Getting It Right

Home medical equipment providers who choose to focus on sleep-disordered breathing are fully aware of the opportunities that exist in this market. But fierce competition and changing dynamics mean these companies must develop a sound, comprehensive strategy to keep this business profitable. HomeCareXtra spoke with three successful providers and learned there is no cookie-cutter approach to becoming a market leader in treating patients with SDB.

DASCO Home Medical Equipment Company

Westerville, Ohio

Additional locations: Alliance, Ashland, Columbus, Lima, Marion, Springfield and Xenia, Ohio, and Shelbyville, Ind.

Service and reliability are what set DASCO Home Medical Equipment Company apart. Although the company “happened” into sleep years ago, says President Jason Seeley, its current sleep program leaves nothing to chance.

“We have been involved in the sleep market for a long time, but to be honest, we got into it by accident,” Seeley says. “It started when we moved our home office in Columbus to a different part of town. There happened to be a sleep lab down the street. I stopped in to introduce myself and was told that there was a need for providers that could take care of sleep patients at home.”

According to Seeley, sleep labs are looking for the following:

• Prompt service: It is not unusual for DASCO to set up a sleep patient with their equipment the day the order comes in.
• Accreditation: Seeley says sleep centers understand the hard work and diligence it takes to become accredited. DASCO has been accredited by the Joint Commission on Accreditation of Healthcare Organizations since 1987.
• Follow up: Quick and regular follow-ups with customers ensure compliance and, ultimately, better health for patients.

Today, the company provides CPAP and bi-level services to thousands of patients in its service area. As for marketing its sleep services, DASCO has recently increased and expanded its efforts.

“In the past, we have spent most of our time talking with sleep labs about our programs, but over the last year, we have begun to spend more time talking with family physicians and cardiologists,” notes Seeley. “These doctors have many patients dealing with obstructive sleep apnea who are undiagnosed. Talking to physicians about identifying these people and getting them in for a sleep study sooner has proven to be important.”

When a patient is able to get the treatment he needs sooner, then doctors view DASCO as a valuable resource, he adds.

“Additionally, working with physicians has also improved the relationships we have with our sleep lab referral sources. We are in a position to recommend them to the family doctors and cardiologists we partner with,” Seeley points out.

Seeley and his team also know that compliance is important to patient health, physician referrals — and the company’s bottom line.

“One of our biggest challenges is keeping patients compliant with their therapy,” he says. “Wearing a mask on your face all night can be difficult for people. An uncomfortable mask or one that does not fit properly can frustrate people to the point of not using their machine. Obviously, the therapy won’t be able to help a patient if they aren’t using it.”

But from a business perspective, giving a patient multiple masks and sending a health care professional out on a lot of visits for one issue can get very expensive, he explains, so the goal is to spend the appropriate amount of time on education and proper fit at the initial patient contact.

“We offer a wide variety of masks, and we make sure the mask fits when the customer is lying down like they would when they sleep,” he says. “It is important to get it right the first time.”

And, he adds, “we follow up with all sleep customers within 72 hours of the initial set-up. The purpose of this follow-up is to make sure there are no issues that need to be addressed. If there are, we can nip them in the bud.”

Premier HomeCare

Louisville, Ky.

Additional locations: Elizabethtown, Lexington, London, Pikeville, Richmond and Scottsburg

Community involvement, outstanding long-term patient support and working closely with physicians, sleep labs and referral sources are the backbone of Premier HomeCare’s sleep program.

“With over 12 million people affected by obstructive sleep apnea, there is a huge need for this therapy,” says Wayne Knewasser, vice president of public relations and government affairs. “Continued support, awareness and education about sleep disorders will steadily increase for a number of years. Having the success we are having with positive outcomes for our patients and our referral sources will ensure steady growth for a number of years.”

Knewasser notes that successful patient compliance, cited by most sleep providers as the most challenging part of running a successful program, relies heavily on initial introductions, simple and thorough education and a heavy emphasis on service.

Premier’s patients are contacted the day the referral is received. Therapy is started within 24 to 72 hours of the referral, although in most cases, it is the same day. If initial contact with the patient is not made within 48 hours, the home care coordinator is notified who then contacts the referral source to determine a plan of action.

