Solving the compliance puzzle

One of the keys to improving CPAP compliance is to understand where the challenges lie. To raise the static 55% compliance rate, providers need to learn about patient issues and set out to correct them, sleep vendors say.

Achieving compliance with CPAP masks has been difficult ever since the technology was introduced—especially for patients just starting the therapy. Although there are various reasons why, Susie Justus, clinical support specialist for San Diego-based ResMed, says the two major factors are improper mask fitting techniques and lack of patient education and support tools.

“We've found that HMEs who set patients up with quality-sized masks and devices can drive better compliance from the start,” she said. “There will be no need to waste staff time on callbacks due to poorly fit masks or a question of device function, with the ability to view data within an hour of last usage.”

CPAP acclimation can be difficult for first-time users, acknowledges Steve Moore, senior vice president of sales and marketing for Allston, Mass.-based Human Design Medical.

“It is important to have the most comfortable and preferable interface from the start and I am a firm believer that everyone should receive an auto CPAP,” he said. “Auto CPAPs run at a lower overall pressure throughout the night and are definitely more comfortable than a fixed pressure device.”

Mark D'Angelo, sleep business leader for Murrysville, Pa.-based Philips Respironics, says that while it has been common to attribute lack of compliance to the patient alone, “those days are gone.” And despite the average compliance rate reportedly being flat, “the aggregate score shadows some of the good success sleep providers are achieving with the use of a full range of new technologies,” he said.

Comfort = compliance

Basically, comfort correlates to compliance, says Thomas Moulton, president and CEO of Hampton, N.H.-based Sleepnet. However, many patients remain unaware of more comfortable options, he says, because they are not frequently carried as in-stock items.

“Whereas a compliant patient can become a customer for life, a non-compliant patient can become a 'one-and-done' customer,” Moulton said. “In both cases, a tremendous amount of time and resources is spent by the provider on the original visits. So, while serving both has significant upfront costs, it is only the compliant patient that enables the provider to achieve a reasonable profit level.”

CPAP apps

The proliferation of mobile communication devices has entered the sleep therapy world, as well, with new apps serving valuable roles for patients, D'Angelo said.

“Patients' lives are increasingly connected and their CPAP therapy should be, too,” he said. “Coaching and motivational tools and techniques need to be an integral part of a therapy protocol, and in many cases today, they're not. Mobile apps and web-based solutions that actively engage patients in their therapy can increase compliance as much as 22%.”

New software and apps for smart phones and tablets can encourage a patient to adhere to therapy while also alerting the sleep provider of a patient who may be struggling to adapt. Interactive tools that motivate patients to adhere to therapy and encourage behavioral change can lead to better patient outcomes, but in many cases D'Angelo said these types of tools “are still being underutilized.”

Stressing resupply

Educating patients on the importance of mask replacement continues to be an important factor in patient compliance that allows providers to generate additional reimbursement, Justus said.

“Many patients aren't aware of programs available to help them resupply their equipment automatically, and some don't even know they can replace their masks,” she said. “In fact, a nationwide study of 300 sleep apnea patients commissioned by ResMed found that two-thirds of infrequent suppliers weren't aware of the option to enroll in a resupply program, but more than half said they would have liked the choice.”

Resupply is a drastically overlooked practice in the sleep industry, D'Angelo said.

“It is crucial for HMEs to service their patients long-term, but a lot of providers aren't doing this effectively or efficiently,” he said. “Providers also need to start thinking about service and revenue models in much longer terms. It's not about taking care of a patient for 30 or even 90 days.  The industry will be sustained on supplying and engaging with patients as they progress along the healthcare journey over the course of years.”

New competition

The appearance of more retail sleep centers is a sign of strength in the market, but it also means new competition for established providers. To maintain an advantage against these new entries, providers need to emphasize their strengths, says Brian Palmer, director of marketing for sleep at Somerset, Pa.-based DeVilbiss Healthcare.

“Providers already have the knowledge and capabilities to compete in the retail space,” he said. “They have the supply chain already established and the staff to support patients. The biggest challenge in the retail market is patients are going to want choice. Savvy patients will know what they want and be willing to shop around to find it.”