Monitoring Across Miles

Providers embrace simplified data gathering and analysis to benefit patients and gain business efficiencies.

Data Gathering and AnalysisJan Davis, RRT, says the Tallahassee, Fla., branch of Barnes Healthcare Services is about to enter a whole new era in its CPAP business, based on a large HMO contract the company just won. “The sleep business for this location will very likely triple what we are currently doing,” says Davis, who is regional clinical manager.

When the contract goes into effect June 1, 2010, there’s one resource Davis will rely on to get a great job done for patients — compliance monitoring technology. The Tallahassee branch has been using ResMed’s ResTraxx system since this past fall on about half of its new patients each month, while the other half are monitored using traditional card downloads. When the new infl ux of HMO patients begins, efficiency will be essential. “We are going to go with more ResTraxx because we are not going to have as much time to make as many calls to patients to see how they are doing,” Davis says. “Using ResTraxx, we will call the red fl aggers and the people who have been on yellow for three nights.”

Barnes Healthcare Services is among the many home respiratory companies discovering the efficiencies and opportunities available via compliance monitoring technology, innovative devices that include wireless systems, wired modems and downloadable data cards, all developed to track what’s going on with the patient’s CPAP therapy in the home.

Such technology makes sense for a variety of reasons, sources say. It improves efficiency, as Davis mentions, but it also enables better care, which is another of her priorities. “Our motto is, ‘We take care of people.’ The way to show people you care about them is by staying in touch. We pride ourselves in following up with patients, and this technology makes it so much easier.” The technology identifies patients who are having difficulties, such as mask leak, so a therapist can intervene right away, Davis says.

Finally, another benefit — and not the least — comes from the fact that compliance monitoring technology enables the objective reporting necessary for reimbursement by Medicare and many private payers who want proof that CPAP devices are being used properly by patients. Without the data, there are no dollars.

Just the Beginning

Because of compliance monitoring technology’s many advantages, its ascendance is just beginning, manufacturers say. Further advances are expected to enhance what the technology can do and how widely it is used.

For example, Philips Respironics offers EncoreAnywhere, a Web-based compliance monitoring system for its PAP devices, says Maura Weis, senior marketing manager, sleep therapy, at Philips Home Healthcare Solutions in Monroeville, Pa. “In the past 10 years, we’ve gone from looking at data on the machine all the way up to a Web-based system, where the device stays in the patient’s home, and information is detected and automatically transferred to a data system that can be accessed by multiple care team members no matter where they are,” Weis says. “All they need to do is be connected to their computer, which is connected to the Internet. They can change the patient’s prescription and transfer that back to the patient’s device. Now we are not talking about days of getting data to the appropriate care team members and days until the intervention, we are talking about hours.” Philips Respironics was honored in March for the embedded wireless capabilities of its System One device and its EncoreAnywhere program by GSMA, a global organization focused on the growth of the mobile communications industry.

Not only has the wireless and wired compliance technology evolved, so has the data available, Weis says. For example, EncoreAnywhere records sleep sessions breath by breath, producing fully scored sleep reports similar to PSGs. Now, it can also detect two additional types of advanced events, including clear airway apneas, or central apneas, and periodic breathing, which is associated with cardiovascular disease. These cannot be treated with a CPAP device, so the clinician knows quick intervention is essential to good patient care, she says.

Irvine, Calif.-based Fisher & Paykel Healthcare just introduced a new compliance monitoring tool based on USB technology, the SmartStick Net, according to Masoud Vahidi, senior product manager. “The SmartStick Net is a Web-based solution involving the patient and the provider,” he explains. “On the patient side, all they need to have is Internet access and a USB port. The patient uses the SmartStick to upload data to a website. It’s very easy, and the patient gets a success message on the computer. On the provider side, all they need is Internet access. They login to the SmartStick portal and can see the data.”

Vahidi points out that the SmartStick Net sidesteps the issues with wireless and wired technology, such as geographic coverage and cost. “With our solution, providers don’t have any of the difficulties associated with the current technologies in the market,” he says. “It’s an almost no-cost solution for easy access to patient data and ensuring the patient meets CMS requirements.”

SmartStick Net complements the other compliance monitoring technology Fisher & Paykel is planning to offer, Vahidi notes. “We believe that no single technology will be sufficient for all our customers,” he says. “In the future, we will offer a variety of technologies to meet the variety of needs of our customers, including wireless, wired or patient-involvement devices.”

Weis agrees. While she knows that the buzzword “wireless” gets people excited, she prefers to emphasize that compliance technology facilitates the fl ow of data to and from the device, and that can happen using wired or wireless options. “Both of them are important to have as part of a company’s sleep management equipment, based on the patient-specific environment.”

Indeed, wireless technology, which runs on the same communications network as cell phones, has limitations based on geographic coverage. Wendell Smith, CRT, of Advanced Care Medical Equipment, encounters that issue as he serves patients from four branches spread out in south central Oklahoma. He would like to use wireless compliance monitoring systems with more of his patients, but has found that only about 40 percent live in areas where the cell service is reliable enough.

Still, Smith is keen on the advantages for that group. “Over-the-air saves time, and I can see daily that the patients are cooking right along,” he says. “I know that I can generate the compliance report right away, and I don’t have to wait for the card in the mail. Wireless is the way to go. It is the fastest and most economical as far as staff efficiency. The card works; wireless works better.”

