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?
- By David Kopf
- Dec 01, 2020
Sleep 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
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 (spirohealthservices.com), 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
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
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
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.