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CategoriesCPAP,  Reducing Costs

How to Profit 
with CPAP Masks

by Sunset Admin

Emerging technologies and lower cost alternatives present new opportunities.

With competitive bidding looming on the horizon, and reimbursements potentially being cut by 40-50 percent, many HME providers are looking for lower cost alternatives to save their profit margins. We at Sunset Healthcare Solutions sell masks from nearly every manufacturer, so we’re often asked about sales trends in the respiratory industry. Recently we have seen a spike in lower-cost masks, as providers are looking to turn away from masks that carry a hefty price tag. Also, masks that fit a unique niche in the marketplace are doing well, since HMEs want to stand out from their competition and explore alternatives that fit the specific needs of their clients. In this article we’ll explore some of the options available and what you should look for when selecting masks.

In terms of selecting a brand, we have found that while sleep doctors or labs might be partial to a certain brand because they like the sales rep who visits their office every week, studies have shown that end-users do not tend to have the same brand recognition for their mask. In fact, many PAP patients don’t even know the name of the mask they are using. Often patients are open to trying a new mask as long as it’s comfortable and works for them. So if you have doctors or labs who do not prescribe a certain brand of mask, you have the freedom to find alternatives that fit the needs of your patient while also saving you money. There are many types of masks in the market such as InnoMed, RespCare, Sunset, SleepWeaver or the new Tap-Pap mask that are lower cost than the traditional name brand manufacturers.

Above all, your masks need to work for your patient, so ask them what they are looking for and try to find a mask that fits those needs. For some clients, a lightweight mask might be the most important requirement, while others might prefer one that reduces red marks or eases their claustrophobia symptoms. Once you find out what your patients are looking for, do some research into alternatives to masks you currently buy:

•  Go online to review websites like cpap.com 
or cpaphelpdesk.com to see what other 
patients are saying about the masks you are less familiar with.

•  Ask manufacturers for samples to let your 
patients try them—many are happy to give 
customers a sample or free trial as a way 
to gain additional business.

•  If you are not able to get a free sample, most manufacturers have a money back guarantee so if you or your clients are not satisfied with the masks, you can return them at no cost.

We have had particularly good feedback on 
the following masks that are all available at 
a price that allows profit after competitive 
bidding reimbursements go into effect:

Nasal Pillows

RespCare Aloha Mask: It’s gotten great reviews on cpap.com, is very lightweight, quiet and has fully adjustable pillows to get a good seal.

TAP-Pap: This mask is new to the market and is already one of the top selling nasal pillow masks. It has a mouthpiece to hold it in place, so it completely eliminates the need for headgear.

Breeze SleepGear: This classic mask has been around for a while and continues to be popular with nasal pillow users because it doesn’t have straps against the cheeks and has seven pillow sizes to fit everyone.

Nasal

Sunset Deluxe Nasal Mask: Sunset’s newest nasal mask is extremely lightweight and has a replacement cushion for added reimbursement.

SleepWeaver Advance and Élan: If you haven’t tried a cloth mask yet, we recommend it. The Advance mask is one of our top sellers and the newer Élan is not far behind.

Full Face

Sunset Full Face Mask: This popular mask is the one-piece design that has the same features as the older generation Probasics Zzz-Mask that many patients loved. Probasics has discontinued the mask but it’s still available through Sunset.

Fisher & Paykel Flexifit 431: This mask features much of the same technology of their newer Forma mask such as the glider strap and under chin design, but it’s an older generation so it comes at a lower price. As a bonus, they included all three size cushions in the same box so you only have to stock one model.

Sunset Deluxe Full Face Mask: Available this April, this new Deluxe Full Face mask is ultra-lightweight because they removed the T-bar forehead support. That also created a clear line of sight which is great for claustrophobic patients.

If you try a new mask and isn’t exactly right for your patient, give that feedback to the manufacturer. You would be surprised by how often those little tips can make a big difference. When Sunset launched their new Deluxe CPAP masks earlier this year, we listened to the feedback from several of our customers and added some additional features, like an extra swivel at the connection, which would make the mask more comfortable for active sleepers.

CategoriesCPAP

New and Improved Deluxe CPAP Masks

by Sunset Admin

At Sunset we always strive to go above and beyond to meet our customers’ needs. We set out to improve the new Deluxe Masks to include additional features to add comfort at a price that will make your next competitive bid a little easier.  Look around at the new masks’ features and give us a call if you want to see one for yourself.

why_youll_love-cm005

 

 

CategoriesCPAP

Top 10 Reasons to Try a Cloth CPAP Mask

by Sunset Admin

Sleepweaver

We’ve been long-time fans of the SleepWeaver masks here at Sunset Healthcare Solutions. In fact, the Advance is one of our top-selling CPAP masks and the newer Élan is not far behind. If you haven’t tried them yet, here’s a list of our Top 10 reasons to consider them.

