If you want to maximize revenue with a CPAP supply replacement program, your obstructive sleep apnea (OSA) patients must be compliant with their therapy. Patients don't need new masks or tubing if they aren't using the CPAP. Providers should have a patient care model that provides frequent compliance follow-up during the first few months of therapy, and intermittent follow-up once patients are acclimated and attaining positive therapy outcomes. To accomplish this, you must:

• Provide the equipment and accessories that will give the patient the best opportunity of success with the therapy. At times, the initial investment may need to be slightly higher than desired to drive adherence over the long haul. A low-end mask may maximize profit, but negatively impact the patient's odds for success.
• Be proactive instead of reactive. Send mailers, hold regularly scheduled CPAP clinics, make compliance and supply replacement phone calls, and display OSA supplies and out-of-pocket accessories in your store. Consider third-party service providers to help contact patients on a regular basis. Discuss the benefits of supply replacement and the patient's needs at every opportunity—including the initial patient setup. Patients should know what their insurance health benefits are—encourage them to learn more.
• Document, document, document. Keep patient records up-to-date each time supplies are issued. Collect multiple contact options from the patient. Obtain permission to use e-mail because HIPAA security requires either encryption/ decryption of patient data, or patient permission. Know what each payor's specific replacement policies are and what documentation they require for timely claims processing.

How often should CPAP equipment be replaced? Masks and other related accessories should be replaced when they show signs of wear, such as cracking or tearing. Home care masks tend to last 3 to 6 months depending on several factors, which greatly influence variability in useful life. Those factors include: cushion seal deterioration due to interaction with facial oils and/or acidity; proper fitting and sizing at initial mask setup; and frequency and method of mask cleaning.

How do the above factors impact mask life expectancy and therapy? Well, once a cushion seal becomes compromised due to interaction with facial oils, the sealing effect deteriorates despite proper mask and facial hygiene. As a result, excessive leaks occur, frequently prompting patients to over-tighten headgear. The leaks can reduce the effectiveness of PAP therapy. Over-tightening causes discomfort and pressure points. The net result of both issues is reduced compliance to therapy.

Luckily, most insurance payors provide benefits for consumable OSA supplies. Coverage varies significantly by payor. With medical necessity, Medicare will replace all masks as frequently as every 3 months; most payors pay for replacements every 3 to 6 months. Replacement of CPAP devices also varies by payor; Medicare allows for replacement, with necessity, after 5 years. It is important to gather and document local payor replacement policies to reduce claim delays caused by improper documentation.

COMMON MISTAKES

One common misstep is making compliance and supply replacement phone calls to OSA patients during the day. OSA patients lead healthy, productive lives that include work, family, and leisure activities. Given their active lifestyles, phone calls are ideally made in the evening to their home phone numbers. Even better, ask your patients about their contact preferences—document the phone number and time of day they would prefer to receive supply replacement reminder calls.

Another misstep is using clinical professionals to make routine compliance and supply replacement phone calls. Experience shows that a large number of contacts will result in answering machine messages, which is not a good use of a clinical staff member's time. Administrative staff can make these calls, directing patients with compliance and adherence issues to clinicians for follow-up. Over time, patients contacted on a regular basis have fewer and fewer therapy adherence issues.

Lastly, poorly kept patient files make it difficult to know when a patient is eligible for replacement supplies. Apply procedures to ensure all transactions are documented. If your system is not capable of proactively tracking eligibility, seek an upgrade or third-party solution.

Also know that a compliance and supply replacement program will require additional staff.

MANUFACTURER'S ROLE

Just as providers are required to comply with Medicare and Medicaid anti-kickback statutes and related fraud and abuse laws, so are the manufacturers. Any services provided by a manufacturer for the HME must be provided at fair market value.

Look to the manufacturer to include supply replacement-related reminders or tools within mask packaging. For example, Respironics provides wallet cards to give to the patient—documenting contact information, device settings, and the mask provided. This card includes an area to circle when the patient becomes eligible for a replacement mask, as well as a reminder sticker to place on a calendar.

Compliance monitoring software, such as EncorePro or EncoreAnywhere from Respironics, often includes tickler functionality to track patient eligibility for supplies.

Some manufacturers have educational Web sites for patients that include an area where they can elect to receive e-mails when they are eligible for new supplies. As patients self-enroll, an e-mail reminder is compliant with HIPAA security regulations.

Other ways a manufacturer may support supply replacement is by offering cost-effective packaging alternatives, such as kits that already include tubing and filters, or masks packaged with the first replacement cushion. Finally, a manufacturer's drop-ship program can assist with the fulfillment of supply orders and inventory management.

Laurie Scott is US marketing manager, patient interface, for Respironics Inc, Murrysville, Pa.