Business Solutions

Expanding Your Sleep Network

The key to sleep therapy success is creating a constant stream of referrals.

sleep therapy networkSleep therapy continues to evolve as a competitive, difficult business that offers HME providers considerable revenue opportunity. The sleep market is growing, but success depends on many factors, including diligent data collection, favorable patient outcomes, keeping current with technology and, like many other HME business categories, traversing the volume of rules and regulations that continue to challenge the HME universe in general.

“Improved patient outcomes are, of course, key elements of a successful, modern sleep business,” said Jon Yerbury, Vice President, Marketing, Americas, ResMed. “But so too is the efficient management of resources within HME providers that enables them to provide better patient care and the ability to take on even more patients. Remote patient monitoring saves HMEs significant time and labor, enabling them to focus on increasing referrals a nd servicing more patients while providing the same quality of care. In a 2015 report, Berg Insight reported that remote monitoring is growing faster in the sleep therapy segment than in any other healthcare market. The report projected that in 2016, sleep will surpass remote cardiac rhythm monitoring, which has traditionally been the largest market segment.”

Sleep therapy provider Gary Sheehan, President and CEO, Cape Medical Supply, Inc., an HME provider considered a sleep therapy pioneer, said his company’s growth is “moderating,” but sleep therapy offers opportunities for providers. Two of the biggest challenges Sheehan sees are rules and regulations, which he said are impeding growth.

“Utilization management organizations are creating time delays and Medicare’s audits have long since left the realm of reasonableness,” said Sheehan. “The government needs to get back to focusing on if there was a clinical need, was the product delivered and is the patient using and benefiting from it. They have us chasing our tails for information and the physician and lab communities are growing increasingly frustrated by all that we are asking from them to simply get patients set up. It’s not a good situation and we fail to understand who benefits from the environment they are creating. It’s certainly not patient-centric and doesn’t support quality outcomes in a timely fashion.”

With all these difficulties of maintaining a sleep business considered, a sleep therapy provider must have exemplary company systems to overcome these challenges in order to maintain and grow patient referrals, which are the lifeblood of the sleep therapy business.

“There are many ways to grow the sleep business — d irect marketing to sleep labs being the most important,” said Robyn Parrott, RRT, President, Sleep Solutions Home Medical. “We incorporate social media, emails and patient educational programs. Overall, 90% of our business comes from referrals.”

Sheehan agreed with the importance of referrals: “Absolutely, referrals are the only way to grow a sleep business.”


Sleep Review’s first quarter 2016 sleep center survey results ( indicate that sleep patient volume growth and per patient revenue are growing, although not at the same clip as indicated in their last survey.

For example, the survey said that over the last 12 months of the Q1 2016 survey, average beds per respondent decreased slightly by 1 percent to 7.7 beds, but over the next 12 months, average beds per respondent are expected to increase by 5 percent to 8.1 beds. Regarding patient growth, respondents reported a patient volume growth of 6 percent over the last 12 months and expect a 6 percent growth over the next 12 months. These patient growth figures show a slow down from 8 percent growth (over the last 12 months) and 9 percent growth (over the next 12 months), according to the Sleep Center’s last survey, released in third quarter 2015.

Yerbury said these recent findings demonstrate that the sleep business is growing as it taps further into the undiagnosed patient population. Educated sleep patients and the technology to diagnose and treat sleep issues are creating more patient volume and thus the race for more referrals.

“There is broad awareness of sleep apnea and its impact on patients health and community well being, and physicians and other healthcare decision makers across the care continuum continue to screen for it and refer in for diagnostics where appropriate,” Sheehan said. “It’s still a growing market, but not to the same degree it was a decade ago when awareness was just beginning to come about. There is an opportunity for providers who can work in a complex regulatory and reimbursement provider and can put together a program that is closely monitored and delivers strong outcomes for patients and healthcare professionals.

“There are innumerable barriers put in place by payers and it is increasingly difficult to provide the right level of service and care to patients, in a timely fashion,” he continues. “If you can construct a program, wrap a lot of data around it, drive reporting to deliver visibility and stay on top of it as it scales, it’s still a good line of business to be in. It’s not a place to dabble and we still see providers who lack scale and sophistication trying to win share and that creates a lot of bad outcomes for patients and a black eye for an industry that can’t afford it.”


