In 1998, Todd Cressler, president and CEO of CressCare Medical, Harrisburg, Pa, crunched the numbers and found undeniable profit potential in CPAP and bilevel PAP treatment. Today, his business has proven that potential, developing more than 25 strong relationships with sleep laboratories and sleep physicians in the Harrisburg area. (For more on how CressCare started and developed, see the December 2005 cover profile archive at www.hmetoday. com.) In the wake of CMS' upcoming decision that may allow home testing for OSA—and new regulations for testing, screening, and treating OSA in big rig truck drivers— HME Today talked with Cressler about making the most of new opportunities.

HME Today: How has your business evolved and changed over the last 3 years? What have been the biggest changes in CPAP that you have seen?

Cressler: Specifically with CPAP, we've seen ongoing growth. There are more sleep labs opening up, which means there are more possibilities for working with sleep labs with different types of programs that basically help to better manage their patients. We've had growth of about 20%. Also, our supply business has grown upward of 50% per year and continues to grow.

Now with the trucking industry and what is about to unfold with that—which has nothing to do with billing health insurance—we see that as a huge opportunity. We actually started with our first 600-employee trucking company in February of this year.

HME Today: Have you had problems with various sleep labs "self-dispensing" CPAP units and depriving you of referrals?

Cressler: No. However, we have run into companies, specifically based out of California, that pay sleep labs to dispense their CPAPs, and then they'll bill the insurance company and give the sleep labs a fee to do the setup. Other than that, we have 25 to 30 sleep lab customers, and none that I know of dispenses their own CPAPs.

HME Today: CMS is scheduled to release a final decision (on March 14, 2008) on whether to allow home testing to qualify Medicare patients for CPAP. If CMS decides in favor of home testing, what will it mean for HME/CPAP providers?

Cressler: I think there will be even more opportunity to work with sleep labs and to get people tested who typically wouldn't come into a sleep lab, and then get those patients diagnosed and on therapy.

HME Today: How will this decision affect relationships with sleep laboratories and sleep physicians?

Cressler: I know there are a lot of people out there, including sleep labs and physicians, that are misinformed—that think that home testing is going to occur and DME companies, or just any company, are going to go out there and start doing home testing. For right now, as of today, nothing is set in stone. In fact, they seem to be talking more about sleep labs being the only ones able to do home testing, and you'll need certain credentialing to do that.

For us, specifically, in the central Pennsylvania area, my business model will be working directly with the sleep labs to enable them to get more business coming through their doors and to utilize home testing as an option for them— whether they do it or I do it for them. That's our approach, because the patients still have to be titrated.

HME Today: So you see home testing being positive for HME/CPAP providers?

Cressler: Absolutely. As an industry, there will be more peo- ple diagnosed with OSA than before, which will lead to even more CPAP referrals. Providers can also go directly to employer groups—to FedEx for example—and screen all of their drivers, test them, and get them on therapy. That's where I'm moving.

HME Today: Do you believe there is enough business to go around to satisfy HME providers, sleep labs, and sleep physicians?

Cressler: I think there is more than enough. I think there is enough for Web-based Internet providers, enough for DME, and enough for companies that I know will be going after employer groups in the transportation industry.

It will be the people who have a positive approach and a positive attitude toward change who will be the winners. The culture of our company and the direction of our company—other than our goal to provide good patient care—are to literally make drivers on the road safer and prevent casualties on the road. So, for every CPAP setup that we do, we train our therapists and tell them that's exactly what you're doing: You're preventing a possible fatality from occurring by educating that patient on how not to be drowsy, and, hopefully, nobody's going to be falling asleep at the wheel anymore due to OSA.

Todd Cressler

HME Today: What is the single biggest piece of advice you can give to HME providers who wish to boost sleep lab referrals and referrals from sleep physicians?

Cressler: What grew our business is proper patient management with follow-up and compliance data. We also have constant interaction with that customer for the life of that customer. That's what is growing our business. It is so important to have accurate reporting of data—clinical and nonclinical— to all members of the health care continuum who are involved, whether that's the sleep doctor, the sleep lab, the primary care physician, or the employer. Also, you must have and utilize the right software systems to do all of that.

HME Today: Among providers who wish to boost referrals from sleep labs and sleep physicians, what are some of the biggest misconceptions?

Cressler: There are a lot of things that we have tried that did not work. But the one thing that has worked well is patient clinics, where we invite 500 customers into a location. We get a turnout of about 80 to 100. Then we give them education and equipment checks, things like that. That's been a nice revenue booster. It's not expensive when you compare it to what you get in revenue that night. One night we got close to $18,000 in a matter of 3 hours. These were existing patients who were due for supplies. However, if I had not had the clinic, they probably would not have come in.

HME Today: For providers who want to boost these referrals, what should they definitely avoid?

Cressler: If I think about my 14 years in the business, the number one mistake that I've made is not hiring the right person. You have to hire the behaviors you want in an individual, not the ability. You have to get the right systems in place to hire the people that mesh within the culture of your organization, and have the right behaviors, rather than worrying about their experience. They can always be trained, and I would say that for any business.

You don't want people making promises that they can't follow through with. We'll never say we'll do something and not be able to do it. You must have the right people in the right positions doing the right thing, and set up a system that is managing your patients and creating what you want for your organization, and then keeping on task with those things.

HME Today: Any other ways to boost referrals?

Cressler: Patient follow-up. We just did a mailing to almost 5,000 customers and generated quite a bit of revenue.

HME Today: What do you think the sleep lab/CPAP provider relationship will look like in 3 to 5 years?

To find more articles on CPAP, visit our free archives section. For more on Todd Cressler, read his December 2005 cover profile, also in our convenient archives section, which requires no log-on or fee. December 2005 Opportunity Never Rests By Todd Cressler How one provider reduces Medicare dependence by focusing on sleep.

Cressler: I think it's going to be a close relationship. A pattern is occurring here where they're cutting the providers in one city from eight different providers down to two. Two is going to be the magical number around here.

So you've got to position yourself with the right people, the right patient care, and the right reporting to the referral sources so that you're one of the two. And you have got to be able to manage the patients with either CPAP Builder or whatever software you pick that's right for your company.

HME Today: Do you believe in a diversified line of CPAP devices?

Cressler: I believe in providing what the referral source wants. However, I have for perhaps the last 5 or 6 years tailored and gone toward one relationship, and that has been proven for us to be the right way to do it. I don't suggest people put all their eggs in one basket, but that's what I did, and so far so good.

Interview conducted by Tor Valenza, staff writer for HME Today.