It may mean stepping outside their
current comfort zone, but it is necessary.
“By working with private insurers and expanding their
coverage area, there are opportunities for HME providers to enter
into the diagnostic component,” says Tom Pontzius, president
of VGM Group's Nationwide Respiratory. “There are numerous
ways to partner with sleep labs to expand coverage areas and
diversify the existing base of sleep business and expand beyond
obstructive sleep apnea.”
As with all areas of HME products and services, delivery costs
continue to have a negative impact on profitability.
According to Mastin, providers who have chosen to schedule
on-site evaluations and product set-ups are discovering that
patients are accepting this procedure and are realizing
considerable cost-savings.
Ron Richard, senior vice president of strategic marketing for
ResMed, says on-site procedures can benefit patients by providing
increased scheduling flexibility, and can benefit clinicians since
they have all of their masks, educational materials and products on
hand.
“It enables [providers] to improve overall patient
satisfaction and engage the patient in selecting the device that
matches their lifestyle and needs,” Richard explains.
“The patients we have spoken with about this model expressed
they felt it was like making an appointment to see their dentist or
doctor, so it did not seem to be anything out of the norm for
them.
“For sleep centers and HME providers,” he continues,
“this approach is more efficient from a cost standpoint as it
can decrease expenses related to non-reimbursed activities, driving
times and appointments that are canceled en route or if the patient
is not at home.”
When first diagnosed with sleep-disordered breathing, patients
are naturally confused about their condition and the requisite
treatments, creating a strong need for education.
According to Pontzius, patient education is “key in
maintaining an efficient approach to patient care. By conducting
thorough patient and referral source education, providers will be
able to capitalize on their expertise and generate additional
revenue,” he adds.
Patients need to know the purpose of the therapy and what to
expect, notes Jezerc. She encourages providers to make it clear
that the prescribed treatment is not “just to make them feel
better — it is actually lifesaving.”
Since sleep apnea is a chronic condition, disease management
programs can enhance patient therapy, according to Richard.
“Disease management programs already include monitoring
chronic conditions to offset health care costs associated with
medical protocols that intervene when appropriate to modify the
patient's behaviors or therapy,” he says.
“Early detection and intervention can reduce health care
costs and improve outcomes. Sleep is linked to so many chronic
conditions. It would seem natural for this disease to become an
integral part of an overall patient management program.”
Choosing the right products and the right vendor alliances can
have a direct correlation with profitability. Patient choice
certainly is a factor to consider, but providers cannot feasibly
offer every style of mask.
Invacare's Messenger points out that it may be difficult to
streamline inventory — which could mean the patient's first
choice is not available — but doing so is a financially
prudent decision.
“There have to be 50 to 60 masks out there on the market,
and there is no reason for somebody to have to go with the
‘mask of the month,’ so to speak. Providers should try
to control their inventory so that they are offering two or three
different types of nasal masks and face masks and nasal
pillows,” he advises.
When selecting which products to carry, it is critical to choose
those that are effective and reliable. Choosing a product based
only on price can result in long-term loss.
Jezerc says the best approach is to determine which products
work best for the company's therapists.
Providing a clinically efficient, high-quality mask at the
beginning can improve patient satisfaction and should thus decrease
costs, adds Rudolph.
Keeping patients informed about the supplies that need to be
replaced is not only financially sound, it is essential for
ensuring positive clinical outcomes. And follow-up programs that
notify patients they are eligible for a new mask or tubing can
create a consistent source of revenue.
“Through the use of follow-up programs and maintaining
contact with their patients, mask and accessory reorders will help
in the increase of profits as it relates to revenues,” says
Nationwide Respiratory's Pontzius.
ResMed's Richard adds that there are a variety of ways follow-up
programs can be effective, and points out they can offer additional
bonuses.
“Providers are looking at various ways to increase their
revenue based on follow-up programs utilizing automated call
systems, postcards and e-mail notices to make sure the patients
replace their masks and accessories,” Richard says.
“These programs also can be used to answer questions about
their therapy, which improves patient satisfaction and documents
outcomes, so [providers] are in compliance with accreditation
programs.”
Such resupply programs offer a significant, yet often
under-utilized, opportunity for providers.
Currently this is an untapped market, says Respironics' Jezerc.
She advises providers to create a comprehensive patient database,
even if it means starting with new patients. Then, existing
patients can be added as time allows.
According to the experts, the market for treating
sleep-disordered breathing does not appear to be slowing down.
Providers who create beneficial partnerships with payers, referral
sources and manufacturers are looking at an incredible
opportunity.
Utilize Manufacturer Support Programs To Increase Success
If you haven't already, take advantage of manufacturer support
to increase your success in providing products and services that
treat sleep-disordered breathing. Many offer programs that address
both patient and referral source education, marketing and
operations.
Fisher & Paykel recently launched a new patient education
program called Vigor8. “This program was designed for those
who live with obstructive sleep apnea and those that care for
them,” explains Christian Kiely, home care product manager.
“We feel this tool is uniquely positioned to drive home care
provider efficiencies, particularly in the areas of patient set-up,
follow-up and education.”
Invacare offers educational programs designed to help clinicians
become better sleep therapy providers by helping them understand
the technology that exists today and what is appropriate for their
patients, notes Bob Messenger, RRT, clinical manager of respiratory
products.
“We have also put together some tools to help providers
who aren't currently in the sleep market to evaluate that market so
that they have a good understanding of the requirements.”
