Sleep
Moving Toward the Masses
The CPAP market looks a lot like the rest of the home care industry these days — full of potential mixed with uncertainty. Manufacturers and providers alike have reason for optimism, but reimbursement challenges, the threat of competitive bidding and troublesome Medicare audits have screeched business to a halt in some cases.
The undiagnosed sleep apnea masses beckon to home medical equipment providers, but as with any modality that sees a utilization spike, the government becomes suspicious. Helen Kent, president of Carlsbad, Calif.-based Progressive Medical, has responded by redirecting her energy toward private insurance and a large military presence in the San Diego area.
“I'm not going after Medicare, and I'm not marketing to people who have Medicare patients,” says Kent. “We have a huge military population, and that's where we are gearing a lot of our sales.”
Kent's current Medicare patient population consists of many neuromuscular cases (such as ALS) that get Medicare prior to age 65. “If I had my druthers, I would say no to every Medicare patient that comes through that door,” says Kent, “because there is a possibility that I have to pay that money back after all my hard work.”
In all, Medicare beneficiaries still represent about a third of Kent's patients, but that percentage figures to go down even further in 2011 and 2012.
“I'm passionate about this industry, and it breaks my heart to see what they're doing to us,” says Kent. “The boomers are here, and they are going to need us before we need them. If CMS gets rid of moms and pops, discharge planners are going to have chaos when it comes to many issues beyond just CPAP. Patients are going to be in the hospital twice as long.”
Round 2 of competitive bidding will hit Progressive Medical, but Kent has no interest in putting forth a number that she knows would be unsustainable. “I'm not going to bid,” she says bluntly. “Look at those prices they have established. Why would you go through the hassle of bidding when you're going to go out of business with those prices anyway? It is spinning your wheels.”
