In many aspects, sleep medicine is changing at a faster pace than most other medical specialties. Sleep professionals sometimes feel their established business practices are being upended in a flurry of the latest technologies, updated laws and regulations, and increasing patient awareness.
Perhaps no group has felt these changes close more tightly around their throats than sleep DMEs (durable medical equipment suppliers). Due to pressures such as Medicare’s Competitive Bidding Program, many sleep DMEs don’t even have time to catch their breath before rolling out yet another cost-cutting measure.
But necessity is the mother of invention, and there has been at least one sleep DME innovation that is showing some early positive results: group CPAP setup classes for obstructive sleep apnea (OSA) patients. A few sleep DMEs have implemented group setups with success, and others should consider their upsides, which range from the obvious cost-savings to, more surprisingly, the possibility of higher patient adherence.
“Four to six patients can be set up on therapy within 90 minutes, compared to one patient in at least 60 minutes,” says Amber Hamer, ResMed program manager, therapy solutions marketing, to HME News. “Not only will the provider be able to better service their community by seeing more patients, they are also creating a supportive learning environment for patients who are about to embark on this journey.”1
It’s easy to forget, for those who see OSA patients every day, how isolating and distressing a new diagnosis of a sleep-breathing disorder can be. For the newly diagnosed, simply being in the company of others who have the same diagnosis can provide some comfort and confidence. Indeed, a 2013 study found that a group educational program improved adherence. Patients who participated in the group program used their CPAP on average more hours per night, on more nights, and fewer group education patients stopped using the device versus those who received one-on-one education. And the time savings for the educators themselves were substantial. “Group education resulted in a 3- to 4-fold increase in the number of patients seen per unit time,” the authors write.2
Group setups can also provide an opportunity to assign “peer buddies,” which, according to a pilot study, may also improve adherence. In this pilot, trained peers with OSA who were adherent to therapy were paired with newly diagnosed subjects. The trained buddies shared their experiences and insights with the newly diagnosed via supervised in-person sessions and telephone calls. The results showed this affordable intervention is “feasible and received high patient satisfaction ratings,” as well as may be a way to improve adherence (though the authors note that a larger study is needed).3
Of course, downsides to group classes also exist, and they won’t be a fit for every DME or every patient. DMEs will still need to comply with HIPAA requirements for each patient, coordinate billing with multiple payors (simultaneously, in this case), and push through a learning curve. But the upsides could be a win for both the sleep DME and for the patients.
Sree Roy is editor of Sleep Review.
1. Flaherty T. Q&A: Best in CPAP class. HME News. 2016 Feb 22.
2. Lettieri CJ, Walter RJ. Impact of group education on continuous positive airway pressure adherence. J Clin Sleep Med. 2013 Jun 15;9(6):537–541.
3. Parthasarathy S, Wendel C, Haynes PL, Atwood C, Kuna S. A pilot study of CPAP adherence promotion by peer buddies with sleep apnea. J Clin Sleep Med. 2013 Jun 15;9(6):543–550.