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Sleep Therapy's Coronavirus Academy

Sleep providers had to tackle a tough learning curve during the early days of the COVID-19 public health emergency. What are the lessons they learned, the insights they gained, and how do they apply to the rest of the industry and possible future outbreaks?

COVID-19Sleep therapy often functions as an excellent perfect micro that defines the macro of the home medical equipment business. We’ve seen this with several trends, such as the interplay of technology and therapy, remote patient monitoring, coordinating with multiple funding sources, and outcomes-oriented healthcare.

And now we’re seeing it with COVID-19. When it comes to the public health emergency, providers of sleep therapy equipment and services have had to ascend a steep learning curve to reshape how they safely and effectively provide products and services, and they have had to innovate new workflows and use new tools to get there.

Now that we are several months into the public health emergency and have a moment to look back and assess, where do sleep providers stand? What lessons have they learned? What insights have they gained? How does all this help them prepare for future spikes in COVID-19, or worse, another pandemic? They’re good questions to ask, because that learning curve can apply to the rest of the industry.

To help answer those questions are Gary Sheehan, MBA, the CEO of New England regional sleep and respiratory provider Spiro Health (, and Sonal Matai, the business leader of Philips North America Sleep and Respiratory. Both share a variety of insights on sleep therapy business, care, technology and how COVID-19 has influenced the entire sector. Let’s dive in:

HMEB: If you had to give a really tight, thumbnail description, how would you characterize HME providers’ “education” when it’s come to the last six or seven months? Did they pass the test?

Sonal: At the outset, there was some wondering about “what does it mean?” For all of us in the industry, we were asking, what does it truly mean in terms of how will you manage a business, where will get our patients and a referral? How will we do what we do today? And if I was to look at the last few months, I think the industry and everyone across it have responded exceptionally elegantly to it.

At the outset, there were some struggles. It took a while for everybody to realize that it’s not going away and that they needed to change their ways. I think, initially, there were some naysayers in terms of connectivity and managing your business with a remote mindset: “How can you do that? How will you move your own patient intake team or your patient service team, etc. and do remote setup?” Not everyone was initially there, but the way everyone ultimately valued and understood that they needed to get into this remote environment and looked at what was needed to be successful has been quite phenomenal.

Gary: Most of the sleep providers I’ve talked to were very creative and had done a really good job of providing uninterrupted service. You just adapt a little bit: the consultations and the fitting is different, and some of these 2D and 3D mask fitters that have come out came out at exactly the right time for us. It’s been great to have that tool in our toolkit because we haven’t lost as much in the way of compliance as we probably would have guessed eight or nine months ago.

HMEB: What was the initial transition like?

Gary: We were monitoring the situation globally and had real concerns in February and into March. We made the decision Wednesday, March 11 to push everybody to remote beginning that Friday — of course, Friday the 13th. Over that weekend, we had to figure out how to run our business with our entire employee population at home. We were fortunate to have a pretty strong technology infrastructure already in place, not purpose-built for the intent of a pandemic, but there we were. And then we quickly ramped up policies, procedures, processes to run the business remotely, do remote shipments at scale, arrange for follow-up consultations. And I think, look, a lot of sleep providers, I think, had remote shipping on their roadmap of things to try and tackle.

There were concerns about brand reputation; of going too far, too fast with it. However, a lot of us had been thinking about it for a while. I think some people had already been doing it in pockets, but we were just forced to adapt really quickly.

And I’m very proud of our team’s ability to do that and the service we were able to provide. The patient feedback that we got over the first several months was overwhelmingly positive in terms of our ability to provide service without interruption. And then we began to educate our referral partners on how they could operate in a COVID world through home sleep testing and telehealth consultation; trying to help coach them up a little bit because without them diagnosing new cases, the pool quickly dries up.

HMEB: Have there been some key lessons that providers have learned? Will they last?

Gary: We’ve learned a lot over the last several months. We will continue to take those learnings and apply them to how we do business moving forward. We are selectively, very slowly, and cautiously reopening some of our facilities for folks who demand in-person. I still think it’s a very tenuous time for the country and for the states that we operate in. So we’re still biased towards remote setups. First, because it’s worked well and, second, we don’t want to be involved directly or indirectly with further transmission at this point.

From a patient services point of view, a key adaptation we have made is the remote setup and the consultation follow-up. I think even when this is over with, that might be the preferred methodology with an in-person setup, postinitial setup. It’s a bit of a mouthful, but it might be a more constructive dialogue to start therapy for two or three nights and then have a setup in person before — rather than just sitting in a room and learning about it cold. I think the first few nights of therapy introduce a lot of questions. So, perhaps a drop-ship or a shipping model first, and then an in-person consultation or telehealth consultation after.

