Harold Davis, RRT

Developing a sleep program is much more than buying a few continuous positive airway pressure (CPAP) machines and letting everyone know that you are doing sleep. As in all medicine, the first rule is to do no harm and we need to remember this in business as well. With the addition of each new business segment, we must research and prepare to avoid giving ourselves a black eye in our markets. We must take the time to do it right. The keys to program development are understanding your market and conducting the research to ascertain what the market requires.

The sleep market is exploding, as is recognition by the public that there is a huge problem with the way we sleep. Besides just being sleepy, we are learning that sleep affects other aspects of life. Research has determined that patients suffering from refractory high blood pressure should be sleep tested. In our own facility in Conway, Ariz, patients have been able to decrease blood pressure medicine or even go off of it after being treated for obstructive sleep apnea (OSA).

Talk to Referral Sources
After determining that there is a need, you must determine what specifically the market needs. The only way to do this is actually talk to the people that are referring the CPAP equipment.

Referrals in the sleep business come from many sources. Some come directly from the sleep laboratories, some from the case management department at the hospital where the sleep laboratory is located, and others come directly from sleep doctors and primary care physicians.

The requirements of the referrals are varied. Some have absolutely no requirements, and others require extensive follow-ups and frequent downloads to look at patient compliance. I have seen sleep laboratories and sleep physicians actually make the medical equipment provider sign an agreement to follow up in a certain way, download at required intervals, and use specific types of sleep equipment. No matter what the requirements—if you want to develop a successful program, you must design it in a way that will satisfy your referral.

Another important step is to let the potential referral know that you have certain needs as well, and find out how they meet your needs. The major need for medical equipment providers is the ability to obtain the prescription and sleep study in a timely manner.

Medicare requires that providers have a copy of the sleep study in their patient file, and many third-party payors require a copy with the claim. Your reimbursement is important, so find out how the referral can help you obtain the required information.

After a thorough investigation of your market, it is time to develop your follow-up program. First find out who is legally able to perform CPAP and bilevel setups in your area. Refer to the Respiratory Practice Act in your state to see if the law requires equipment setup by a licensed respiratory practitioner. It is recommended that a practitioner perform the setup and follow-up on all CPAP patients.

After you have determined who can provide the setup, develop the follow-up program. When designing your program, do not make it so extensive that you actually lose money. Over the past years, we have seen CPAP reimbursement decrease and equipment costs increase as manufacturers developed new equipment with exciting bells and whistles that allow downloads of efficacy and compliance data. It is an important balancing act to design your follow-up program to meet the needs of your market and not to follow up so much that you actually lose money. Follow-up is expensive, but it is important to patients, referrals, and insurance providers.

Early Compliance Crucial
Research indicates patients must become compliant with CPAP in the first 1 to 2 weeks. If you do not establish compliance within this time frame, the patient may never use the prescribed equipment. Therefore, the follow-up should be intense in the first 2 weeks. The initial equipment setup is best performed in the office if possible. Your office should contain a multitude of patient masks and interfaces, and it is important that patients are involved in selecting their masks if physicians’ orders allow.

The number one reason patients are not compliant with their CPAP therapy is because the mask leaks or is not comfortable. After the initial setup, the patient should be contacted after the first night of sleep and then weekly for 2 weeks. I suggest at least a monthly call for 2 months. In reality, you will probably contact your patient a lot more than this because patients have questions and concerns.

A lot of times the comfort of the interface becomes more of an issue after patients receive enough sleep therapy to overcome their massive sleep deficits. Remember that you should write your sleep program follow-up to the minimum requirements of your market, but be prepared to follow up more than the requirements.

Patient compliance is crucial, and your referrals will be looking at your outcomes. Also keep in mind that telephone calls are less expensive than home visits, and also encourage patients to bring their units to your office for downloads. Follow-up after the first couple of months can be in line with the time frame that new supplies are needed and reimbursed. After the follow-up, it is important that this information is delivered to the sleep laboratory and/or physician because this adds validity to your program.

Don’t Forget Marketing
The laboratories and physicians in your area must know that you are providing sleep products. Marketing is much more than taking donuts and candy to a referral and saying hello. Marketing must center on the service that you provide rather than the equipment.

It is vitally important to formalize a detailed marketing plan. Good marketing plans require frequent follow-up with referrals (every 2 to 3 weeks), with specific goals. The most important thing is to ASK FOR THE BUSINESS. Sometimes we do not get referrals because we do not ask.

Sleep laboratories, HME dealers, and physicians are involved in marketing. It would be a great idea to market together, and a good way to do this is to provide community education through local health fairs, newspaper advertisements, radio, or TV. Together you can identify patients that may have OSA and eventually generate revenue for everyone. It is much easier to market when a referral sees you as a partner rather than just another medical equipment company wanting their business.

Harold Davis, RRT, is chief operating officer for Baker Medical Inc, Conway, Ariz, and founder of Davis and Associates. He can be reached via e-mail: cte96797@centurytel.net.