Still Betting on Sleep Therapy

According to an Irish proverb, a good laugh and a long sleep are the best cures in the doctor's book. It seems modern-day physicians agree, at least about the sleep part.

Physicians' ever-increasing awareness of obstructive sleep apnea and associated comorbities, paired with consumer interest, continues to be a primary driver in the sleep-disordered breathing market. After a decade of solid growth, sleep therapy remains one of the most consistent performers in home care, with brisk sales and numbers of new patient referrals. Although the dragging economy has contributed to a slowdown in patient volume growth in recent quarters, home medical equipment providers taking part in a survey said they are optimistic that growth will accelerate again in 2010.

The survey, conducted by HomeCare and William Blair & Co., also shows HME providers expect home sleep testing to boost patient volumes in the coming years, although it's not a major factor yet. The thought is that home testing will be considerably more appealing to the estimated 30 percent of patients that never go to a sleep lab to receive a diagnosis.

Among the most prominent trends the survey confirms, however, is the movement toward improving patient compliance.

No one argues with the fact that SDB patients are a resistant population; getting patients to breathe for the first time on a CPAP can be challenging — and costly. Patients either don't follow the physician's prescribed regimen or find the devices uncomfortable and stop using them. So providers must move quickly and aggressively early on to keep patients compliant.

CMS compounded the challenge last year with a coverage change that mandates a patient return to the physician for a face-to-face evaluation between 31 and 90 days of starting the therapy. But patients who balk at another visit to the doctor and physicians not in tune with the rules often make it difficult to get the documentation providers must have to show patient benefit.

In response, those in the survey said they have ramped up efforts to keep patients compliant with their therapy and ensure payment from Medicare. They're using a combination of tactics to do that, including increased contact and support coupled with more use of data management/monitoring equipment. Some said they are recommending higher-end devices and masks to help promote compliance.