What do compliance, sales and public relations have in common? For the CPAP business, they all work in concert.
For many home medical equipment providers, each of these functions is performed by different employees. However, this is not necessary. Rather, these functions can be accomplished in one task by one individual.
As every HME company struggles to find ways to cut costs and maintain profitability, it is essential to delve into operational efficiencies. CPAP supply sales is a great way to drive additional revenue while maintaining compliance and generating good will.
COMPLIANCE
You often hear that the biggest obstacle to overcome in the CPAP business is getting patients to remain compliant.
Specifically, many patients use their CPAPs sporadically and inconsistently, if at all. While this may be caused by scenarios outside your control — the common cold, vacations, a leaky mask — you can help improve this problem by staying in contact with your CPAP patients. Further, during a patient's first month of CPAP use, if you follow up on a regular basis, you should find that during the ensuing few months, the patient should become a compliant CPAP user.
FOLLOW-UP
So how do you follow up in the initial phase of CPAP use? The first step is to schedule a regular follow-up call with the patient to determine if he or she is using the device and understands how to clean it properly. If you find that the patient requires more clinical assistance, have a respiratory therapist follow up with a trouble-shooting phone call.
If the RT determines that the case is more complicated, that may require a personal visit to the patient, or the patient may schedule a time to come in for an RT appointment. Most important, by asking pointed questions such as how the mask feels, if patients are experiencing leaking, if they feel more rested during the day, you should be able to correct any problems before they render the patient noncompliant.
PATIENT RANKING
When a patient starts on service, you will quickly know if they are a high- or low-maintenance patient. The RT who sets up the equipment will have a preliminary idea by how cooperative the patient is during the initial set-up.
Assigning a rank to each patient will tell you whether the patient will require more or less frequent follow-up calls or even an on-site visit. If you conduct on-site visits, try to do them at the office to maintain lower costs.
The ranking will also tell you if you can use a technician to follow up, especially for patients who easily grasp how to use and clean the device. (This also depends upon the licensing requirements in your state.)
By establishing this type of protocol, you will use your key staff more wisely and reduce expenses ultimately. A thorough patient training and follow-up is the key to success in creating patient compliance.
SMART CARDS
Although they may be more costly, for some patients, you will want to measure outcomes by computer as provided by the smart cards used in CPAPs. Specifically useful for patients who may not be compliant, you will know exactly how often they are using their machines. In addition, some third-party payers require this data management outcome for continued authorization. Some HME companies dispense CPAPs with smart cards exclusively, while others use them as needed based on patient ranking and/or insurance type.
MEDICARE REQUIREMENTS
While some third-party payers require the actual utilization reports (from the smart card downloads), Medicare simply requires that the patient use the device. Explicitly, the rules require that the patient and/or the doctor be contacted (verbally or in writing) between days 61 and 90 of continuous use, and documentation of this contact is required upon request.
To be exact, the Local Coverage Determination for CPAPs states: “Continued coverage of an E0601 (CPAP) device beyond the first three months of therapy requires that, no sooner than the 61st day after initiating therapy, the supplier ascertain from either the beneficiary or the treating physician that the beneficiary is continuing to use the CPAP device.”
Therefore, even if you contact the patient within the first 72 hours, during the second and fourth weeks and again in the sixth month, for example, this does not meet Medicare's requirement for “continued coverage.” In fact, technically, you should not append the “KX” modifier if you can't establish whether the patient is using the device between days 61 and 90.
Even more difficult is that as the provider, you are responsible for ensuring that the patient has used the device for which you are billing on a monthly basis. Otherwise, you are potentially billing for something that is not used.
To be sure of continued compliance, that means you either contact each patient each month (and maintain a written record) to be certain they are using the machine, or you use the data from the smart card each month. It will show you if and when the patient used the device — the exact number of hours used per night.
Either way, it is your responsibility to ensure that you are billing for something that the patient is actually using.
SUPPLY SALES
While fulfilling your compliance requirement, you could simultaneously garner additional revenue. How? Although Medicare does not allow you to auto-ship or auto-dispense supplies, if the patient is using your device and is about to exhaust the current supply, he or she may “request” a refill. In this case, you are entitled to dispense it.
Further, since you are contacting patients to ascertain compliance with the device, it is an opportune time to establish whether they need any additional supplies. Specifically, you should know when they got their last supply (by HCPCS) and how frequently they can obtain this supply. For example, if you are calling a patient every three months, you should know which of their supplies are allowed per month, per three months and per six months.
Merely contacting patients every six months because they can get their mask and headgear replaced is short-sighted if they are using other supplies.
Optimally, your software should tell you which items patients are using and when they are due for replenishment. Some manufacturers also provide this type of tracking tool at no charge or for a nominal fee. If it is not already built into your system, I recommend that you take advantage of the manufacturer's tracking tool to ensure maximum revenue and compliance.
As is evident, it is prudent to track the patient's utilization of supplies. Some HME companies prefer to send a letter notifying patients when they are due for additional supplies and which supplies they have been using. Other companies prefer to call the patient to promote a better response rate utilizing a script and contact sheet. Still others will use an automated attendant solution to perform this task.
While it depends upon your clientele and your staff's knowledge and skill level, you should consider using a combination of all three methods. Once you implement this CPAP supply program, track each patient for outcomes and measure your revenue per CPAP supply patient this year and compare it to last year's. You should see a marked improvement.
PR/GOOD WILL
While you work to achieve success in the area of CPAP compliance, and you simultaneously attempt to build additional revenue in CPAP supply sales, you should be aware of your opportunity to enhance good will and remind the patient of your superior service. This is easy to achieve by asking a few questions that help you with quality improvement.
A call to see how the patient is doing and if he or she has any questions, while technically a compliance matter, also establishes a desire to provide superior service. In addition, it elicits quality patient care.
Finally, it creates a sense of loyalty with the patient, a real allegiance to a company that seems willing to meet his or her needs and exceed expectations. This type of “care call” will help distinguish your company from the pack and create the personal touch.
In summary, charge your staff with measurable goals to increase CPAP supply sales, monitor compliance and promote good will. This can all be accomplished simultaneously. As a result, you should be able to generate additional revenue and maximize operational efficiency.
This is truly a way to ensure your profitability — welcome relief in today's HME environment.
Miriam Lieber is president of Lieber Consulting, Sherman Oaks, Calif., specializing in operations management and reimbursement for the HME industry. She can be reached at 818/789-0670 or by e-mail at miriam@lieberconsulting.com.
