Sleep awareness seeps into public consciousness

Monday, June 30, 2008

To date, one of the biggest challenges in the sleep-disordered breathing market has been, despite the HME industry’s best PR efforts, a lack of awareness and understanding about the benefits of CPAP therapy within the medical community and the general public.

But there are signs-literally-that the message may finally be getting through, and sleep providers are in a perfect position to capitalize on that increased awareness, vendors say.

“One bellwether is signs that are popping up in airport security lines in Denver, Philadelphia and Los Angeles that instruct passengers to ‘take laptops out, shoes off and CPAPs out,’” observes Mick Farrell, senior vice president of Poway, Calif.-based ResMed’s sleep strategic business unit.

Farrell concedes that airport signage mentioning CPAPs is a gold mine of free advertising that has the potential to reach more people than any other method, though he said that a joint publicity campaign with Murrysville, Pa.-based Respironics has successfully resulted in stories written by high-profile newspapers like The New York Times and Wall Street Journal.

“The campaign is an ongoing initiative that shows we believe it’s important to keep sleep-disordered breathing in the public eye and continue to look for opportunities in high-profile venues,” said Gretchen Jezerc, Respironics’ director of U.S. marketing, sleep-disordered breathing. “It’s a challenging nut to crack, but it’s an opportunity for vendors and providers to engage the physician community.”

Develop relationships

Heightened consciousness, combined with key market drivers such as competitive bidding and potential Medicare coverage for home-based sleep testing, bode well for providers serving the CPAP market, respiratory manufacturers say.

“As much as competitive bidding represents a challenge, home testing is a huge growth opportunity,” Farrell said. “Though prices are going down, volumes will be going up, which drives growth and economies of scale.”

Farrell recommends providers seek out partnerships with sleep testing laboratories, sleep physicians and other clinicians that specialize in sleep disorders to build the business. And while there is no precise timeline for CMS’s approval of home-based testing, providers that have relationships in place will be ahead of the competition once the Medicare payer makes its coverage determinations, he said.

Bob Messenger, product manager of sleep products for Elyria, Ohio-based Invacare maintains that providers with established sleep lab partnerships can strengthen their ties by helping those labs develop a home diagnostic program.

“One of the greatest assets of the HME provider that is not typically present in a sleep lab is their ability to operate and coordinate services over a large area,” Messenger said. “These assets offer the provider an opportunity to generate revenue by providing patient set-up, instruction and equipment retrieval all on a fee-for-service basis. Additionally, they would be favorably positioned to receive the CPAP referral.”

Other providers may pursue a more aggressive opportunity to partner with a home diagnostic entity, Messenger explained, noting that “E-based and local options are surfacing that will allow providers to play a more central role in the recruitment of patients directly from family practitioners, internists and other primary care physicians. These partnerships will offer providers much greater control over the CPAP brand and model and other therapeutic options.”

Respironics has developed a First Impressions program that includes instructional materials for physicians on sleep apnea, Jezerc said.

“These materials are applicable for providers to use and talk about with physicians,” she said. “It informs them that there are people in their waiting room who have OSA and what to look for during examinations.”

Additionally, there are informational pamphlets on OSA that can be placed in the waiting room for patients to read, Jezerc said.

Innovation = compliance?

Manufacturers report that CPAP design improvements are key to increasing compliance among apnea patients. Therefore, new generations of therapy equipment are smaller, lighter and quieter, with more attention being placed on mask fit and comfort.

“Today’s CPAPs are much more user friendly and less disruptive for the patient and bed partner,” said Kristin Mastin, director of marketing for Somerset, Pa.-based DeVilbiss Healthcare. “There are fewer objections to the devices. Likewise, CPAP interfaces have become less invasive, lighter weight and ultimately more comfortable, which can help boost patient adherence.”

ResMed is focusing on noise, the third highest complaint among CPAP users, Farrell said, after education and mask comfort. Introduced at Medtrade Spring, the company’s S8 Elite is designed to be 75% quieter than its predecessor.

DeVilbiss is concentrating on the education component, offering an Introduction to CPAP video featuring its IntelliPAP line. The program includes CPAP users speaking frankly about their experience as well as promoting strategies “to acclimate and optimize therapy,” Mastin said.

Research by Invacare suggests that CPAP compliance is increasing as the result of better educational programs and aggressive patient follow-up, Messenger said.

“Despite all the bells and whistles that are incorporated into masks and CPAP units, there is a lack of evidence that these result in any improvement in acceptance of CPAP therapy,” he said. “The best outcomes seem to result when patients receive education on both sleep apnea and on the equipment.

Regular follow-up, particularly during the first several days of therapy seems to improve long-term acceptance and adherence to CPAP. It seems that good old-fashioned human interaction wins out over our best technology.”