While technology can help boost crucial CPAP compliance rates, it is no substitute for educating patients and providing diligent follow-up.

Criteria and guidelines in the treatment of sleep-disordered breathing (SDB) have finally been dragged into the 21st century. Today, if you don't have a solid CPAP compliance program, it could mean higher costs and decreased revenues.

In the past, HME providers relied on patients to truthfully report how they felt and how many hours per night they used therapy. Hour meters were the next best thing in the progression. However, this advancement was not without its problems. Patients realized they could just run the motor without using the therapy and just give the hours-used reading to the HME provider. Left untreated, the patient's disease process continued in a downward spiral, but HMEs continued to be reimbursed by carriers.

HME costs were minimal. The PAPs were simple blowers, and overhead was low because the company could staff unskilled employees. Compliance rates were also low; approximately 30% to 40% of patients actually used therapy.

Only within the last 7 years have companies had the luxury of using smarter PAP devices that are downloadable. Of course, these devices were more expensive, leaving HME providers to absorb the cost while at the same time feeling the effects of lower-reimbursement carriers.

Along with the improvement in technology came the need for skilled employees to decipher the information. Did compliance improve with these advancements? Not necessarily. Sure, we had the ability to extract the data whether it was the "law of averages" or "real time," and the information was forwarded to the carriers to prove compliance for reimbursement, but efficacy was lacking. With the advancement in technology and the increased cost of skilled employees, compliance rates increased only slightly to between 40% and 45%.

With advances in technology by manufacturers, CPAP is no longer acceptable for everyone. HME providers and their staffs must be sharp enough to recognize this. CPAP devices are blowers made to stent the airway open in patients with obstructive sleep apnea—healthy patients more or less. Once the disease has progressed significantly, CPAP is no longer acceptable. This is when compliance takes a dive.

Place CPAP on a cardiac patient exhibiting Cheyne-Stokes respiration and it will fail, usually within the first 3 months. The failure rate is the same when CPAP is placed on a COPD patient.

The new American Academy of Sleep Medicine (AASM) recommendations commencing July 1, 2009, state that follow-up is mandated. This has not been an industry standard, and many HME providers and sleep labs are going to be left holding the bag of denied claims.

Follow-up is a tremendous benefit for the patient and the HME provider. Focus on training staff to meet the individual needs of patients, and empower patients to improve compliance. When healthy living becomes a lifestyle choice, compliance is a given.

Technology to prove compliance is worth its "weight in gold" for HME providers. The new AASM recommendations open the door for savvy HMEs to become invaluable to local sleep labs by assisting them with effective follow-up programs. Accredited sleep labs want patients initiated on PAP therapy, and must have objective data from the device (periodically and at the 12th week of use) to trend patterns and remedy problems.

The objective data is cumulative and encompass several criteria, including progress notes, patients' perspectives on how therapy is going, and data extracted from downloads proving efficacy. The latter is monumental for HME providers, and staff members must understand the "art of titration" and "disease to device."

Thank goodness the new regulations are forcing our industry to raise the bar in patient care, although the cuts in reimbursement make this a rather difficult feat. Clinicians in the HMEs must think outside the box and be willing to do the unforgivable: approach the referring source of the patient and show the captured data, along with the patient's follow-up. Show referral sources that the pressures ordered and/or equipment is not appropriate for that patient and their disease state. This can be a hardship on the HME providers willing to take the risk of upsetting the referring physician and/or the sleep lab where the patient was studied.

The key to boosting compliance rates lies in the knowledge of your staff. Fancy downloadable devices only confirm what your staff should already know. HME providers need to set themselves up for success at the beginning, during the discovery of medical history and review of the studies performed.

90% COMPLIANCE

Our compliance rate is 90% and higher. We achieve this through education and efficacy of therapy. It isn't enough to absorb the cost of more expensive PAP devices and skilled employees; patients must be educated about their disorders and the physiological ramifications of untreated SDB. We have an extremely tight program starting with the initial order and intake. There is no need to worry about compliance. It is a given when we empower the patient with knowledge.

ON THE WEB For more information and articles on CPAP/Sleep, visit our free archives section. Additional articles include: CMS Approves In-Home CPAP Qualification By Mickey Letson in the April 2008 issue New Era, New Opportunities By Tor Valenza in the March 2008 issue Which Brands Should You Carry? By Todd Cressler in the February 2008 issue To keep up with the latest industry news, you can simply go to our site where news is updated daily. If you prefer news delivered straight to your e-mail inbox, subscribe to our weekly (and free) Friday Report e-newsletter. We adhere to a strict anti-spam policy.

Not only are our employees skilled and registered in their field, they are investigators who are trained to discover what isn't readily addressed through little to no pertinent medical history. No stone is left unturned. We insist on "significant others" being present at the initial appointment to gather information that the patient is usually unaware of.

If the sleep study was performed by an outside entity, the pressures are verified through the current technology of "real time" downloads. If the pressure isn't effective, we request the ability to retitrate the patient to find the appropriate pressure and device needed from the referring physician. Post-discovery, the physician is notified of the findings, the patient is set on effective therapy, and our tight follow-up program is implemented.

While I agree with the directive from the AASM and wholeheartedly believe in smart PAP devices, I truly believe compliance lies in knowledgeable staff, and the smart devices are tools to aid in proving compliance. Becoming compliant lies in educating the patient on the disorder and the therapy needed to stop the disease process. With this comes the need to have qualified, well-trained, registered clinical staff with the ability to empower patients through knowledge.

Melanie P. Arledge is the manager at Progressive Medical, Carlsbad, Calif. She can be reached via e-mail through the HME Today editor: .