New patients are asked to visit the company’s office, which includes a private area with a full-reclining chair that allows clinical staff to provide a proper fit. If the individual is unable to come to the office, the staff will schedule a home visit.

“Our typical set-up time on average is in excess of 60 minutes,” says Knewasser. “Patients are given verbal and written instructions about their therapy, how it works and the expected benefits. They also receive additional information on obstructive sleep apnea and its effects.”

He adds that spending extra time during initial introduction of the therapy helps the patient become more confident with the equipment, which results in better compliance. Also, an emphasis on mask selection is based on facial structure and patient comfort — not on price.

Compliance checks and reports are conducted 30 and 60 days from the initial start date. Copies are sent to the referral source and the payer source. Patients are re-contacted quarterly thereafter and asked to complete a questionnaire on the status of their equipment, supplies and general well-being.

Premier also encourages patients to participate in local AWAKE meetings. Members of its marketing and clinical staff attend these meetings regularly, offering advice and encouragement.

Marketing the company’s sleep program involves targeting both referral sources and patients. For example, the company participates in local community health fairs and company-sponsored health fairs.

“Recently, we participated in a company-sponsored health fair at a local Ford assembly plant. Over 900 individuals visited the area where they were able to ask questions and experience first-hand CPAP equipment,” says Knewasser. “We provided brochures with the Epworth Sleepiness Scale, an assessment tool, to allow the individuals to be better informed about sleep disorders and to consult with their physician if a questionable result was obtained.”

Other marketing strategies include offering CEU programs regarding sleep disorders, partnering with manufacturers to demonstrate new products and technology to referring physicians and sleep labs, and promoting a disease management program called “Sleep Healthy.”

“Our CEU programs are held in our corporate office conference room or at a designated offsite facility,” Knewasser explains. “Our programs are tailored to meet the continuing education requirements of case managers, discharge planners, respiratory therapists and cardio/pulmonary rehabilitation departments.”

But for Premier, patient satisfaction remains a priority. “We are committed to being able to provide all of their HME needs — not just one facet of their overall care,” says Knewasser. “We are there for our patients 24 hours a day.”

CressCare Medical

Harrisburg, Pa.

Additional locations: Newport, Wyomissing and Carlisle

Eight years ago, Todd Cressler saw a lack of interest from competing providers in focusing on sleep therapy. He also knew that the growing number of people being identified and diagnosed with sleep-disordered breathing would only continue, so he created a business plan that would enable CressCare Medical to meet the needs of both patients and referral sources.

“At that time, no other companies wanted the business — everyone wanted to focus on nebulizers and oxygen,” says Cressler, the company’s president and CEO. “I started developing the customized software to track and report compliance on all my patients. It snowballed from there.”

Since then, new patient programs, the latest in product technology and a commitment to compliance and quality assurance have become CressCare’s platform for success in the sleep arena.

The provider employs eight respiratory therapists who conduct all set-ups and equipment orientations, which can take place at the patient’s home or work or at the CressCare office. The company strongly emphasizes compliance. Its internal CPAP/Bi-level clinical policy states that the primary intent is to get patients compliant with their prescribed therapy through intensive education and support.

“Our policy states that the RT should always contact the patient the same day as the referral comes in. The intake staff should ask where and when the patient is available and how they want to be contacted,” adds Cressler. “The patient is our No. 1 priority, and they deserve the best in customer service.”

The company has a standard protocol for contacting patients that includes calling the patient’s home phone, cell phone and work phone (if provided). Staff members are instructed to leave messages until they reach the patient. If there is not a return phone call in 24 hours, the sleep lab is called and informed. CressCare also mails patients forms in a constant effort to keep updated on their progress.

Cressler believes follow-up is critical to successful compliance. After the initial set-up, the patient is contacted at various intervals, and patients also are mailed a quality assurance survey every six months.

Sales and marketing efforts are ongoing as well. The company’s sales force targets sleep labs and markets to primary care physicians, cardiologists, otolaryngologists (ENT physicians) and insurance companies. What makes the company successful, says Cressler, is a marketing program that includes an easy referral process, detailed quarterly compliance reports and summary data, training programs that offer CEU credits and an auto-titration program.

But in the end, Cressler gives 100 percent of the credit for the company’s success in the sleep arena to his staff. “Hire the best and you get the best,” he advises.