Mail order madness?

YARMOUTH, Maine - When it comes to providing quality respiratory care, mail order just doesn't cut it, say providers.

“It's a terrible patient care model,” said Thad Connally, president of First Choice Home Medical in Bowling Green, Ky. “It takes a lot of coaching and hand holding to get the right mask fit and the right pressures.'”

To be sure, the model isn't common—yet—but providers are starting to see it happen more, and they don't like it, especially when it encroaches on their turf.

Provider Judee Hale was surprised to learn that one of her oxygen patients had been referred to Bakersfield, Calif.-based Pacific Pulmonary Services for CPAP.

“The first thing the patient did was call Oxygen Plus to come out and put it together and hook it up,” said Hale, president of Oxygen Plus in Stanville, Ky. “(Pacific) was instructing on how to bleed oxygen and CPAP together (over the phone). An RT should do that.”

Adding insult to injury: The patient had problems with the equipment and wanted to switch to Oxygen Plus.

“We can't do that,” said Hale. “It's not my equipment.”

Respiratory providers aren't the only ones who don't care for the mail order model.

“We've had some complaints from the sleep labs,” said Mike Marnhout, president of Bluegrass Oxygen in Lexington, Ky. “There's no face to face, the patients get confused and don't feel like they are getting a good explanation when they call the 800 number.”

With Medicare cutting reimbursement—Round 2 rates, announced Jan. 30, included an average cut of 47% for CPAP—providers say it's likely that commercial payers will follow suit.

“I was asked by one insurer if I offered CPAP mail order and I told them I don't even think being in the next town treats the patient adequately,” said Eric Parkhill, vice president of clinical operations/corporate compliance for Home Medical Professionals in Gainesville, Ga. “You have to be hands on.”

Good, bad or otherwise, providers realize they are going to have to get creative if they want to stay in business.

“I do think we need to think about alternative ways for delivery,” said Lisa Feierstein, vice president of Raleigh, N.C.-based Active Healthcare. “The same old, same old isn't going to cut it anymore.”