Drew Terry, senior director of product management for the Sleep Strategic Business Unit of ResMed in San Diego, notes that one reason wireless works better is the immediacy of it. “The best time to be most effective in helping a patient be successful with therapy is in the first week. If you can see that the patient isn’t using the equipment, and you have the conversation with him right up front, you have a much better chance of helping him overcome the challenges,” Terry says. “That’s the unique value that the wireless technology brings, because of its immediacy and because of exception reporting. ResMed’s ResTraxx is designed with a visual matrix; green is good, yellow is caution and red means action is required. At a quick glance, you can look at a whole set of patients and see which ones need help, and that makes our HME company partners efficient in how they spend their resources to help patients.”

Manufacturers report that the adoption rate of wireless and wired compliance monitoring technology is on the upswing. Terry says: “It’s growing, but it’s not the majority yet. A lot of companies are still using the data cards because they have successful systems set up to handle compliance reporting requirements that way.” Weis adds: “Respironics just closed a quarter where we saw a record spike in modem technology being purchased on closer to 20 percent of all devices. We are seeing it climb, but it is hard to predict because of the models providers have to utilize modems in a different way. But we think that selling modems on at least a third of our devices is not unreasonable. Cost certainly is a factor. There’s a cost to providers when they buy a modem, and there’s a transaction fee for the data services when the modem is used.”

True, if there is any objection from the providers, it is to the cost of compliance monitoring technology. That’s why Laura Castricone, RRT, director of clinical services for Health Complex Medical in Waterbury, Conn., hasn’t dived in. “We’d love to be cutting-edge, but because of the cost, we haven’t decided if the technology is going to work for us,” she says. So for now, the company is continuing with the system it developed for using download cards to track compliance. The company’s relatively contained service area in Connecticut makes the process manageable, and patients send the cards in through the mail at regular intervals for downloads by therapists. “Wireless technology is great and very exciting, but it’s not absolutely necessary because the card technology comes with the device.”

Broadening the Opportunity

Despite cost issues, compliance monitoring technology can be the start of good things for both the patient and the respiratory provider, sources say. “One of the most powerful pieces of feedback we get is from providers who have increased their compliance rates using the technology,” Terry says. “That has a very strong value, because once patients are compliant, not only are they getting treated, but in order for them to remain on therapy, they are going to need masks and supplies and care downstream. This helps patients be successful and helps HME companies accomplish their economic goals.”

Another trend in compliance monitoring technology is fostering patient involvement. Terry says that ResMed’s new S9 device gives the patient information about compliance through an LCD screen. “With something as complex as trying to change someone’s nightly behavior, it’s important to get them engaged in their own therapy,” he says. “The S9 provides a sleep quality indicator at the end of every night that tells them how long they used it, if they had a good mask fit and, if the providers make it available, their AHI. Like a diabetic who monitors blood glucose, sleep patients can participate in their therapy and work with the clinician to achieve their goals.”

Finally, using compliance data for research and aggregating it in new ways represent opportunities for the future, manufacturers say. “There is a lot of discussion about health care informatics, and dozens of health portals are being designed to exchange health information,” Terry says. “Combining daily sleep data with blood glucose levels from a diabetic who also has sleep apnea in a health portal is a real possibility in the future. Data can be aggregated and presented to health care providers so it is not all coming from individual solutions.”

Clearly there’s more on the horizon when it comes to compliance monitoring technology, so providers can stay tuned and participate when and how it best fits their business and their patient base.

Compliance Technology HCPCS Code Exists, But Reimbursement Is Scant

Compliance monitoring technology exists, and so does a related Medicare HCPCS Code: A9279. The technology provides valuable patient data, but the code has no value. At this time, Medicare does not reimburse for it.

Officially, A9279 is described as “monitoring feature/device, standalone or integrated, any type, includes all accessories, components and electronics, not otherwise classified.” Beth Guevara, senior manager, reimbursement planning, Phillips Home Healthcare Solutions, explains the situation: “While the code has been created, Medicare does not cover it. It’s disappointing, but it’s nice to have the code because there can be situations on the commercial side where providers may receive reimbursement under the A9279 code.”

Guevara says the code went into effect January 1, 2007, in advance of the compliance requirements for CPAP therapy in the fall 2008. She says that CPAP manufacturers had conversations with the Medicare medical directors about the code given the compliance requirements, but the payers decided it would remain unreimbursable.

“We were hoping those requirements would be a way to get the code covered,” Guevara says. “That could change, in the future, you never know. At this point, the providers are doing the work covered by the code, but for no reimbursement.”

On the private payer side, there has been more progress. Guevara knows that some CPAP providers have been reimbursed under A9279 for their use of compliance monitoring technology. “Respironics put together a program of materials to help providers who want to get the code reimbursed through commercial contracts,” she says. “It includes studies showing the value of compliance monitoring and the value of a good follow-up program. When providers went in for contracting, they could discuss the compliance monitoring program that they have, and why it would be a good program to cover.”

Guevara reports, however, that many providers opted to bill using the code, rather than negotiate beforehand. Typically, the insurers paid for a while, but then questioned the charge and stopped the reimbursement. “If this is handled in the correct manner, and the provider negotiates for payment up front, there is more likelihood of long-term success for payment of the code,” she concludes.

This article originally appeared in the Respiratory & Sleep Management June 2010 issue of HME Business.

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