VGM Wants to Help HMEs Remove Barriers from CPAP Shopping

Published in Hardware & Software on October 03, 2022

By VGM Forbin, a division of VGM

Those who have built their careers in the home medical equipment industry understand that there are significant differences between their businesses and those of their luxury-goods-offering counterparts. As medical equipment moves from manufacturers through warehouses and retailers to end users, there are several points of friction those outside HME are free to ignore. Guiding a patient through the process to get their equipment only adds to the difficulty. For more than 35 years, VGM has been determined to face those challenges and alleviate the burden on HME businesses. This year, teams across VGM divisions have been studying those challenges for sleep and PAP and considering possible solutions. Solving the complex challenges for sleep should reveal strategies for other product categories as well.

What complications does the sleep and PAP industry face?

Diagnosis Can Be Nonlinear, Uncomfortable, and Expensive

Patients might expect they have obstructive sleep apnea years before they are diagnosed. Many common issues with poor sleep are ignored or simply accepted. Once a patient decides to discuss sleep issues with his or her family physician, they still must make and keep an appointment with a sleep clinic. Each step requires trust and presents unfamiliarity. There are new providers to meet. Testing can be a disruptive process. Financial concerns can keep someone from proceeding. When hesitation derails the process, the patient can find himself or herself back at the beginning.

Parallels elsewhere in health: Across health categories, referrals and unfamiliar providers can make patients uncomfortable. Symptoms can get deprioritized or ignored.

Many Items Need a Prescription. Others Do Not

Shopping for CPAP machines, masks, tubing, and accessories, a patient could have a difficult time discerning which items they are at liberty to purchase, or which others need to be prescribed first. Further, having a prescription doesn’t help a person make all the necessary choices for their PAP setup. For instance, understanding how they breathe, their proneness to allergies, or their sleeping position should inform their mask choices, but these discussions don’t always accompany the prescription. Recommendations, when provided in these areas, may rely on self-reported data which can be incomplete or inaccurate.

Parallels elsewhere in health: Diabetes, incontinence, and orthotics are just a few of the many health product categories that require prescriptions for some items while not for others.

Who Pays?

Complicated insurance benefits might make it uncomfortable to shop for equipment, accessories, and supplies. Insurers can vary dramatically in the coverage they offer. Even different policies with the same insurance company are likely to diverge. State guidelines attempt to offer some standardization, but the sheer number of variables can be difficult to understand, even with a guide.

A patient may also be unlikely to remember how often they are entitled to replacement equipment and supplies within their policy. Because some of these items can cost hundreds, and even thousands of dollars, patients may be afraid to make a wrong choice.

Parallels elsewhere in health: Across health categories, understanding which items might be covered and how often replacement is available can be prohibitively challenging.

Overwhelming Options

With a variety of features and vastly different price points, a patient new to PAP equipment might feel anxious about their options. Comparisons often come with bias. Once a machine has been chosen, ensuring you find compatible accessories can be similarly frustrating. Choosing a machine can be a three year commitment through insurance and a sizeable investment without.

Parallels elsewhere in health: Maternity breast pumps can be similarly complex with compatibility challenges.

Will It Get Used? Are There Compliance Issues?

Insurance coverage is additionally complicated by matters of compliant use. A CPAP regimen brings a change in lifestyle. A patient may be tempted to forgo treatment after they have already received their equipment. Half of CPAP users discontinue use within the first year. Such bleak compliance outlooks can be discouraging. Is getting equipment and supplies worthwhile when so many seem unable to form a habit of use?

Parallels elsewhere in health: While proving compliance is unique to sleep equipment, orthotics face many of the same challenges with consistent use. Bracing can initially be uncomfortable and feel bulky.

The Dangers and Benefits Can Be Hard to See Day to Day

A patient might be more determined to talk to their doctor, submit to a sleep test, understand their insurance coverage, and compliantly use their machine if the benefits were more apparent. While the hazards of sleep deprivation are well-documented, the most serious effects might not reveal themselves for months or even years. Any one night without treatment could seem negligible, an additional night as well.

Parallels elsewhere in health: Exposure to carcinogens, high blood pressure, and glaucoma are examples of other health hazards that might seem symptomless until complications mount.

What Do We Expect to Find?

The teams working to overcome these challenges have promising initial ideas. Many revolve around presenting clear information, better connecting stores to insurance and clinics, and building technologies that introduce tools at the right moments. Remedies to each of the above challenges can help patients more confidently get solutions to their sleep issues. Retailers and manufacturers can more fluidly get equipment to those who need it. Solutions will likely be developed and released incrementally. By tackling the particularly challenging sleep industry first, the technologies created may be more easily adapted to other product categories as well. Significant steps are expected over the next several months.

Respiratory therapists, sleep centers, and medical equipment providers, would you like to follow VGM’s progress? Complete this short form on VGM Forbin’s website or connect with your VGM Regional Account Manager.

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