Success in Sleep

As has been the case in recent years, the awareness of sleep-disordered breathing and the health problems it causes continues to rise. The identification of symptoms and risks are highlighted continually in both the mainstream media and through personal and clinical blogs. Likewise, primary care physicians are increasingly becoming more attuned to the needs of their at-risk patients.

Finding

So it would appear safe to say the market is growing. But with growth comes change.

"It is pretty much a unanimous agreement that the sleep market is changing. There are a lot of forces at play that all of the parties — from vendors to HME providers to physicians — are wide awake about, and [they are] thinking seriously about what it means to them and the roles they play in the diagnostic and treatment pathway," says Maura Weis, Philips Respironics' director of sleep marketing for North America. "Sometimes these challenges create new and better ways of providing positive care.

"There is growth, for sure," Weis says, "but it is a matter of how to obtain the growth in a profitable way while maintaining the appropriate level of care. What this calls for is for the different entities to look at things with a different mind and, ideally, look at each other as to how to work together to maintain the growth and make it profitable while maintaining the high level of care that patients deserve."

Citing the nation's obesity epidemic and an increased level of acceptance by patients to get tested, Bob Hoffman, director of VGM Group's Nationwide Respiratory division, agrees that the opportunity for growth still exists. "Most individuals know somebody who is on a CPAP and have heard firsthand the benefits it can offer," he says.

But he does note that the country's economic slowdown has hurt. "With higher deductibles now commonplace, getting the sleep test is oftentimes something that can easily be put off from the patient's perspective," he says.

Weis expands on his point. "Another issue is patient coverage plans and the changes in some of the deductible models. This is influencing the patient's perspective on what they want to do for themselves related to recognizing the sleep issue and moving into a treatment plan," she says.

The effects of the recently announced rates under Round 1 of the DMEPOS competitive bidding program, with the average cut for CPAP, RADs and related supplies at 34 percent, also will certainly affect the sleep market and its providers.

"In terms of the competitive bidding rates that we just learned about — wow. What a shocker to us all. People are even questioning the accuracy of it all and saying that there has to be some bad math here," says Weis. "The results are what they are, and they are pretty alarming. Obviously, we are still waiting to see what the next steps are and what contracts will be secured."

She also points to the likely trickle-down effect from other payers once the bid program is implemented (January 2011).

Kristin Mastin, director of marketing for DeVilbiss Healthcare, had a similar reaction to the Round 1 rates.

"With average CPAP fees dwindling by another 34 percent under competitive bidding, it's clear that our industry remains under attack," she says.

Compliance = Success

Following diagnosis and a treatment prescription, clinical success for the patient and economic success for providers are completely dependent on compliance.

"Compliance is key," stresses provider Todd Cressler of Pennsylvania-based CressCare Medical. Calling it one of his company's key metrics, he says, "We promote and encourage our staff to come up with programs and ideas that positively affect compliance."

Even with a dedicated focus, however, compliance can still be a hurdle. For Cressler, that means about 12 percent of set-ups result in pick-ups due to lack of compliance. Of those, Cressler says, a quarter are attributable to insurance medical policy, while the remainder are patients who, despite all best efforts, simply are not CPAP-compliant.