Solid relationships with sleep laboratories will improve patient outcomes and boost your sleep therapy business.  

After spending many years providing positive airway pressure (PAP) therapy for patients in the home, my wife and I decided that we wanted to open a sleep diagnostic facility. Many hours went into planning this facility, and we wanted it to be different from other laboratories in our area.

Two major concerns were patients’ comfort and compliance if they were diagnosed with a sleep-related problem. The comfort issue was huge, and we spared no expense to mimic the home environment as much as possible. Our lab is designed on a “bed and breakfast” theme, including beds that are adjustable for comfort, as well as a light breakfast in the morning.

We also realized that a great facility and superior testing were not enough if patients diagnosed with obstructive sleep apnea (OSA) were not compliant. Without compliance, our efforts to diagnose accurately and improve people’s lives would be in vain.

My experience in sleep from the DME side of the business taught me that many times the relationship between the laboratory and the DME provider was not always the best. When the relationship was poor, the patient usually suffered. Through the years of working with sleep laboratories, I found that they all were a little different. Many labs had no concern about the treatment phase for patients. Their goal was to make a diagnosis and leave the compliance concerns to referring physicians and DME companies. There were those who were rigid and would order a specific blower and nasal interface for the patient and demand that they be used. Many times, it was hard to get these orders changed if a patient was uncomfortable with the nasal interface—a difficult problem for the DME company that was trying to drive patient compliance.

Other laboratories had no regard for the DME company and would not provide reports and other documentation the DME required to bill Medicare and other third-party payors for the patient’s equipment. Since I opened a lab that did not self-dispense, I realized I would have to partner with a DME to obtain the best patient outcomes.

The other real problem is the DME company itself. Many DME companies  work to the point of exhaustion at gaining patient compliance. However, there are others that see themselves as only equipment providers and not part of the patient’s treatment team. The latter have no concern with servicing the patient or encouraging compliance, but will deliver the equipment as ordered, explain its use, then provide no follow-up. These types of providers hurt the laboratories as well as the DME industry.

Patients set up by less than conscientious providers never receive the help and follow-up needed to be compliant. They are left with the thought that there is no treatment to correct their disabling disease. This is sad because often just a nasal interface change could boost compliance, successfully address the OSA, and improve blood pressure and other cardiac conditions.

Partnering with Good DME companies
With these issues in mind, we decided to be a laboratory that would be concerned about patient compliance, but not so rigid as to actually interfere with the compliance we were trying to obtain. We needed to find a way to “partner” with good DME companies that were dedicated to servicing patients that we referred to them. We looked for four or five companies in our area that had the same passion for outcomes as we did.

Our search began with the physicians that would actually refer their patients to us. We asked them who they used to supply their patients with medical equipment and why they chose those companies. Their answer always was related to service and what they heard from the patients that had received service from the DME companies. After we did our research, several companies rose to the top of our list.

The next step was to interview these companies to see if they would meet the criteria and requirements that we had set for follow-up. The follow-up we required of the DME was simple: 1) set up the equipment within 24 hours of order (in either the patient’s home or DME office); 2) follow-up via telephone in 1 working day of setup; 3) follow-up via telephone in 1 week of setup; 4) follow-up via telephone in 1 month with a download; and 5) follow-up via telephone in 2 months and again on month 3.

Because of these meetings, I can truly say that we developed strong relationships with our DME partners. We listened to our DME partners and designed our prescription for PAP therapy to allow the selection of two different blowers and to allow for substitution of the nasal interface that was used in the lab. Together, we are working with each patient to help them become compliant with this all-important therapy.

Although we have our preferred medical equipment providers, we do honor the requests of our referrals and patients. Patients sometimes have other equipment in their home and prefer to work with one provider. We agree with this and work with those providers by asking them to follow up according to our guidelines.

Ultimately, our main concern should always be patients and their outcomes with the therapy ordered. We have chosen a proactive approach by developing a network of medical equipment providers that share our same passion for diagnosing and treating sleep-related disorders. We use a partnership approach and understand the expectations of both the laboratory and the DME company, which has allowed us to increase patient compliance with therapy and provide an environment that is friendly for the patients and the DME partners.

Harold L. Davis, RRT, has more than 20 years of medical experience with an emphasis in HME for the last 15 years. Davis is the respiratory specialist for Nationwide Respiratory, a division of the Van G. Miller (VGM) Group of Waterloo, Iowa. Davis and his wife own Sleep Centers of Arkansas, Searcy, Ark, and can be reached via e-mail: dreams4you@sbcglobal.net.