Dropship CPAP program takes heat

ORLANDO, Fla. - Rotech's controversial new dropship CPAP program continues to draw fire from critics who claim it sets a dangerous precedent and generates profits by compromising outcomes. The Carolina Sleep Association even claims the program runs afoul of South Carolina law, which requires that CPAP units be set up in the home by a licensed respiratory therapist, said President Robert Evelyn. “It's crucial to compliance and education of the patient,” Evelyn said. “They don't take a newly diagnosed diabetic patient, for example, send him home and then mail him his hypodermic needles and viles and say, ‘Call us if you have any problems.' It's not done. It is not a continuum of care that is accepted.” The association has begun assembling information on the Rotech program and intends to turn it over to South Carolina's attorney general, Evelyn said. In March, managed-care giant Gentiva agreed to partner with Rotech to establish a dropship CPAP program in 48 states. Rotech didn't not return a call for this story. Under “Patient Direct,” Rotech mails the patient a CPAP unit, the requested mask, supplies, instructions and Rotech contact information within 24 hours of receiving an order. CPAP settings are calibrated according to physician orders. The company provides a 24-hour help line. A Rotech employee contacts the patient prior to delivery and following shipment to confirm delivery and answer questions. If questions cannot be answered over the phone, the patient can visit one of Rotech's 500 locations. If a patient can't visit a location, a respiratory clinician will go the patient's home. Rotech monitors patient compliance via follow-up phone calls and encourages regular replacement of CPAP disposables. Many respiratory therapists fear that by not providing face-to-face instruction and education for this notoriously non-compliant patient base, positive outcomes will be hard to achieve. Especially, many wonder how Rotech will assure that the CPAP mask, the key component in patient compliance, fits properly. Often, the mask information that comes from a referral source is not accurate and the supplier has to resize it, sources say. However, with manufacturers pushing toward more standard interfaces where one size fits most patients, it may not be as big an issue as some suspect, said one provider. “We've all had it in the back of our minds that if we could get out of doing home delivery of CPAP, it would make sense because the margins are low,” said the provider. “It's not like it takes a rocket scientist to figure out how to use a CPAP machine - it's got an on-off switch and one hole that the tubing comes out - but no one has been willing to do this.” “If I went out in my market and told all the labs I was going to drive cost out of my business by dropshipping these things, the phone would stop ringing because there are 40 other doughnut-carrying guys promising the labs the world.” Other providers also said Rotech's model probably wouldn't work with local payors accustomed to more personal care. But national insurers are a different story. In an effort to save money, some may opt to adopt this low-cost model. That, say many respiratory therapists, would be pennywise and pound foolish. While an insurer may save money on the front end, noncompliance with CPAP therapy leads to congestive heart failure and other dangerous co-morbidities. The result, they say, would be increased hospitalizations and physician visits, which drive up the cost of healthcare. One respiratory provider considered a dropship CPAP program similar to Rotech's and abandoned it for just that reason. “It is not as appealing as you would think because there concerns about compliance,” the provider said. “The ideal model is to get the patient the CPAP quickly, provide an overview and then have them come in for training.”