  1. More sleep positions – because it’s made of cloth instead of hard plastic, patients can sleep on their back, side or stomach without rigid buckles, hard clips or faceplates digging into their skin. Cloth mask users report waking up in the middle of the night and wondering if it is still on their face, only to find it gently resting in place.CPAP mask lines
  2. The cloth material inflates like a balloon that pushes gently against the patient’s face to form a seal. Because it’s fabric, it can match the contours of any patient’s face to reduce leaks. The material also works to wick away moisture, reducing rainout.
  3. For customers who complain about their conventional hard plastic CPAP mask leaving behind ugly and uncomfortable red marks, this mask is a great alternative.  Made almost entirely of soft, wicking material, this mask adds comfort, minimizes skin irritation and strap marks.
  4. The new Élan comes with a regular and large cushion to better fit a wide variety of patients. Also included in the kit are a feather weight tube and tether strap.
  5. Both masks can be comfortably worn while wearing glasses, no bulky T-bars, so you provide your customers with the nasal mask with a view! Patients will enjoy a clear line of sight, great for people who are claustrophobic.Sleepweaver colors and washing
  6. Patients can personalize their mask with five fun colors and fashionable prints: Leopard, Camo, Pink, Tan or Blue.
  7. Less noise – the masks are designed with new, smaller exhalation holes that diffuse the air to eliminate noise upon exhalation. This provides a quieter night’s sleep for the patient and their bed partner.
  8. Both masks can be easily cleaned by hand washing with a mild non-abrasive detergent. If needed, they also can be disinfected and reprocessed to be used between patients in a hospital or sleep lab setting.
  9. Both masks come with a 90 day warranty and 30 day risk-free money back guarantee. If you aren’t happy with it, contact your Sunset rep and we’ll send your money back. There’s no excuse not to try.
  10. You don’t have to just take our word for it, try it yourself and see why 12% of all nasal CPAP users on cpap.com have made a switch to the cloth mask.
CategoriesCompany Culture

Sunset Knows Quality

by Sunset Admin

quality

Here at Sunset we pride ourselves on bringing quality CPAP and respiratory products to market. We follow rigid quality standards to ensure each of our products will meet the needs of our customers. The following article explains how we select the products that we add to our line and gives details on one of our most important quality assurance processes, the First Article Inspection.

When Sunset is looking to bring on a new product from a new or existing supplier, they must first be approved by Quality. The approval process for a new supplier consists of three main steps:

  1. An on-site audit and/or a completed supplier survey. Any vendor or supplier that we purchase supplies or components from must be qualified. They should have their own quality systems in place and be able to show us evidence of the testing and inspections they have done within their own facility before they send products to us for testing.
  2. Once we have determined they meet our standards, we review and approve their FDA registration information, making sure the FDA has qualified them as well.
  3. Finally, we request product samples and pass them through several departments including Business Development, Quality and Marketing to make sure they meet everyone’s standards. Each department has their own set of tests and questions for the supplier at that time.

Once the supplier approval process is complete, and we are ready to place an order, the Purchasing department will alert the Quality team to inspect the product once it arrives. At this time we perform what is called a First Article Inspection. First Articles are intended to confirm the physical configuration of a device and its components to ensure the specifications meet those agreed upon by Sunset and the supplier.

During each First Article Inspection, we compare the product we receive to the Device Master Record (DMR) to ensure they match our quality standards. The DMR consists of detailed drawings, dimensions, material specifications and any other details about the product and packaging that we have determined and passed along to the supplier prior to bringing on the product. We thoroughly compare every component to ensure the product has met our predetermined specifications.  In some instances, we also perform additional tests to verify product performance.

The details of the inspection are recorded on a First Article Inspection Form. If anything needs to change, we send the product back to the supplier and repeat the process over again. Once everything looks ok, we fill out another form called an Engineering Change Order which we use to formally release the product into inventory.

By performing First Articles we are ensuring our products are held to the standards we have in place and those that are set by regulated bodies. These product inspections are one of the many ways we ensure we are continuously bringing the highest quality CPAP and respiratory products to market. First Article Inspections ultimately provide peace of mind for both Sunset and our valued customers.

