CPAP providers enter 'brave new world'

A 2008 CMS regulation that requires CPAP providers to compile and report compliance data for Medicare patients has created a new environment for the market, industry observers say. Its effect has essentially changed the way HME companies do business, with some exiting the Medicare program and others modifying their approaches in various ways.

“The compliance requirement has prompted some providers to alter how frequently they 'touch' the patient in that first couple of months,” said Kristin Mastin, director of marketing for Somerset, Pa.-based DeVilbiss Healthcare. “Proper intervention and patient support are key factors to increasing CPAP adherence and providers only have three months to achieve this or they will not be paid for the full 13-month period.”

Gretchen Jezerc, director of U.S. marketing-sleep disordered breathing for Murrysville, Pa.-based Philips Respironics, calls it a “polarization” of the market.

“Providers who are doing any amount of business with Medicare patients have definitely trended toward devices that have actual download capability and shown more interest in data management offerings with a modem,” she said. “Other providers are just focusing on managed care, though because reimbursement is tight in certain areas, they are furnishing more basic CPAPs with less data capability. The $64 million question is whether commercial payers will follow CMS's lead.”

It is probably more a matter of when private payers will follow CMS's lead and whether the industry is prepared for that next wave of compliance tracking needs, said Mick Farrell, senior vice president of the global sleep strategic business unit at San Diego-based ResMed.

“The good news is that we have tested the systems with our HME partners in terms of wireless coverage and in terms of cloud computing capability and can now scale to where we need to go as providers and manufacturers working together to meet this challenge,” he said. “Our goal is to provide products, services and support to our HME provider customers so that they have all the tools to win in this brave new world of CPAP adherence tracking.”

Adoption of wireless monitoring modules continues to expand as providers find that the advantages of “no touch-no effort from the patient” models make good clinical and good economic sense, Farrell said.

“Providers are seeing a high ROI from investments in wireless technology services by increasing the cost-effectiveness, speed and ability to intervene-by-exception with noncompliant patients,” he said. “By not relying on the patient to take any action and not spending time on the phone asking for patients to bring cards into the HME location to download, costs are being saved for the provider.”

Realizing benefits

Providers that continue to accept Medicare are being forced to change existing CPAP protocols, Mastin said. Among the obstacles they face: higher costs associated with contacting the patient more frequently; generating required adherence documentation from devices; and getting patients to see their doctor for a face-to-face re-evaluation. Yet the requirements are also yielding some positive results, Mastin said.

“Clearly with increased communication and intervention by providers to achieve the adherence goal, patients are more likely to comply with therapy and reap the benefits of their CPAP therapy,” she said. “This also presents a huge opportunity for providers to continue to service the patient long-term with CPAP supply replenishment and enrich their relationship with the patient. This deeper relationship could translate into brand loyalty, generating additional business from that patient in the future for needs outside of their CPAP therapy.”

Jezerc added that more providers appear to be showing a higher degree of interest and activity in CPAP parts replenishment.

“We're getting more requests for information and tools, so that's really good news,” she said.

Mastin said some providers have pointed out that mining for replenishment sales can be costly, however, because call centers can be expensive, inefficient and minimally effective.

“More providers are looking into automated solutions that have the ability to make more calls and off-hour calls in less time,” she said. “We are listening very closely to our providers and are developing turn-key solutions that take much of the cost and concerns out of replenishment sales.”

New testing methods

The “new normal” in the market also includes some “interesting models” emerging in the sleep testing area, Jezerc said.

“We are seeing more providers working with physicians to screen and then actually test their patients outside the sleep lab,” she said. “Most would agree that home testing isn't right for everyone, but for the patients it is appropriate for, that model is emerging more and more. Of course it can't be done for Medicare, but there is nothing to preclude providers from doing it for commercial insurers.”