With growing public awareness of sleep disordered breathing, primary care physicians are the group that will see most of these patients. Home medical equipment providers have a unique opportunity to educate PCPs on symptoms, risks and treatment options for patients with SDB. It is important to get their patients who are at risk into the proper diagnostic channels and then have them referred to an HME provider so they can begin the process of becoming successful in their therapy.
The research firm Frost & Sullivan conducted a survey on the United States sleep apnea diagnostics and devices market in 2006. When questioned, independent sleep labs said nearly 50 percent of referrals come from PCPs. Although this number is encouraging, the majority of PCPs still do not inquire about sleep habits or screen patients who may be at risk for SDB.
In another survey, a questionnaire was distributed to patients immediately following an initial PCP visit at two outpatient clinics. Of the 78 adults who participated, 11 percent had no sleeping complaints, and only 14 percent were asked anything about sleeping complaints during their physician visit. The remaining 86 percent did not discuss anything about sleeping; yet, 88 percent of these patients reported sleeping complaints.
WHY TARGET PCPS?
HME providers should focus marketing efforts on PCPs for a variety of reasons.
According to a 2005 Harris Interactive research poll, 70 percent of initial discussions about SDB occur with a PCP, and 40 percent of polysomnography referrals come from PCPs. In addition, marketing to PCPs offers an opportunity to increase the volume of your sleep business by educating PCPs on the occurrence and risk factors of untreated SDB. For example, use research to show them the association between SDB and common conditions, including:
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Over 80 percent of patients with drug-resistant hypertension have SDB.
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Fifty percent of patients with congestive heart failure have SDB.
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Thirty-five percent of patients with hypertension have SDB.
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Seventy-seven percent of patients who are morbidly obese have SDB.
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Fifty percent of patients with diabetes have SDB.
If HME providers help educate doctors in their market, they will be more proactive in bringing up sleep habits with patients.
However, it is important to consider the negative perception of sleep care. For some PCPs, the diagnostic process is confusing. They also may have experienced suboptimal patient follow-up procedures with past patients. This may leave them reluctant to diagnose and prescribe therapy.
For clinicians, referrals are a clinical and a business decision. When making a referral, they are concerned with whether the HME provider will take good care of the patient and support them through the initiation of therapy. They also want to ensure the patient will experience positive effects of therapy, i.e., mask fit, humidification, and pressure relief. Achieving this may require close attention to the patient's feedback. Long-term benefits of the treatment are at the forefront for physicians.
Frustrations about compliance have led PCPs to believe that they have to do most of the work with these patients when they often are only able to spend around 10 minutes with patients during routine exams.
To combat PCPs' concerns about compliance, HME providers should highlight their compliance plans — which might include therapy support hotlines and trained respiratory therapists for mask-fittings — and demonstrate how they can partner with the PCP to achieve the greatest results. To be successful, HME providers must create a workable plan that addresses barriers and provides patient options for therapy.
FOCUS ON COMPETENCIES
When marketing to referral sources, including PCPs, providers should focus on key competencies, including patient care, education, management and follow-up. Provide a complete program that includes educational seminars and in-service programs for referring physicians and nurse practitioners.
The service offerings vary from HME provider to HME provider in any given market. It is important to show doctors that these services are different and do result in improved patient care.
HME providers should also educate doctors on screening methods and tools. The Berlin Questionnaire and Epworth Sleepiness Scale are two validated questionnaires that do not have recognition with non-sleep physicians. HME providers can provide PCPs with these tools and suggest patients fill them out when they check in for their appointments.
The Berlin Questionnaire is a self-administered screening tool that is comprised of 10 questions and is a common method of identifying high-risk patients. After patients complete the questionnaire, office nurses can score them or HME providers can pick them up weekly, score them and return them to the physician.
HME providers can also offer posters that could be placed in exam rooms and brochures for physician waiting rooms. They provide a list of questions that PCPs can have on hand to use during exams, including:
- Do you snore?
- Are you excessively tired during the day?
- Have you been told you stop breathing during sleep?
- Do you have a history of hypertension?
- Is your neck size more than 17 inches (males) or more than 16 inches (females)?
A positive answer to three or more of these questions indicates a high likelihood for sleep apnea, and physicians should consider referral to a sleep lab.
To increase referrals from PCPs, focus on being a leader in the field and a driver of change. Promoting patient needs and the benefits that result from treatment can encourage PCPs to see you as a partner in their efforts regarding patient care for sleep apnea.
When promoting screening for SDB, emphasize that roughly 20 percent of adults have some form of sleep apnea. It is also helpful to reiterate that screening is not time-consuming or difficult. Likewise, most insurance companies, including Medicare and Medicaid, cover sleep studies and positive airway pressure therapy.
HME providers who are looking to expand their sleep programs should target physicians with whom they already have relationships for other products. The partnership of PCP physicians and HME providers for sleep therapy will benefit the business and the patients.
Eighty-six percent of physician visits do not address sleep-related issues; therefore, there is an opportunity to improve the standards that exist today.
Top PCP Questions about Treating Sleep Disordered Breathing — and How to Respond
Why should I refer when compliance is so low?
Explain your own compliance rates. Demonstrate how your business provides good initial set-up and follow-up. Explain humidification and mask selection. Make sure the doctor knows that he/she will not be responsible for patient follow-up/questions/issues and that your team has a process to respond to all issues.
Aren't those CPAP machines really big and loud to sleep with?
Show a newer model and let the physician hear it running. Many have not seen a CPAP device in recent years when real technology improvements have been made.
Does anyone really use that equipment?
Tell physicians there are over a million patients on therapy and let them know how many patients you are providing therapy to on a monthly basis.
Who will follow up with my patient?
Discuss your aftercare plan. Assure physicians that you will follow up with the patient and explain how that process works. Partner with them if they require downloads and efficacy data.
Kristie Burns is the senior director of market development for ResMed Corp., Poway, Calif. She can be contacted at KristieB@ResMed.com.
