It is hard to navigate around an industry filled with acronyms. HCFA became CMS, Rx became CMN, HIDA, NAMES, HHSSA, and now AHCA became AAHomecare or AAH. Even earlier ASTA became HIDA and NADMEC became NAMES. (See glossary on page 12 for acronym definitions.)

I’m not new to the industry, having grown up during the time of the golden commode, when rented DME (there I go again with letters) could generate significant income with a fairly small service commitment. Today, I operate a successful 51-year-old respiratory, HME, and pharmacy services business in Cleveland. But when AAHomecare asked me to temporarily chair the Sleep Disordered Breathing Task Force (SDBTF) of the HME/Respiratory Therapy Council of AAHomecare, I still had a lot of learning to do.

The genesis of the SDBTF was the HME/RT Council’s discovery, last May, that many AAHomecare members wanted more direction, information, and advocacy on behalf of sleep disordered breathing treatment.

I could relate to their need for more information. I come from an operations and financial background with a deep love of the work we do in our industry. I can generally keep up in a clinical conversation (as long as I only listen), but I had to learn a whole new alphabet soup to chair the SDBTF.

OSA no longer means Overnight Snoring Association to me. I learned that obstructive sleep apnea, although often characterized by snoring, is a serious respiratory condition. Fortunately, treatment modalities, such as continuous positive airway pressure (CPAP) therapy, can restore restful sleep, reduce serious complications of sleep apnea, and improve the quality of life for our patients.

Identifying the obstacles

The first challenge the council faced was to assemble a group of sleep disordered breathing home health care leaders that was representative of product manufacturers, industry consultants, and clinicians. The group would discuss sleep disorder issues and serve our membership.

It became apparent that the clinicians in our industry were continually being challenged to prove the necessity for OSA therapy, monitor product utilization, determine patient compliance, and provide virtually unlimited clinical and accessory support to improve patient outcomes. The clinical benefits of patient compliance are anecdotally self-evident. But where is the necessary reimbursement?

Through numerous teleconferences and with tremendous support from James Jorkasky, vice president of membership and strategic development for AAHomecare, and Kim Kianka-Roberti, director of meetings and education for AAHomecare, the task force introduced a five-part series of educational audio conferences with experts on sleep disordered breathing. Nicholas MacMillan of Out of the Box Consulting and the AAHomecare Regulatory Committee volunteered his time to chair this subcommittee.

The SDBTF’s goal was to serve the educational needs of our membership, so we made sure the audio conference program topics included diagnosis, treatment, billing, compliance, measuring outcomes, and sleep study services at home. A total of five 90-minute interactive audio conferences were offered providing continuing education units (CEUs).

Waking Legislators
But just educating members was not enough. With the help of Asela Cuervo, vice president and general counsel for AAHomecare, the SDBTF has also been active in providing clinical background to CMS. When CMS solicited comments on a national coverage policy for CPAP, many of the clinicians on the task force provided input supporting the diagnostic factors recommending CPAP therapy and showing that additional reimbursement for the many compliance accessories could improve outcomes.

Finally, the task force has been active in advocating for separate reimbursement for the clinical activities associated with these therapies. Specifically, we believe that:

• Clinical services/compliance monitoring in relation to many therapies that home health care providers deliver are beneficial to patient outcomes.
• Home health care providers are best qualified to provide these services.
• Payment for services should be unbundled from equipment so greater levels of patient compliance monitoring and clinical services can be provided efficiently and effectively.

The clinical component of compliance is the key to successful outcomes in treating OSA, congestive heart failure, asthma, and numerous other diagnoses that home health care providers treat in conjunction with various therapeutic modalities. The difficulty, as we all have experienced, is that we are often viewed as equipment providers and the clinical component is not separated from the reimbursement for the product. This puts financial limits on the extent to which we can commit clinical resources above and beyond the product itself.

The clinicians, providers, manufacturers, and consultants that make up the SDBTF urge an industry commitment to fund the research necessary to support the separate and distinct, fair compensation for professional services rendered to our patients above and beyond the simple Healthcare Common Procedure Coding System (HCPCS) code. I have been overwhelmed by the expertise and commitment shown by the nearly 50 members of this growing task force. These are professionals who care and wish to better the lives of the patients we serve. Without an adequate reimbursement mechanism, our patients will not be fully served.

There are many projects that are being discussed at our meetings. We hope to work more closely and expand our relationship with other related organizations such as the American Association for Respiratory Care and the American Sleep Apnea Association. We believe that a consensus-model protocol should be developed delineating the clinical criteria to promote compliance. The task force will also be discussing the appropriateness and implementation of ambulatory sleep study programs.

We spend nearly a third of our lives sleeping. The professionals in our industry using modern treatment modalities can help those who suffer from a sleep breathing disorder. The issues that face us as an industry, both clinically and financially, are challenging and engaging. I have personally found these discussions to be interesting and provoking...and I have added several new acronyms to my vocabulary.

Joel D. Marx is president and CEO of Medical Service Companies of Oakwood Village, Ohio, a suburb of Cleveland. For more information on SDBTF, contact Kim Kianka-Roberti at (703) 535-1887.