There are a variety of ways that providers can increase their stream of referrals. To help sleep therapy providers capture referrals to grow their business, HME Business tapped industry leaders, who in their own words offer the following top tips for growing a sleep therapy patient referral base.


Gary Sheehan“Sleep therapy providers must have a strong direct sales force that is in the field talking about the strengths of your program and working collaboratively with your healthcare partners to drive compliant referrals,” Sheehan says. “There is a lot of education that goes into generating clean referrals and working to get patients set up timely given the overall regulatory environment.

“Also, you need to be able to explain how you do what you do and discuss the outcomes that doing it that way creates,” he continues. “Through-putting compliant patients is the primary goal from a clinical and business perspective — you need a process built to do that and a team capable of communicating that to the referral population to drive preference, traction and growth.

Sheehan adds that reporting is critical.

“We have an extraordinarily detailed reporting infrastructure and can demonstrate to our partners compliance rates based on the RT that performed the setup, the mask used, the payer, etc.,” he explains. “This gives our partners confidence that their patients are with a high-quality provider who has a depth of knowledge in the business line.

“Again, this is a highly complex business space and we continue to see too many providers in it who don’t belong here — it’s not good for patients health outcomes or the industry as a whole and I think some network narrowing will likely be coming soon, particularly given the fact that there is so much information available on outcomes and so much clinical utilization data at our fingertips and at the payers’ fingertips,” he adds. “We make a meaningful investment to drive compliance and are very proud of our program and the results it creates. We win new business, very simply, because we are better managers of our patients and their health outcomes than the providers we compete with.”

This improves referral relationships, Sheehan adds. A provider’s partners must know that it has its practice in order, and an effective way to accomplish that is to use technology to measure and monitor each business step and the infrastructure to make changes, he explains.

“Providers have to understand their sleep therapy practice from end to end and have visibility into performance from the moment a referral hits their system through when a patient is actively reordering supplies,” he says. “What are your cycle times, throughputs, bottlenecks and volume challenges? If you cannot report regularly on these elements and report them back to healthcare professionals and payers, sooner or later you will be left behind. The ability to leverage data for decision making and growth is an essential element of being a modern, innovative provider, and something referral partners and payers will rightly come to expect.”


Angela Gludice“Traditionally, HMEs secured referral sources by old-fashioned salesmanship with a complement of donuts, coffee and luncheons in an effort to build relationships,” Giudice, who stresses that is now changing.

“At the end of the day, referral sources are primarily interested in the level of care and support provided to their patients,” she says. “One way to drive referrals is to demonstrate increased compliance with their patients. CPAP therapy has a large drop off rate and an HME that can show their referral sources concrete metrics of improvement likely develops an edge with the referral. Demonstrating a willingness to go beyond the minimum necessary (i.e., hosting patient therapy support meetings, patient educational forums, etc.) demonstrates an HME provider’s commitment to sleep.”

Giudice also highlights staging patient education events as a key way to foster strong relationships between providers, patients and referral partners.

“Patient feedback and word of mouth goes a long way to making [referrals] feel comfortable with an HME company,” she says. “Hosting events, such as A.W.A.K.E. meetings for PAP therapy gives patients a forum to interact with HME and clinical staff and other sleep therapy patients. These meetings encourage good faith between the patient and the HME company playing host.”


Jim Doty“For the vast majority of providers, physician referrals drive their sleep business,” Doty says. “We hear the top ways to drive referrals are to support each patient’s use and make life easy for the doctor’s staff. HMEs can market themselves more valuably with their referral relationships and, in doing so, can have greater patient management success.

“Before we had connected solutions that let providers measure patients’ adherence to therapy, referral sources would evaluate providers simply on the service they provided to their office,” he continues. “While this remains important, being able to know the specific patients who may respond to therapy has increased intervention and has made providers more efficient while also improving the number of patients who continue to use therapy.”

