Most providers start with great intentions. They come up with a solid clinical plan, which encompasses quite a bit of follow-up for patients receiving their CPAP/bilevel positive airway pressure (sleep) therapy. Unfortunately, as the business grows and life becomes busier, other priorities take over and these great clinical plans are left undone. This causes an unfortunate spiral that leads to less patient compliance and patients who feel less connected to your company—all leading to dissatisfaction, and ultimately a loss in revenue from multiple angles. It is important to develop a realistic plan that maximizes compliance, boosts revenue, and improves profits.

The first mistake most providers make is that they become overzealous in the frequency of optimum follow-up. They create a program that simply cannot be maintained due to its expense. They also typically rely on respiratory therapists (RTs) to do all follow-up work.

Most RTs end up so busy on the road, and doing new setups, that the necessary follow-up does not get done or is delayed. You end up losing the effectiveness of the program. Establish continuity with the patient by having the original RT do the first and second follow-up. Treat this with the same level of importance as a new setup, since most failures to comply occur within the first 30 days of receiving the equipment. It is important to get the patient into a schedule where a set person, team, or even an outsource solution is providing the ongoing follow-up necessary for success. These folks may not have a clinical degree, but must be experts in customer care and sleep therapy, and have excellent communication skills.

The longer the patient is on therapy, the more simple the routine follow-up is—if you keep up with the established protocol and you have the right people taking responsibility. The patient learns to expect your calls that demonstrate you are a quality provider. The complexity comes in managing the volume of calls that need to take place, and finding the time to do them.

Typically, ongoing follow-up calls may take on a primary focus of supply replenishment. However, do not underestimate the power of compliance and patient retention associated with these calls. Often patients do not realize they are due for replacement supplies. Many of them lead busy lives and are of working age. They rely on us to track replacement timing and reach out to them. Know the recommended replacement guidelines in conjunction with what the payors will allow. Educating patients is an ongoing task for the life of the sleep therapy.

As providers, we know that supplies wear out and break down over time. Ultraviolet light causes nasal interfaces to slowly harden, requiring the patient to progressively tighten the mask to prevent leaks. This can lead to marks on the face and even skin breakdown. It is also important to routinely replace the tubing because tiny micropores can develop as the tubing ages, and this can allow bacteria to grow in the tube. Bacteria like warm moist environments to grow, and it is difficult to clean the inside of the tubing carefully. The sinus cavity is not the place to be blowing bacteria.

Most patients do not clean their tubing every day, as is recommended, so the risk of infections is higher. Many times patients need assistance in managing their heated humidification as well. As seasons change, necessary adjustments for optimization may not take place. They may even have shut off the humidification completely. This affects comfort, compliance, and general well-being. You must follow your patients for an appropriate continuity of care. Not only is it the proper thing to do, but it also is important to establish you are a clinically viable provider to your physicians, sleep labs, and referral sources.

They want to know that you are going to take care of patients even after their equipment has been purchased. These are things a referral source looks for when deciding to continue using a provider, and even choosing them as a primary vendor. This, of course, generates ongoing new revenue to your company in the way of additional patients. Also, providing routine replacement supplies is a great source of revenue, and patients appreciate the customer service.

We speak to sleep patients a lot. When a provider signs up for our services, we often find that there has not been any contact with patients in months or even years. Patients are happy to hear from us, and often wonder why no one has reached out to them sooner.

ON THE WEB To find more articles, visit our free archives section. Our convenient archives require no log-on or fee. Find helpful articles such as: October 2008 Go to a Different Well By Ann Tisthammer. Type 2 diabetes and cardiovascular disease are markets for CPAP. June 2008 Don't Neglect the Human Touch By Melanie P. Arledge. Technology can boost CPAP compliance, but it's no substitute for education. July 2008 Strange Bedfellows by Katie Griffith. New sleep testing possibilities and creative alliances are opening up.

A good follow-up program allows for direct contact to be made at the proper intervals, and gets the patient back into an acceptable routine. Sometimes a patient has changed providers, but at least that allows us to probe deeper and find out why. This data can then be analyzed followed by necessary adjustments in the future.

One of the most positive aspects of a thorough sleep success program is the additional revenue and profit generation that the supply reorders bring to your company. Whether providers outsource or create a fully dedicated focus internally, typically they can easily double (or more than double) their yearly supply revenues. The cost associated with having a program like this is typically in the single digit percentage range of the revenue that is generated. This is a small price to pay for all the goodwill, compliance, and revenue this brings to your company.

AVOID THE PITFALLS

Have a solid plan that assures you will not let patients fall through the cracks. The first step is determining which patients are active. Since many of these patients are no longer showing up as active rentals, you really need to understand how your software system works, where the data is, and how to extract it. If you do not have expertise in "data-mining" your system for these details, work with your software vendor, a consultant, or a company that includes this service in their sleep success program. Being able to work with the data you have is critical to maximizing your effectiveness.

Once you have identified your active patients, you may start off strong in your patient contact campaigns, but focus is lost as time goes on. For some reason in this industry, we tend to get caught up in avoiding direct patient contact. Our associates become uncomfortable or dissatisfied with speaking to patients on the phone. Sometimes they are just "too busy." This typically drives a trend to either not have any contact at all, or enter into a laborious paper (mail) contact system of letters and memos. Unfortunately, mail contact is never as effective as direct phone contact.

In this day and age of junk mail and confusion on how health care works, many letters end up in the trash either unread or not understood. A solid program focuses on direct phone contact and is supplemented by mail contact when patients cannot be reached via the phone.

Lisa Bargmann

How can we legitimately say that we are too busy or do not have the time for our patients? They are, after all, our customers and the lifeblood of our business. Providers are scrambling for profit margin and revenue generation, so why not tap into the customer base you have? Providers are leaving tens of thousands of dollars on the table each year by not managing their existing patient bases.

Whether you do it internally or use an external service, you can build better compliance, revenues, and profits. Be sure to allocate the various functions appropriately so that RTs perform the necessary (early) follow-up, and ongoing follow-up is handled by highly competent and trained phone representatives.

Come up with a process to keep track of who your active patients are. Do not turn your program into a convoluted clerical-based print/mail service that gets ignored. To achieve ongoing success, pay attention to the patients you "already made the sale with."

Lisa Bargmann is vice president of business development for Invacare HCS, Akron, Ohio. She can be reached via e-mail: .