The other key adaptation is the remote workforce. I feel like we can now recruit in all 50 States for support personnel and ship them a phone and on we go. So, it’s a bit of a different view on employee requirements, potentially. We haven’t made that strategy actionable yet, but it’s something that we’re absolutely considering, because it’s been very successful. And I don’t care if they’re working remote. To some degree, it doesn’t matter if they’re five miles from the office or 500 miles from the office.

We’re not doing anything overly exotic, but we’ve focused on education and consultation, so sending patients videos specific to their products, so that they can orient themselves.

Sonal: I think everybody understood that they needed to embrace technology in their own workflow and how we were all as providers managing our patients. We needed to embrace technology at each step. So whether it was on the patient intake side, whether it was on the administrative side, whether it was in billing, whether it was for a remote patient set up, they saw the benefits: you can now do a remote patient set up. You can do a phone call or a video call with your patient to set them up, give the patient the engagement and education tools, etc. I think a lot of providers realized that, and after eight or nine months of this, I think a lot of them have moved there. They’ve realized that by using technology and remote tools, you can still give quality patient care.

Also, they have realized they need to use other partners as well. For me, for all us people that are respiratory providers, we’ve learned to do what you can do best; outsource the rest. And I use that simple phrase, “do what you can do best; outsource the rest.” I think a lot of providers are starting to embrace that philosophy. If I’m very good at managing their efforts, then let me focus on that. So with remote setup, “if Philips can help me with their patient adherence services or their home delivery remote services, let me give it to Philips,” right? Or, “if I can use a different tool for resupply, etc., or any different technology, whether it’s from any other company, I will use that.”

Another lesson is that this pandemic is real, this is not going away. Providers need to put up business continuity plans as an organization. Providers need to continue with their plans and procedures and protocols [for COVID], because even if we go back into how we were a few months ago or last year, I think this could happen again. So you need to be ready. You need to preempt and be prepared so that if it happens,

HMEB: How are patients and referral partners responding to the new models?

Gary: I think we will have remote care as an operating service model now, and I think a lot of patients prefer that. I frankly would probably be one of those patients myself. However, I don’t think we’re going to be 95 percent remote setups post-pandemic. I don’t know what it will be, but certainly we want to meet patients and serve patients how they want to be served.

And I think there’s just going to be an openness to this as a service model in a way that there probably wasn’t nine months ago. I think our referral partners would have been concerned if we were shipping to this degree pre-pandemic, because it just wasn’t the way the business was normally done. I think now that we’ve got good data on patient outcomes, and patient experience, it’s certainly going to be something that we will offer, and I don’t think we will be as resistant. We’ll still have locations and capabilities to serve patients in the community face-to-face, but I do think a lot of patients are still going to relate to having that remote setup.

HMEB: Do you expect a second wave? If so, what do you think is going to happen and what are you advising providers to do in that regard?

Gary: We have a fairly bearish view on the outlook for the United States in terms of COVID and how we’ve responded as a country, as a government, and how we might respond over the ensuing kind of six months. I think the winter’s going to be a little bit ugly. I think people are fed up with it, but that doesn’t mean that it’s gone. I think we’re seeing rising rates in most areas where we operate. It’s very concerning. And then you co-mingle, the anticipation of flu symptoms, and we’re fully expecting things to slow down or shut down at some point in the next 90 days again.

However, we haven’t really taken aggressive steps to go back to doing things the way they were before. So, a second wave is going to be minimally disruptive for us. We still primarily work home. If we have to stand down some of the locations that we’ve opened up, we can do that, but that’s not going to be that disruptive. We’re only able to see sort of five patients per RT per day, because we’re allocating all this cleaning time between visits.

Sonal: My only advice is let’s embrace technology in every facet of what we do. Let’s raise the use of technology at the provider end to run the business more efficiently every day, across every spectrum of what you do. Do what you do best and outsource the rest. And also with the patient. Let’s give them tools like DreamMapper and introduce them to therapy, give them the right patient engagement and education so that they understand what they need to do and better engage with their therapies.

If we have a second wave tomorrow, or we have a wave after two years, or a different outbreak after two years, let’s have a clear protocol and procedures documented. I think that is a very big piece. So we know what we can do next, or at that stage, if it happens.

We cannot forget this experience because what has taught us is that, we can use technology better and still take care of our patients. I don’t want that ethos to go away. Ultimately, the way we manage our patients today should be what are doing tomorrow.

This article originally appeared in the Nov/Dec 2020 issue of HME Business.

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