CategoriesIn The News,  Reducing Costs

Competitive Bidding Update

by Sunset Admin

Competitive Bidding Legislation

What it Means for CPAP Suppliers and How Sunset Can Help

Round 2 reimbursement amounts from Medicare were recently announced. This new competitive bidding legislation means there will be a lot of change in our industry in the next couple of years, especially for smaller stores who may not have the scale to remain competitive due to these new Medicare cuts.  Many HME registered for this process as of March of 2012 and are probably anxiously awaiting their fate.

This new legislation does not affect reimbursement amounts for private insurance; it only affects Medicare reimbursements at this time.   There are pros and cons to accepting a round 2 contract. As Elizabeth Deprey of HME News blogged earlier this week, some HMEs were relieved to be out of a Medicare contract. The high administrative costs of billing Medicare and time consuming government audits are draining and in the end, just not worth it for many smaller companies. The National Association of Independent Medical Equipment Suppliers (NAIMES) has put together an anonymous survey to gauge the end result of round 2 contracts.

The whole logic behind this legislation change is to protect consumer rights; ensuring companies are delivering the highest quality products to their patients at the lowest possible cost.  The bill is also a means for cutting the allocation of Medicare spending on these products by dramatically decreasing reimbursement rates. To give you a little more insight to specifics on how this might affect you, check out the new HCPCS Reimbursement by State. We also put together the chart below so you could better see an example of how HCPCS rates have changed across CPAP supplies specifically.

Product Reimbursement
2012*		 Reimbursement
2013**		 Difference Difference %
CPAP Tube 36.00 15.30 20.70 58%
Replacement Full Face Cushion 65.00 20.40 44.60 69%
Full Face CPAP Mask 170.55 99.00 71.55 42%
Nasal CPAP Mask 106.35 59.00 47.35 44%
Replacement Foam Filters 11.78 6.81 4.97 42%
Replacement Filters 4.88 2.38 2.50 51%
Headgear 32.00 20.40 11.60 36%
Chinstrap 14.50 11.01 3.49 24%

*reimbursement average 2012

**reimbursement Ohio 2013

As you can see, the average 45% decrease in reimbursement rates was no media exaggeration. Some products are affected more than others, for example, replacement cushions’ reimbursement rate decreased 69% while chinstrap reimbursement rates decreased by only 24%, with additional variances by state and region.

So what is Sunset doing to help our customers during these times of reimbursement cuts? We recently came out with a new deluxe line of CPAP masks that include a replaceable cushion and cost about 40-50% less than similar masks from leading manufacturers. We’ll continue to provide the lowest prices to our customers, whenever possible. We’re also looking to add more cash and retail items to our line in the next year so our customers can battle Medicare cuts with a boost to their cash sales.

In addition, we are backing a favorable alternative for home care providers, the Medicare DMEPOS Market Pricing Program.   This act will still reduce Medicare spending but would better accommodate smaller providers and preserve their ability to compete.  John Gallagher and the team with VGM government relations are making a stand for a new Market Pricing Program (MPP), if you’re interested in advocating this, check out VGM DC Link or AAHOMECARE.  Many people in the HME industry are going to be talking about this at MedTrade Spring 2013. So if you’re headed out there, keep an eye out for MPP news and updates. What do you think about the Medicare cuts and MPP? We would love to hear your feedback in the comment section below.

CategoriesOxygen,  Services

Six Tips for Selecting the Right Cannula

by Sunset Admin

cannula

Not all oxygen nasal cannulas are alike

For your patients with chronic obstructive pulmonary disease (COPD), where long-term oxygen therapy is required, a nasal cannula is used to administer oxygen flow. These devices are simple to use and install but not all are created equal.

Following are some helpful tips for selecting the best nasal cannula for each individual patient in order to achieve maximum results.

Know the Basics

No matter which type of cannula you choose, the most important thing is that it works. Make sure the oxygen flow is uninterrupted by selecting a kink-resistant tube. Some are reinforced with multiple internal channels (3-channel, 5-channel or 6-channel tubing) to make the whole tube sturdier. Others are referred to as “smooth bore,” meaning the inside is smooth. In some cases, smooth bore tubes are sufficient if the tube is narrow and the walls are thicker; however, when the tubes are wider, as with a high-flow cannula, multiple channels are recommended for extra support.
The second important factor is patient comfort. To achieve a comfortable fit, the tube should feel soft against the skin and be memory-free. To test this, request samples from your manufacturer and lay them out on a flat surface. If the tube lays flat instead of coiling back up, it is memory-free, which will increase comfort for the patient by securely fitting against his or her face and reducing friction against the skin.

Purchase from a Reputable Dealer

With Medicare’s cuts on oxygen reimbursement, it can be tempting to purchase your cannulas based on price. However, if your patients are not satisfied with the equipment you provide, you will incur the extra cost of either shipping them a new cannula or sending a technician to check on them. Even if you successfully replace faulty equipment, your reputation for providing quality products may suffer, making it well worth the effort to do some additional up-front research.

