Specializing Successfully

Diversification. It is one of the most frequently mentioned words in home health care today, because it’s one way that enables HME providers to remain solvent during uncertain times. In contrast, however, one Seattle company has chosen to concentrate on a single disease state, and is discovering that specialization is the key to its success.

Swedish Sleep Therapy Supply, which is owned by Swedish Medical Center, is the only hospital-based HME in the Pacific Northwest that focuses exclusively on sleep therapy products and services. The strategy is working quite well. The seven-year-old company generates $2.9 million a year in revenue for equipment used to treat the sleep apnea population. The provider currently serves 3,500 patients from its main location in Seattle and a satellite office in Wenatchee 200 miles away.

“We specialize in the sleep apnea population because we have a different attitude about it,” says John Basile, BS, LRCP, the company’s manager.

Making a Connection

For Basile and his staff of five respiratory therapists, the company’s standout difference — and a cornerstone of its success — is rooted in education. As soon as the company receives the physician’s order, events are put into motion that are designed to educate and empower the patient to use his equipment as prescribed, which results in his feeling better and an overall improvement in his health.

This is great for the patients and for Swedish Sleep Therapy Supply. The relationship between sleep apnea patients and their providers has the potential to be a lifelong one.

“These patients are going to be on CPAP (continuous positive airway pressure) for the rest of their lives — not temporarily — and they will be your patients the rest of their lives if you invest in the benefit of their success with the therapy,” says Basile. “If your patients end up being successful on therapy, they will return every year and buy supplies, and at the end of five years, they’re going to buy another machine.”

Basile emphasizes that the way to teach patients how to be successful with CPAP — and all positive airway pressure therapy — is to combine education with patient contact. It is part of his company’s formula.

“Patients are not going to be successful with just education alone — they need support, contact and communication, especially in the first week,” he explains. “If you lose them in the first four days, you’ve probably lost them forever.”

Basile’s formula involves hands-on training and regular follow-up. Patients are contacted immediately after the physician order is placed. Then, they come into the office to receive the equipment and extensive hands-on training in a controlled, educational environment.

To enhance the atmosphere for training, the company’s offices include a consult room with a twin bed and bedside table. The point is to duplicate what will happen at home on the first night of use. After the respiratory therapist explains the machine and the process, the patient demonstrates how he will use the equipment. Following the session, the therapist goes over an educational checklist, and the patient signs an agreement stating that he has learned the necessary points.

The next step is crucial, says Basile. The therapist establishes a date and time during the next week that the patient can be contacted for follow-up, and then calls at that appointed time to discuss problems or questions.

The worst thing an HME provider can do, explains Basile, is not take this condition or a patient’s prescription for CPAP therapy seriously. When patients are first diagnosed with sleep apnea, they have been told by their physician that they have a chronic disease, which, left untreated, will have an overall negative impact on their health. If the HME provider involved takes even several days or a week to provide the equipment and training that is needed, then the message being sent to the patient gets mixed. That is why fast and effective contact is so important to Basile and his staff.

Basile also offers Saturday workshops to patients to help them remain compliant. In the past, these two-hour sessions have included topics like “What’s Good and What’s Not So Good in CPAP Masks,” and “Traveling with Your CPAP.” Typically, 25 or more people show up for the workshops, which include a presentation by a therapist and a group discussion.

Patients also have access to the company’s newsletter and patient-oriented Web site, which offers interactive problem-solving and can even accept replacement orders for equipment.

Basile, who taught at a community college for nearly a decade, uses his expertise in adult learning styles to enhance patient compliance.

“I have taken the information I have about how to teach adults, and we have put together a program that results in excellent patient compliance,” he says. “The national average of compliance is somewhere around 50 to 55 percent; we are showing numbers where our CPAP patients are using their equipment 67 to 76 percent of the time.”

Basile also uses what he and his staff are learning to teach other professionals. Last May, he organized the first-ever one-day seminar in the state that focused on treating sleep apnea patients. Plans are already under way for the 2005 meeting, which is expected to attract clinicians and home health care professionals from Alaska, British Columbia, Idaho, Oregon and Washington.

Getting the Word Out And Keeping Track

Swedish Sleep Therapy Supply operates under the banner of Swedish Medical Center, which is a non-profit organization. This presents a unique challenge to Basile since he cannot market to referral sources the way most HME providers can. Instead, he participates in professional organizations and activities that provide opportunities to publicize what the company does.

Another way he tells potential patients about his services is through an introductory educational session that all sleep apnea patients involved with Swedish Medical Center go through prior to being placed on CPAP. After the session, Basile gives the attendees a list of all the HME providers in the area that they can go to for their equipment.

“I give them a choice; I’m on the list,” he says. “Some of them will choose to do business with me, and some of them will choose to do business with the other durable medical equipment companies.”

Basile says tracking compliance is essential to market a sleep apnea program — even if the physician does not ask for it. And he wants to improve the status quo from how the HME community currently views compliance.

“I support the reporting of compliance and the use of machines that measure the compliance of the patient,” he says. “Everybody wins: The patient wins, the HME provider wins and the insurer wins because it is getting what it paid for.”

Basile uses Respironics’ Encore Pro software to keep track of compliance. With this system, he has access to patient statistics, including prescriptions and insurance, and he has the tools to keep patients and therapists knowledgeable and connected.

“The software also provides the therapists with reminder messages to call the patient and provides reporting on compliance so I can watch the compliance of different patient populations who are using different machines,” he explains.

Specialization is working for Basile and his staff. They see the enormous opportunity in the sleep market, and have determined that the investment is sound.

“I’m going to make a lot of HME managers mad by saying this, but this is not a 30-day commitment. This is a five- to 10-year commitment you have with your patients — this therapy is lifelong,” emphasizes Basile. “Treat it that way and you will reap the rewards. Continue to look at it as a 30-day immediate gratification, and that’s the way it’s going to be.” “This therapy is lifelong. Treat it that way and you will reap the rewards. Continue to look at it as a 30-day immediate gratification, and that’s the way it’s going to be.”