And Advanced Home Care's McBride is worried about non-grandfathering of sleep supply patients.

“There is data that supports the link between compliance and supply replenishment on a frequent basis,” he explains. “Patients who use suppliers that did not win the bid will be forced to convert to winning bidders. Besides a prescription for supplies, CMS requires suppliers keep a copy of the sleep study, which means winning bidders will be forced to flood physician offices with new prescription requests and the sleep labs for sleep study requests.”

He adds losing bidders that have a proactive supply replenishment program have limited incentives to spend valuable time assisting patients in the transfer to a winning supplier.

“Assuming there are cracks in the system and patients will fall behind on their interface, then compliance will be impacted,” McBride reasons. “When you couple this with the co-morbidity studies, it seems like there is a likelihood we will see a health decline for some patients resulting in increased health care utilization at the physician and hospital level.”

Also as in the oxygen market, there is apprehension among those working in the sleep sector that contracts were awarded to companies that have not previously participated in the treatment of SDB.

“This will contribute to the overall service level and information and education a beneficiary will receive,” says Pontzius. “Competitive bidding's impact on the beneficiary will be significant, leading to more people not being compliant and benefiting from a therapy that increases their quality of life.”

Companies will have to determine what they can afford to provide for the patient while keeping the patient's well-being in mind. That means working toward compliance because it is vital to the patient's success, says Clevidence of Medical Service Company.

“Compliance data gathering can be very expensive, and the more precise information you want to obtain, the more costly it will be,” he says. “High-end CPAP units are expensive, and the cost of harvesting the information and getting it to the physician is expensive.

“Patients need our clinical support and push to use the equipment.”

Provider Brennen Garry, president of Kansas City-based UniMed, sees a two-sided situation. “I would like to think that we are going to be extremely busy since our competition has been greatly reduced,” he says. “Sleep really took a hit in Kansas City, so our biggest concern is replacing the revenue while maintaining our service and technology model.”

At press time, momentum was building in Congress to delay competitive bidding.

“But who knows for sure?” asks Todd Cressler, CEO of CressCare Medical in Harrisburg, Pa. “Even if that happens, reimbursement is going to drop. There still have to be health care savings.”

Cressler also believes the industry needs to look at different coding for varying levels of CPAP therapy. “We need to look at different coding for different technology, just like we did with oxygen,” he says. “But first, let's stop competitive bidding and then address how we're going to save the country and the health care system money.”

DEFINING THE DRA

The Deficit Reduction Act of 2005, which transfers ownership of oxygen equipment to the beneficiary after 36 months of continuous use, is another startling reality with an impact that has not yet been defined.

“The transfer of ownership of oxygen equipment to the beneficiary will put a tremendous amount of pressure on the beneficiary to understand when their equipment is in need of repair and servicing in addition to not having a source for emergency after hours support when needed,” says Pontzius.

“There will be many calls for service and repair that won't be covered by Medicare, and the beneficiary will be responsible for payment of these services. [Beneficiaries will be in] a situation that will ultimately force them into non-compliance or going without therapy altogether.”

According to Advanced Home Care's McBride, “The 36-month cap will devastate many providers this January. When you add the reduced reimbursement rates due to national competitive bidding to the cap, providers are going to experience the perfect storm.”