Things that make you go ‘Hmmm…’

A few points to consider before getting involved with Sleep

1. Don’t Put Your Reputation at Risk.
If providers try to test patients who were never candidates to be tested per the national coverage determination then they lose their credibility and instead establish a reputation for just going after numbers instead of trying to drive quality outcome, Kelly Riley, director of The Med Group’s National Respiratory Network, says that could hurt the provider’s reputation tremendously.

2. If you’re going to do it, do it all the way.
If providers half heartedly go into this and improperly assess patients, it could cause problems for the provider, says Marcia Nusgart, R.Ph., executive director of the Coalition of Respiratory Care Manufacturers. “The patient may not be treated appropriately. There could even be false negatives which could be dangerous.

3. Pick one.
Ron Richard, vice president of sales and marketing at SeQual Inc., advises that home care companies involved in CPAP setups, should refrain from doing portable sleep testing. Doing so, will potentially cause concern and raise some issues with referral sources.

“They may not want you doing portable sleep studies, and they may view you now as a competitor instead of an ally,” he says. “So you have to be very sensitive before you go off and want to do this type of business and think about what you may be risking by losing potential referrals by your already established sleep labs that are sending you patients to have CPAPS set up.”

Doing home testing and setting patients up with CPAP can also come across as fraudulent.“You could be scoring all these studies so that everybody tests positive and everybody needs to be set up on CPAP,” Richard says. It could be a situation of, ‘by the way I have a CPAP machine and I’m going to put you on one tomorrow.”‘

4. Is there room for us all?
Providers should ponder about whether or not there’s enough business out there and whether or not the payors that they’re currently working with will reimburse them for a procedure and just how much will that reimbursement be, Richard says.

Here are a few questions Richard says he believes every provider should ask themselves before pursing this model.
•    Do I have a clinical expertise to employ a program like this and do I have the ban width?
•    Do I have the resources?
•    Am I going to be taking time away from my employees to put them on to something that’s not producing that great of a revenue stream, diluting their capabilities and interrupting their normal job flow?
•    Do I have the capital to acquire the equipment I need to make a program successful?

This article originally appeared in the May 2008 issue of HME Business.

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