Targeting Compliance

With the first quarter of 2010 already in the rearview mirror, manufacturers and providers agree that government policy continues to shape the CPAP market more than any other force. In late 2008, the rules for Medicare patients shifted dramatically when CMS required a follow-up physician visit for patients.

Despite efforts to educate physicians about the 30- to 90-day face-to-face requirement, countless providers had to do a lot of reminding. Some docs did not take kindly to the new direction, which inevitably lead to some friction.

"It can be really frustrating and difficult for patients and physicians," acknowledges Patrick Clevidence, RRT, vice president, respiratory service, for Cleveland-based Medical Service Co. "Physicians say, 'I usually see patients in two weeks, and now you are saying you want me to request them between 30 and 90 days. Why do I have to do this?'"

While only 20 percent of Clevidence's CPAP patients are Medicare beneficiaries, the Cleveland-based provider must allocate one full-time employee who does little else but follow up on those patients. "We call the patient, get the compliance download, and call the doctor's office," confirms Clevidence. "We make sure patients went to their appointment, make sure physicians actually document notes in their charts — so it is a lot of education."

It takes a lot of time and effort to cultivate compliant patients, and Clevidence laments that much of that effort goes unpaid and, therefore, must be done as efficiently as possible. Fortunately, the company's educational push with its referral sources seems to be working, Clevidence says.

Helen Kent, RRT, CEO of Carlsbad, Calif.-based Progressive Medical, contends that working with patients is often easier than working with doctors. After all, providers see patients much more than they see physicians, so educating patients about the 30- to 90-day window gets patients on board and advocating on their own behalf.

Using her considerable powers of persuasion, Kent gets patients on her side while also conveying the impact of CPAP therapy on overall health. Once patients share her enthusiasm, she puts the onus on them to make appointments with physicians. Physicians can conceivably ignore home care providers, but patients typically receive proper attention.