No Rest for Sleep Providers

According to the providers responding to HomeCare’s 2006 Sleep Survey, this expanding sector is one of the bright spots in an otherwise-uncertain HME marketplace.

In fact, survey participants — 203 HME providers from around the country — said they expect sleep-related revenues to increase at an average of 19 percent for 2007. And 36 percent said sleep business now represents more than a quarter of their revenue. That’s up more than double from the 17 percent of providers who reported this volume of sleep business from our last survey in 2003.

Almost 90 percent of the respondents now employ respiratory therapists either full- (68 percent) or part-time (21 percent). Another statistic that underscores providers’ commitment to this market shows that 10 percent now employ full-time registered polysomnographic techs, up from 5 percent in 2003.

While providers have been growing their sleep business, so have sleep labs. There are now a median six sleep labs in respondents’ markets, with a third of providers reporting more than 10. But only 8 percent said their HMEs have their own sleep labs, and most of those who don’t said they have no plans to add one (81 percent).

There has, however, been a big increase in the percentage of providers who offer in-home sleep testing, up from 8 percent in 2003 to 20 percent this year. Unattended in-home sleep studies are the most common, and the only, service offered by a majority of the respondents.

As far as sleep therapy equipment, providers overwhelmingly said they think smaller devices are the most exciting development. And although compliance data gathering/monitoring systems have made their jobs easier, they said, keeping patients compliant is still the toughest part of running a successful sleep therapy program.

SURVEY FAST STATS

Providers responding to the survey have a median 300 sleep therapy clients, although 36 percent have 500 or more. Seventeen percent indicated they have fewer than 50 sleep clients, and 14 percent said they have 2,500 or more sleep clients. For these providers:

• Sleep business represents, on average, 28 percent of total revenue.
• The vast majority (88 percent) expect their revenue from sleep business to increase over the next 12 months, with the average increase anticipated at 19 percent.
• Two-thirds (68 percent) employ full-time registered respiratory therapists, while 21 percent employ this position parttime.
• Registered polysomnographic technicians are employed full-time by 10 percent, and part-time by 2 percent.
• They carry, on average, between four and five brands of masks, four brands of headgear, two to three brands of CPAPs, and two to three brands of bi-levels. But a significant number (46 percent) carry more than five brands of masks and more than five brands of headgear (36 percent).
• About half advertise their sleep equipment/services to consumers, and half don’t.
• There are a median six sleep labs in their markets, with one-third (35 percent) reporting more than 10 sleep labs in their markets, and two-thirds (67 percent) reporting continuing growth in the number of sleep labs.
• On average, it takes from two to three weeks to get patients into a sleep lab, with the median wait at three-and-a-half weeks.
• Only 8 percent indicate that their company has a sleep lab, and most of those who don’t have no plans to add one (81 percent).
• Twenty percent offer in-home sleep testing. Unattended in-home sleep studies are the most common and the only service offered by two-thirds (67 percent).
• Fifty-four percent fit/set-up the majority of sleep patients in their offices compared to 43 percent at the patient’s home.
• More than half (57 percent) say private insurance is their primary payer for sleep products/services, followed by Medicare at 23 percent and managed care at 17 percent.

How many brands of the following products do you carry?

Progressive Market

Providers responding to the survey overwhelmingly said they think the smaller size of sleep devices is the most exciting development in sleep disorders therapy. But they also listed a number of other technological advances and market trends that underscore the continuing progress in this sector. A representative sample of their responses follows.

• Better compliance monitoring
• Better masks
• Better quality interfaces
• Comfort features, including heated humidity. “Built-in humidifiers have allowed for better compliance and overall better reimbursement from Medicare,” one respondent said.
• Consumer-friendly machines
• Different modalities to help with patient need
• Easily portable units
• Equipment that is smaller and easier for patients to use
• Home screening devices. “This is the next stage of sleep for home care,” predicted a survey participant.
• Increased physician recognition of OSA. Physicians seem to be gaining experience and are no longer set on “only one type of mask when it comes to difficult customers to fit,” a provider noted.
• More comfortable and less obtrusive masks/new mask designs and materials/wider variety of masks
• More variety in machines
• New headgear
• Quieter machines
• Remote access to compliance/Internet-enabled compliance monitoring
• Smaller equipment with more features, including diagnostic data collection and reporting. “Devices are becoming smaller and more sophisticated,” one survey participant summed up.

What is the most rewarding part of operating a sleep therapy business?

While they said it in different ways, in answer to this survey question more than 100 individual sleep therapy providers told us that improving people’s lives is their greatest reward. Here is a sample of responses in providers’ own words:

“Change in clients’ lives when they are compliant”

“Enabling spouses to sleep in the same bedroom”

“Gaining physicians’ trust in treating their patients”

“Great positive responses from patients and family members”

“Happy, productive people”

“Having clients tell you how wonderful they feel after they start using their equipment”

“Having patients experience the benefits of getting a good night’s sleep”

“Hearing patients return to say they have never felt better. And that they no longer nap during the day, have lots more energy and wish they had done this 10 years ago”

“Helping patients live normal lives again”

“Improving patients’ quality of life”

“Knowing that we may have helped to prevent an apnea-related death”

“Knowing you are preventing long-term and more serious disease”

“Patient contact”

“Patient satisfaction”

“Positive medical outcomes”

“Saving a lot of marriages!”

“To help people enjoy life more”