It is well known that patients with obstructive sleep apnea must be compliant to ensure long-term positive outcomes. However, one facet that is often ignored is the value that fresh supplies provide.
Equipment, such as masks or tubing, has a limited lifespan. Normal wear and tear, as well as patient reactions as a result, can cause soreness, redness and irritation — all of which lead to decreased or improper use. When supplies are up-to-date, risk of infection is reduced and the positive airway pressure machine continues to function correctly and effectively.
For HME providers, there are clear benefits to having a supply replacement program. Improved patient compliance enhances referral source satisfaction while providing a steady income stream. When you implement such a program, your contact with patients increases and you begin a long-term relationship that can result in their reliance on you for supplies, as well as their future need for HME products.
It can also serve as a way to differentiate your business from your competitors. A supply replacement program can demonstrate to referral sources that you are focused on compliance and adherence to prescribed therapy. If you can document how your program is increasing compliance, it serves as a strong marketing tool for the physicians and sleep labs from which you receive referrals.
A supply replacement model that focuses on patient care is good for patients, is financially viable for most payers and is good for your business.
In a 2007 study of 100 providers, only 37 percent had a primarily proactive supply replacement program in place; others had more reactive models. In addition, a survey conducted by the consumer-based group Talk about Sleep and ResMed showed 40 percent of patients heard from their HME providers once a year or less, and 54 percent went 10 months or more without replacing their masks.
For many providers, creating a supply replacement program seems overwhelming. Yet, it does not have to be. The process, in theory, is quite simple. You contact patients about their compliance and equipment needs, provide products and continue the cycle as deemed appropriate by your care model and reimbursement regulations.
Often, providers cite labor constraints, billing and eligibility difficulties as the reasons they have not implemented a program. These are valid concerns, but the benefits to your patients and your profit center are overwhelmingly in your favor.
You should think of a supply replacement program as a structured set of processes and procedures that are designed to better set-up, manage, track and proactively follow-up with patients to improve patient acceptance, comfort and results while growing your business and capturing the ongoing revenue associated with regular CPAP mask and accessory replacement.
Get Organized
There are many approaches that can be taken and, often, starting small is effective. For example, begin a new process to introduce supply replacement to your new patients as you set them up. You can then go back and begin introducing existing patients to the program as time allows. There are several steps to take when starting, including:
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Be prepared to bill payer sources.
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Know when to contact patients.
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Determine how to contact patients.
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Consider how you will purchase and deliver products.
When setting up your system to bill payers — either Medicare or private pay — it is important to document and maintain schedules, allowables and specific filing needs for each contract. Also, each time you contact patients, be sure to inform them of their coverage and ask if it has changed.
The next step is to determine how and when you are going to contact your patients. You want this process to be to their benefit; you do not want it to border on harassment. The key is to have good patient files that allow you to contact them when it is appropriate. There are a variety of programs that can do this, whether you use your billing software or invest in a specialty soft- ware program.
Timing can be critical in this process. Ask your patients if they want to be contacted by phone, mail or email. Find out if you can call them at work or if they prefer to be called in the evening.
In any instance, it is important to make sure you have the proper contact information, such as a complete home address and both work and home phone numbers. Some patients may prefer being contacted by email. If this is the case, be sure you have their permission due to HIPPA privacy rules.
Regardless of how you choose to contact your patients concerning their eligibility for new supplies, there are certain things you should and should not do.
Do:
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Inform patients why they may need regular replacement supplies.
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Ask about therapy and compliance issues and offer clinical intervention and support.
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Review your OSA replacement process at new patient initial set-up.
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Explain their insurance eligibility and rights.
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Let them know about their copayments.
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Dedicate a portion of your retail space to OSA awareness and PAP replacement supplies.
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Tell them what accessories may be of interest or may enhance their therapy experience, such as PAP pillows, hose covers and cleaners.
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Inform them about which items are not covered that may be paid for "out of pocket."
Don't:
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Tell patients what they need.
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Imply that their insurance provider says they need supplies.
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Ship supplies that are not authorized by the patient.
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Ask your patient if it is okay to automatically ship supplies on a monthly or quarterly basis, unless it is approved by the payer.
There is some confusion regarding your ability to contact Medicare patients by telephone. For Medicare patients, the Centers for Medicare and Medicaid Services does have specific rules that must be followed. Special payment rules (detailed in § 424.57) state:
"(c) Application certification standards. The supplier:
(11) Must agree not to contact a beneficiary by telephone when supplying a Medicare-covered item unless one of the following applies:
(i) The individual has given written permission to the supplier to contact them concerning the furnishing of a Medicare-covered item that is to be rented or purchased.
(ii) The supplier has furnished a Medicare-covered item to the individual and the supplier is contacting the individual to coordinate the delivery of the item.
(iii) If the contact concerns the furnishing of a Medicare-covered item other than a covered item already furnished to the individual, the supplier has furnished at least one covered item to the individual during the 15-month period preceding the date on which the supplier makes such contact."
According to Medicare, up to a three-month supply of appropriate accessories may be dispensed and billed at one time, provided the following steps are completed for each re-supply transaction:
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The patient is contacted.
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The patient acknowledges the need for supplies.
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The patient approves the re-supply and quantity desired of each of the CPAP accessories.
When submitting a claim for a three-month supply, place the date of service in both the "To" and "From" date fields, and mention "90 day supply" in the notes area.
Get Patients On Board
For supply replacement to be successful, patients must understand the need and buy in to the importance. Start the process with each set-up, which can set the tone for a long-term relationship and a lifetime of therapy adherence.
Be sure to explain why patients should replace supplies regularly, and emphasize how properly functioning equipment will enhance their results. Also, provide them with a reference tool that details their coverage, their rights and what a "normal" replacement cycle involves.
You can also create custom tools and reminders for them to take home for later reference or you can use those offered by various manufacturers.Once you have your plan outlined as to how you will inform patients of your supply replacement program and the methods you will use to execute it, be sure you are internally prepared.
Consider how you will address the need for additional staff members, and take the hours they will need to work into consideration. Keep these employees focused on this task and avoid pulling them away to handle unforeseen crises. Make sure they are clinically trained to make the calls and to answer the questions patients will have on side effects, compliance and overall anxieties about their treatment.
Finally, be sure there is a plan in place to reward them for their efforts to improve and maintain patient data, compliance levels and sales of replacement supplies.Remember, a supply replacement program is multi-faceted. Incorporate a variety of methods into your plan, such as email, mass mailings, phone calls and in-house clinics to ensure broad-based success. Keep in mind that more and more companies are offering services to contact patients to track compliance and inquire about supply needs. Don't forget to weigh these options as you plan your program.
On a final note, keep in mind that you may need to invest more in product inventory and order processing to accommodate the additional masks and accessories required for a replacement inititative. If that prospect alarms you, consider third party drop-ship services that enable you to purchase and ship products after you make the supply sale.Again, don't be remiss in letting your referral sources know your commitment to compliance and long-term patient care. It is good for their patients and it is good for your business.
Laurie Scott is the U.S. marketing manager for patient interface products and supply replacement initiatives for Philips Respironics, Murrysville, Pa. You can contact her at laurie.scott@philips.com.