According to Messenger, the company also can help providers
develop relationships and create programs to meet the needs of
“non-traditional sources” for sleep referrals. He adds
that Invacare offers team selling opportunities and has clinical
specialists in the field who are specifically focused on this
area.
“Our goal is to help the provider become a more effective
and efficient provider of sleep therapy,” he says.
Mick Farrell, vice president of marketing for ResMed, says the
company provides opportunities for providers to enhance their
growth, including programs for marketing to cardiovascular
clinicians, primary care physician practices and diabetes
educators, as well as those in emerging areas like occupational
health.
The company can help improve profitability with “mask
guarantee programs, follow-up programs that include free mask and
accessories replacment, email services for patients using
MyResMed.com and patient awareness through HealthySleep.com to help
drive undiagnosed patients into the sleep lab and through to the
HME provider,” he says.
ResMed also offers clinical services such as continuing
education programs and clinical protocols for new areas.
“We promote superb patient care by defending the value and
essential place of HME sleep therapy services through our Internet
policies,” says Farrell. “This is important because
better patient education of the risks of cardiovascular disease in
untreated OSA and the quality-of-life improvements from effective
OSA aftercare result in better long-term patient
outcomes.”
In January, Respironics launched its Lasting Impressions
program, which is aimed at boosting providers' success. According
to Gretchen Jezerc, the company's director of U.S. marketing,
sleep-disordered breathing, the program offers materials to help
providers' sales and marketing employees target their referral
sources effectively, and it provides talking points about the
benefits they can offer.
“It includes materials for helping encourage physicians,
primary care physicians and cardiologists to screen and refer
patients because of the compelling facts about the prevalence of
OSA among other comorbidity conditions such as heart disease and
diabetes,” Jezerc says.
Respironics also offers educational materials for providers as
well as additional sales and marketing materials to enhance patient
success and referrals. The company's “Are You Sleeping”
screening device is designed to assist providers in the initial
screening of patients with sleep-disordered breathing.
Sunrise Medical offers free educational courses for both
respiratory therapists and sleep technicians. The company also
offers remote CPAP utilization monitoring as well as parameter
adjustments.
“This allows providers to monitor CPAP adherence and
adjust the prescribed pressure or settings from their
office,” says Kristin Mastin, director of respiratory
marketing for the company's DeVilbiss Respiratory Products
Division.
Monitoring Home Diagnostics
Currently, the vast majority of patients at risk for
sleep-disordered breathing are diagnosed in a sleep lab. But going
forward, this could change, some manufacturers say.
“There are already pockets of certain providers and
certain insurance companies that are using [a home-based] model,
placing people on an auto CPAP device and having that device do the
titration from home,” explains Respironics' Gretchen Jezerc,
director of U.S. marketing, sleep-disordered breathing. She says
many Veterans Administration programs are already working within
this model as are some payers. Jezerc advises providers to keep an
eye out to ensure they are prepared to embrace this model with the
appropriate products and services that it would require.
Ron Richard, senior vice president of strategic marketing for
ResMed, adds that reimbursement is going to play a vital role in
this area.
“Payment for diagnostic-attended polysomnograms is
decreasing across the nation [but] there is a fixed cost for these
tests associated with overhead and technicians,” he notes.
“At some point, only the sickest patients will be studied in
overnight attended sleep centers, thus enabling the physician to
spend time evaluating and getting the patients on the right
therapy.”
Richard adds that if fewer patients are studied in sleep labs,
then a shift in studies will occur somewhere else.
“Most likely, these studies will occur in the home,”
he says. “Perhaps what is more important is the need then to
provide technology that will also tie the portable study to a means
of home titration so therapy can be initiated.”
Types of Sleep-Disordered Breathing Conditions
There are over 80 known sleep disorders. Common sleep disorders
include:
- Circadian Rhythm Disorders
- Excessive Sleepiness
- Insomnia
- Narcolepsy
- Obstructive Sleep Apnea
- Parasomnias
- Periodic Limb Movement Disorder
- Restless Legs Syndrome
Source: National Jewish Medical and Research Center
Effects of OSA
- Unrefreshing, fragmented sleep
- Severe daytime sleepiness
- Morning headaches
- Fluctuating oxygen levels
- Increased heart rate
- Chronic elevation in daytime blood pressure
- Increased risk of stroke
- Higher rate of death due to heart disease
- Impaired glucose tolerance and insulin resistance
- Impaired concentration
- Mood changes
- Increased risk of being involved in a deadly motor vehicle
accident - Disturbed sleep of the bed partner
Source: American Academy of Sleep Medicine
Experts Interviewed:
Mick Farrell, vice president of marketing, and Ron Richard,
senior vice president of strategic marketing, ResMed Corp., Poway,
Calif.; Gretchen Jezerc, director of U.S. marketing,
sleep-disordered breathing, Respironics, Murrysville, Pa.;
Christian Kiely, home care product manager, Fisher & Paykel
Healthcare, Irvine, Calif.; Kristin Mastin, director of respiratory
marketing, DeVilbiss Respiratory Products Division, Sunrise
Medical, Longmont, Colo.; Bob Messenger, RRT, clinical manager of
respiratory products, Invacare Corp., Elyria, Ohio; Tom Pontzius,
president, Nationwide Respiratory, VGM Group, Waterloo, Iowa; and
Kelly Rudolph, marketing manager, Hans Rudolph, Inc., Kansas City,
Mo.
