They call it home care for a reason. Increasingly, however, HME outfits that provide continuous positive airway pressure (CPAP) are standing the concept on its head by asking patients to come to the office for mask fitting rather than visiting them in their domiciles. The good news is that patients don’t object. In fact, they seem appreciative of the ability to undergo mask fitting and receive education about CPAP someplace other than home.

The even better news is that the shift to an-office setting injects incredible efficiencies into the process, saving countless therapist hours and making for a more lustrous bottom line. “We’re saving anywhere from 30 to 90 minutes of drive time per patient this way,” says Joel D. Marx, president of Medical Service Companies, who earlier this year started providing CPAP mask fitting and education in his Cleveland office.

With the time saved, home care companies have the choice of increasing the number of patients each therapist sees in a day, or holding the volume to previous levels but increasing the number of minutes spent with each patient. Also, because education delivered in the office tends to sink in better than when it is provided at home, patients usually have fewer questions later on. Consequently, they call the office less, which frees up more time that therapists can put to other, more productive uses. “Without question, the office is more conducive to providing instruction,” contends Chris Solitaire, RRT, RCP, clinical services manager for MedMart in San Antonio, Tex. “In the home, there can be too many distractions—the phone rings, the kids want something, the dog comes running in, the sound on the TV in the next room is turned way up, and on and on. However, in my office, I can have strict control over the environment, which means we’re not going to have distractions or disruptions. Patients are able to focus and pay attention to every detail and instruction.”

Pattie Wyatt, CEO of Phoenix CPAP Services Inc, La Palma, Calif, shares Solitaire’s opinion. She reports that the improved delivery of education possible in the office yields a compliance rate of 95% among her CPAP patients, which compares quite favorably against the national average of 50%. Moreover, providing the service in-office allows her to present a larger variety of masks and related equipment than she can carry to patients’ homes. “There are six different manufacturers with five different sizes each,” she says. “I can’t bring them all because I don’t have room in my car for that many different options.”

Only an option
From the provider’s perspective, the attractiveness of having patients come into the office is plain. But what about from the vantage point of patients: what’s in it for them? “This appeals mainly to patients who want to have more control over when a service is provided,” Marx replies. “If we come to them, they have no control over precisely when we’ll get there. The therapist may be running late, traffic might be unusually bad, you just never know. But the majority of patients we’re working with on CPAP for obstructive sleep apnea are not homebound. Nothing infuriates young, ambulatory, job-holding patients more than having idled away several hours at home waiting for a therapist visit.”

Importantly, patients retain the freedom to choose whether they will be fitted for a mask in the office or at home. “We don’t force them to come to us,” says Marx. “If we did, patients would start complaining about it to their doctors. Then, the referrals would go to competing providers who were willing to make the home visit.”

Diana Guth, RRT, owner of Home Respiratory Care in Los Angeles, and a pioneer of the in-office mask-fitting movement, says that as many as 97% of her sleep apnea patients willingly travel to her location for service. Not a few travel 50 or more miles to get there. “Often, CPAP patients have never before used home care services,” says Guth. “Patients are accustomed to being seen by clinicians only in an office, so it doesn’t strike them as odd that they should also come to my office.”

Occasionally, someone who is familiar with home care asks why he should have to make the trip to Guth’s office when, given that she is a home care provider, it should be the other way around. She responds by reeling off a list of benefits to in-office fitting. “I point out that, with an office visit, we can provide better equipment choices, which, in turn, can result in better treatment,” she says. “Rarely does anyone refuse the opportunity to have better, more informed choices.”

Visits to the office for mask-fitting and education almost always go smoothly, beginning with the process of appointment scheduling. At Medical Service Companies, for example, a receptionist takes down the name of the patient who is to be fitted, then forwards it to a therapist assigned to cover the territory in which that patient lives. Next, the therapist phones the patient to set up a home visit. In the course of making the arrangements, the therapist introduces the option of an in-office session and spells out the benefits.

Medical Service Companies’ in-office appointment slots run from 8 AM to 6 PM, Monday through Friday. However, the enterprise recently expanded its customer-service hours to 9 PM.

Then there is the matter of generating business for the service. As just one illustration of how it is handled, Medical Service Companies’ field representatives have been making it a point to pass along word of the in-office service to the referral sources with whom they meet.

“We want to make our referrers aware that it exists,” says Marx. “The hope is that we can get even more patients to use it as a result of having their doctor recommend it.”

Marx is quick to emphasize that he doesn’t see in-office fitting as another way to demonstrate the value of his company to referral sources. “It’s really not intended as a selling point for us—it’s more like a survival point,” he says. “It allows us to remain efficient enough to survive the reimbursement cuts and downward pricing pressures of the market.”

As to reimbursement, Guth says her company is paid enough to permit the service to be offered. “But,” she clarifies, “what we’re getting paid for is the equipment only, not the time we spend on fitting and educating.”

That is a source of concern for Guth. She frets that tight-fisted payors could eventually reduce their reimbursement rates for equipment, leaving nothing to cover her cost of fitting and educating. Already, some payors have begun doing precisely that by requiring providers to drop-ship their CPAP machines (as opposed to having a technician or therapist deliver it and set it up); the resultant savings are pocketed by the payor.

Rich Smith is a contributing writer for Dealer/Provider.