When working with physicians, Philips Respironics hears that they like to work with sleep providers who educate their patients thoroughly, according to Doty.

“They often measure this via the number of patients who return to their office asking questions about their therapy and about the percentage of their patients who continue to use therapy following the 90-day trial period,” he says. “By ensuring that patients understand each step of the process, returning to the office can be minimized.”

Doty notes that, while the following items are not necessarily new steps, providers should ensure execute they following with each patient:

The first time a patient is contacted for introductions and insurance verification, explain the process steps and timing, as well as the financial responsibilities. Be prepared to answer any questions they have about OSA or therapy.

At the time of the initial instruction, engage the patient in a motivational discussion and record what they tell you. Reminding them why they are starting therapy may provide motivation later.

Take time to explain the therapy, as well as device use and cleaning. Have the patient repeat the important points back to you so they have more chance of remembering it later.

Use the patient’s use information to determine who may benefit from a follow-up call and make calls as needed.

Initiate the calls or messages to support patient use and offer them supplies as needed to support long-term use.

Run reports from adherence management software to report on patients’ progress and use it to engage the referral source on the progress of their patients.

Also Doty says providers should use a cloud-based data capture and management system, such as his company’s EncoreAnywhere system so that it can have current patient information and adherence rates, which they can then report their to physicians.


Robyn Parrott“Our company does a lot of tracking of numbers,” Parrott says. “Quarterly, we review our mask refits to determine which are the best masks that do not require a refit. We have found that the pillow system mask requires the least amount of refits.”

Also providers must track adherence, which Parrott stresses is much different than compliance.

“Most DMEs are good at compliance but most are not good at adherence,” she notes. “After one year of usage our adherence rate is at 73 percent, meaning 73 percent of our patients are still using and ordering supplies. This is a good reference to market to the referral sources. We also market our patient compliance rate, which is 86.2 percent.”


Jon Yerbury“A traditional way of building sleep referrals is to have dedicated sales representatives who reach out to physicians, build relationships, discuss patient needs and how your business can meet them. Providing your referrals with presentations and product brochures that they can give out to their patients and have in their waiting rooms also helps solidify the partnerships you’re building with them,” Yerbury says.

“Utilizing the latest in technology can help connect you to your physicians and drive referrals. Patient compliance and therapy management systems, such as ResMed’s AirView, allow HME providers to link physicians to their patients and provide them real-time access to patient data in the cloud,” he continues. “This allows for better collaboration between care providers, as well as office efficiencies and less reliance on paperwork and faxing. HME providers should enter each of their referrals into a patient management system, and ensure that they know how to log in and access the data they need.

“It’s also important to proactively share patient compliance and therapy data early with referrals,” he adds. “This ensures that they have the reports they need and the ability to intervene or provide support for patients who are struggling. Showing referrals when a patient is struggling with their PAP pressure or high AHI, for instance, shows them that you are a trusted and valuable partner in keeping patients on track and improving their health outcomes.”

Providers should also help referral sources educate their patients can help foster stronger relationships, according to Yerbury. He says sleep businesses should provide referrals with patient support information, such as brochures, product displays and demonstration masks and devices.

He also highlights providing remote patient monitoring to referrals is important.

“HME providers must have a robust patient compliance and therapy management cloud-based software platform in order to show referral sources patient outcomes,” he says. “Remote monitoring of patients’ therapy allows HMEs to quickly share with physicians when patients have met compliance, and also highlights when therapy changes need to be made, such as a comfort or pressure setting. Reports can be sent electronically to referring physicians, or the referring physician can log in and access the data themselves.”

In summary, Yerbury advises providers to focus on the following in order to drive referrals:

A combination of therapies that benefit the vast majority of patients.

Education materials to physicians, sleep specialists and their patients to help increase awareness of sleep apnea and referrals to your business.

Accessible and actionable data through connected care solutions that efficiently monitor and help improve patient outcomes.

“From retail to HMEs, everyone is invested in creating good data and making sure it offers good decisions — far beyond data for data’s sake,” he adds.

This article originally appeared in the February 2017 issue of HME Business.

HME Business Podcast

Latest Podcasts