Catching Zzz’s on Your Own Terms

Neenah, Wis.-based ThedaCare At Home has set its business apart and is navigating Medicare cuts by promoting products without HCPCS codes and eliminating unnecessary home visits.

ThedaCare At Home is the home care division of ThedaCare, an integrated, community-owned health care system serving the Fox Cities and surrounding Wisconsin regions. The organization is northeast Wisconsin’s second-largest employer with more than 5,000 employees. The company offers home medical equipment, nursing, hospice care, in-home and residential care, senior-care pharmacy, infusion therapy, specialty services and community health programs.

Patients Do the Traveling

But respiratory business drives the provider’s sales, generating approximately 30 percent of its revenue. In 2001, the company split its respiratory department in two, creating separate pulmonary and sleep programs. In 2003, the sleep program made up 39 percent of respiratory revenue, and ThedaCare At Home served more than 1,600 patients with obstructive sleep apnea (OSA), a 40 percent increase over the number of newly diagnosed sleep patients serviced in 2002.

ThedaCare At Home manages its successful sleep program by asking clients to do the traveling themselves. Each of the provider’s four branches has a special sleep treatment room, to which the company partially attributes the rise in sleep business.

“Our program offers a dedicated staff of respiratory therapists whose primary focus is sleep therapy,” says Kathryn Weiher, supervisor of respiratory services. “[In addition,] our change in where care is initiated has shifted in the past few years to a treatment room environment. This change has brought forth not only increased staffing efficiencies but also a better environment for patients to focus on the education we offer in respect to their prescribed therapy.”

The company’s main goal with the treatment room is serving each customer as thoroughly and productively as possible. But another part of its M.O. for bringing patients in is exposing them to the company’s additional DME offerings.

“The type of patient we’re servicing [in the sleep program] is approximately a 45-year-old male or female. These are people who will be needing health care for a long time, not just for themselves but for their parents,” Weiher says. “When patients visit, they get the impression that we’re more than just respiratory. They have to walk past the lift chairs and scooters to get to [the sleep treatment room]. This increases their total picture of ThedaCare.”

The provider sees 90 percent of its sleep patients in the treatment rooms. “Sleep therapy posters adorn the walls, hopefully making the customer feel as though he’s not alone in this new experience,” Weiher says.

She adds that seeing patients on the company’s turf allows the time spent between the sleep specialist and the patient to be more focused. The rooms are stocked with several mask sizes so that sleep specialists do not have to leave the room during sessions.

“We started seeing different kinds of patients, so we started stocking a variety of mask sizes,” Weiher explains. “But when you go to a patient’s home, you are limited to what you can carry. Also, if we bring patients in, we can eliminate external distractions, like the kids coming home from school.”

A commitment to patient education, stringent monitoring and response and collaborative care planning with patients’ physicians has led to compliance data as high as 93 percent.

Auto-CPAP

Seventy percent of the company’s referral sources originate from within the ThedaCare integrated system, which includes one HMO, three hospitals and multiple physician clinics. Because the business is set up this way, Weiher says she’s been successful at promoting auto-CPAP (continuous positive airway pressure) within the organization.

Without a HCPCS code, most providers are hesitant to dispense auto-CPAP, she points out. But with a majority of ThedaCare At Home’s referral sources convinced that auto-CPAP works, the company has made the therapy a top seller.

“We went to our own HMO and said there’s no special code, but I can tell you we’re not putting out nearly the amount of bi-levels, which do have a code,” Weiher says. “Auto-CPAP costs more than a regular CPAP but less than a bi-level. So they agreed. We’re huge in auto-CPAP.”

Weiher says approximately 60 percent of the sleep program patients are prescribed auto therapy while 30 percent are prescribed straight CPAP.

The ultimate goal of auto-CPAP is to keep the patient at the lowest possible pressure for comfort, Weiher explains. The auto-titrating feature responds to the patient on a real-time basis, so as a snore or an apneic episode occurs, the device responds by increasing its pressure until the symptom stops showing.

“The unfortunate thing is that when patients are put into a sleep lab, it’s for a one-night study,” Weiher says. “Then [specialists] have to throw a patient on a mask and titrate to find the level that’s therapeutic.

“But if it takes them six hours to do a diagnosis, it forces them to titrate too quickly, based on one night’s sleep in a strange environment with wires hooked up to the patient. Auto-CPAP takes that variable out of there.” Weiher adds that if a patient gains weight, or even if he or she has a few too many cocktails with dinner, auto-CPAP is an ideal treatment because it ensures patients will have the right amount of pressure, without having to be retested, no matter what variables change.

Sleep therapy has been a lucrative venture for ThedaCare At Home, partially because diagnostic techniques are advancing and the public is becoming more educated about sleep apnea.

“I think with the Internet and with doctors doing more screenings, people are becoming more savvy and thinking, ‘my husband snores a lot, maybe he should get tested.’ I think it’s a program that will see substantial growth in the next five years at least,” Weiher says.

But like most success stories in HME, this one isn’t all about dollar signs. With the right treatment and tools toward a good night’s sleep, patients can expect a better quality of life. Because sleep apnea can cause some people to snore profusely, Weiher says, “some of our customers praise us for saving their marriages.”