CPAP rules: Some patients get it, others try patience

Tuesday, January 26, 2010

Just over a year after Medicare implemented new guidelines for CPAP, many providers still struggle with educating patients on the rules.

"It is difficult sometimes to get patients to actually take the bull by the horns," said Nancy Archdeacon, executive vice president of sales and clinical services for Cincinnati-based Pro2 Respiratory. "A lot of it is out of our control."

The updated guidelines went into effect in November 2008. For initial coverage of a CPAP, patients must have a face-to-face evaluation with a physician before the sleep test. Between 61 and 90 days, they must have a follow-up visit and meet certain criteria for continued coverage.

It's the latter requirement that causes the most difficulties, say providers.

"A lot of patients say they will (discuss the therapy) at their next regular appointment," said Eric Parkhill, vice president of Home Medical Professionals in Atlanta. "They don't realize it's got to be done between 60 and 90 days."

As to whether the guidelines improve patient compliance, the jury is still out.

"I don't see how the second face-to-face visit is either helping or hindering therapy," said Todd Cressler, president/CEO of Harrisburg, Pa.-based CressCare Medical. "Having the medical record is not doing anything for the patient."

A little extra coaching goes a long way for some patients, however.

"We have said, 'Your success with this therapy is dependent not only on you being committed to it but also adhering to it and clearing these hurdles for reimbursement,'" said Archdeacon. "I do think it has helped with some patients who, prior to this, their inclination was to put the CPAP on the shelf."

There will always be patients who don't adapt, say providers.

"The patients who are using it now were using it before, and the patients who weren't, weren't," said Lou Kaufmann, vice president, patient/client services for Bethesda, Md.-based Roberts Home Medical. "If it's been eight or nine weeks since you got the equipment and it's still gathering dust on your night stand, are you going to bother to go back to the doctor?"