Provider Perspective
Teaming Up for Quality
HLS, Sleep Management Institute Deliver Seamless Patient Care
In rural southern Indiana, HLS Home Medical and Sleep Management Institute LLC have developed a sleep therapy program that’s anything but small town. Dean Blessinger, RRT, director of HME operations at HLS Pharmacies Inc., in Evansville, Ind., and June Erny, RRT, RPSGT, managing partner of Sleep Management Institute LLC, in Jasper, Ind., tell why they came to work together and how their patients are benefiting from high-quality sleep studies and carefully administered PAP therapies.
RSM: Tell our readers about HLS Home Medical and Sleep Management Institute.
Blessinger: HLS Pharmacies was founded 13 years ago to bring together eight independent pharmacies for buying power. The owners realized that with the Walmarts of the world they were going to have to do something different, so they delved into home medical equipment and set up HLS Home Medical, which now has nine branches in Indiana, Illinois and Texas.
I came on board six years ago and found a very fledgling operation in HME and particularly home respiratory care. I was committed to taking home respiratory care to a high level, professionalizing the staff and accrediting the organization. We’ve grown the revenue almost threefold since then. We are heavily clinically driven, and we don’t enjoy the double-digit bottom line because we have sacrificed for quality. In the end, we think we will win. Payers are going to start demanding compliance and outcomes measures, and then we will negotiate fee schedules that refl ect our clinical commitment. Each of our locations has a minimum of one registered respiratory therapist, along with a registered nurse. We cross-train and cross-utilize the therapists and nurses.
When it came to our sleep business, we found that not all sleep labs were created equal. HLS was working with about 10 different sleep labs, and some were pretty good while others were not. When they did shoddy titration studies or rushed jobs, we felt like we ended up doing their work for them. Fortunately, because we were using higher-end equipment, we could intercede and get patients on the correct therapy. That was one impetus for me to say, “Enough!” So I looked at starting a lab to do it the right way.
Erny: About five years ago, I was exploring the possibility of starting a sleep lab because the area was underserved. Most of the patients who required sleep diagnostics were driving an hour. My focus was on offering quality care, having better staff and establishing better procedures. That’s when a vendor pointed out that I was on the same path at the same time as Dean. We came together because we share the same philosophy of quality care and staff. From that, Sleep Management Institute LLC was born in August 2006, with Dean and I in partnership.
RSM: How did the sleep lab do during the early days?
Erny: SMI grew very quickly because Jasper was underserved. We started with two beds, and due to tremendous growth, we were studying seven nights a week by the end of the first year. Now we have three beds and study five nights a week and by request. SMI is accredited by the American Academy of Sleep Medicine, which holds sleep labs to the highest standards. We are the only accredited lab in the area.
Blessinger: We had a really good run for two and a half years until the local hospital decided it wanted part of the action and stepped in. They duplicated our service, but not our quality. Their lab is unaccredited, and their staff doesn’t have the same experience and credentials that we have. The hospital lab took some of our volume, but having a competitor forced us to shine up our game and made us even better.
Erny: Yes, we are taking on even more. Since November 2009, we have been managing a hospital sleep lab in Princeton, Ind., and in February, we started from scratch a brand new sleep lab in West Frankfurt, Ill.
RSM: How often do lab patients go to HLS Home Medical for PAP therapy?
Blessinger: We are connected through what we call “preferred providership.” HLS has raised the bar exceptionally high to earn the preferred provider status. Certainly none of the three labs sends all of the business to HLS. There is freedom of choice. However, because HLS uses high-quality equipment and a comprehensive treatment program, the labs are comfortable promoting HLS as the preferred provider.
Erny: SMI goes above and beyond on a regular basis for our patients as does HLS. If a patient has special needs, I can call on HLS, and it’s not usually that way when I work with another HME company. HLS clinicians are committed to ensuring compliance and do what it takes. As an accredited sleep lab, SMI needs routine information on our patients, and I have a difficult time receiving
that from any other HME.
RSM: It sounds like there’s collaboration on the care continuum, from diagnosis to treatment to follow up.
Blessinger: We call the treatment protocol Snooze Path. It came about on a giant dry-eraser board. We asked, “Why do all sleep apnea patients get treated the same?” There should be different pathways of treatment with different levels of interaction based on the severity of the diagnosis, the number and type of co-morbidities, and the occupation. We developed three different pathways, and No. 3 is called “Cannot Fail” for people with a moderate to severe diagnosis, multiple co-morbidities and a dangerous occupation. Clinician interaction is stepped up dramatically in the first 7 to 10 days.
Erny: But before this at the lab, we do a tremendous amount of education. I had a gentleman there this week who I knew was going to be severe, and he knew he was going to be severe, so I did lots of education all through the process. In the morning, he gave me a big hug and said, “You’ve explained why I felt this way my whole life.” He cannot wait to get his equipment. We help patients understand how the health problems they have relate to their sleep disorder. It makes people want to be on CPAP so they can feel better.
RSM: Have the lab and the HME worked together to track patient compliance rates?
Blessinger: Yes, we’ve done two compliance measures in the three and a half years we’ve been doing this. From April 1, 2008, through September 30, 2008, we did 275 polysomnographs, and 241 were positive for sleep disordered breathing, or 87.6 percent. Of the 241 patients, 170 were referred to HLS. We studied compliance as of December 31, 2009, which was from 15 months to 21 months on therapy. Data show that 128 patients were fully compliant at between 15 to 21 months. That’s 75 percent. When we measured our compliance rates at under a year, the compliance rate was 85 percent. We are starting an investigative program to figure out why 10 percent fell off the wagon.
Erny: By the way, those are objective, download-proven compliance rates, not subjective rates from the patient.
RSM: That’s great. To what do you attribute your success?
Erny: Part of it is our willingness to work on mask fit. At the lab, we have such a broad range of masks. When we do a CPAP titration study, we may try 10 masks on a patient before we get him comfy and in bed. We concentrate on letting patients try different styles, so we can start to eliminate mask issues from the beginning.
RSM: So has meeting the Medicare compliance reporting requirements been manageable?
Blessinger: Yes, with the Snooze Path, we were better prepared to handle the Medicare issue. We are fortunate that we haven’t had too many struggles with the physician follow-up visits either. We do a stringent upfront education, telling the patients about the requirements, and only about 20 percent of our volume is Medicare.
RSM: At HLS, what percentage of your business is sleep, and is it growing?
Blessinger: Sleep is around 40 percent of our business, and we’ve had wild growth based on our high compliance rates and the supply sales behind that. We use higher-end equipment with significant clinician interaction, which leads to a lower net bottom line. But the reward for having compliant patients is that before you know it, you are managing thousands of supply customers. We do a really healthy supply business, and we just launched an online order system for patients on our website at www.hlspharmacies.com. Customers place orders and note when they are going to pick up the supplies. We don’t do too much mailing. In our small rural community, people like to come to the store for face-to-face interaction. For customers who don’t use computers, our staff still calls them to get orders. The staff says they can handle it, and we are going to stay as personal as long as we can.
Erny: We share that emphasis on the personal at the lab as well. It keeps us motivated. Every one of our staff members is passionate about taking care of patients and passionate about sleep. We are in a profession where we get to change a patient’s life in one night.
Dean Blessinger, RRT, director of HME operations at
HLS Pharmacies Inc., and June Erny, RRT, RPSGT,
managing partner of Sleep Management Institute LLC,
share a commitment to quality patient care.
This article originally appeared in the Respiratory & Sleep Management June 2010 issue of HME Business.