A qualified distributor will have a rigid set of quality control tests that their products must pass before they can sell them to you, so you can be confident that you will receive a reliable product the first time, every time. Ask your current manufacturer what quality control measures they have in place and if you are not satisfied with the results, look elsewhere.

Make Sure It Fits

Most cannulas come in three basic sizes: adult, pediatric or infant, which can work for the majority of patients.

The shape of the nasal prong can also vary from curved to straight and tapered to flare. This is based on patient preference and nose shape. Most patients prefer a curved shape as it matches the natural curvature of the nasal canal. When placing a cannula with a curved nasal prong on a patient, the curve should face downward. The prongs can also be trimmed slightly for added comfort.

Check the Flow as Prescribed by the Patient’s Doctor

A standard cannula can effectively deliver between 1-6 liters/minute of oxygen. Where higher rates are required (6–15 liters/minute), a high flow cannula is a good way to provide adequate saturation without using a mask. High flow cannulas have a larger bore (wider tube opening compared to standard tubing) to allow for effective delivery of oxygen flows up to 15 LPM.

Check the Oxygen Device

For most oxygen devices, a standard tube — sometimes called “single-lumen” — is used. With regard to oxygen tubing, the description single-lumen means there is one tube carrying the oxygen from the concentrator to the patient. For dual-port oxygen-conserving devices that only deliver oxygen when the patient inhales, a demand cannula should be used. A demand cannula has a split dual-lumen tube with two airways, one that delivers the oxygen and another that senses the breathing pattern of the patient to tell the device when to expel air.
Another factor to check on the device is the maximum tube length that the concentrator allows. Normally, length of oxygen tubing is determined by patient use and preference; however, some concentrators have limits for how long the tube can be before the pressure level will be affected. This information can typically be found in the device instruction guide.

The final thing to note when checking the device is the connection port. Most major manufacturers, including SeQual, Respironics, Invacare and Covidien Nellcor Puritan Bennett, use standard connectors. For non-standard or specialty connections, some manufacturers offer Fits-All connectors that are wider and can be adjusted to fit or separate adaptors that allow a standard tube to be used with a specialty connection.

Replace the Cannula Regularly to Avoid Infection

There is a lot of debate about how often to change a nasal cannula. We recommend homecare companies change their patients’ cannulas once per week to avoid infection and other complications. In addition, the cannula should be changed after the patient has been sick to avoid contact with the bacteria and mucus.

With Medicare’s recent changes in reimbursement, homecare companies have a limit to the amount they receive for oxygen patients. As a result, some manufacturers have established programs to make regular replacement easier and more affordable for their HME/DME customers.

Sunset Healthcare Solutions offers the ability to kit cannulas so DMEs can purchase a 3-month supply for each patient packed in one easy-to-use kit. All of the kits are customizable, so the DME can pick the quantities they are comfortable sending, and Sunset will assemble them at no additional charge.

With this unique approach, the DME can teach their patients how to replace their own cannulas and ship all the supplies they will need at once to save on shipping costs. Some fulfillment companies like our partners PPM, VGM and Jaysec offer drop shipping, so DMEs can have their supplies shipped directly to their patients without having to house inventory.

CategoriesOxygen

Introduction to Oxygen Cylinders

by Sunset Admin

o2-couple-web

For patients who use supplemental oxygen, portable cylinders can be a great way to allow them freedom to move around as they please. Here we’ll review the types of oxygen cylinders, how to determine the best size and key accessories.

What are the different sizes of Oxygen Cylinders?

Two sets of names are used to differentiate between oxygen cylinder sizes. The original set uses an alphabetical system, starting with A for the smallest size and E for the largest portable size. The new naming system begins with the letter “M,” for “medical,” followed by a number that signifies the amount of cubic feet of oxygen in that can be compressed into the cylinder. So the original B cylinder is now often referred to as an M-6 cylinder because it can hold 6 cubic feet of oxygen. Below, see the handy chart that matches oxygen cylinder sizes with their dimensions, capacity and accessories.

How do I know which size is best for my client?

The optimal size will depend on a client’s lifestyle and prescribed flow rate. The most common size is the M6. However, if the client is confined to a wheelchair, a larger E cylinder with a wheelchair bag may be more appropriate. Or, if he or she only leaves the house for short periods of time and weight is an issue, a smaller M4 cylinder may be better.

To determine how long an oxygen cylinder will last, there are several factors to consider: The patient’s prescribed flow rate in L/minute; the tank capacity in liters and whether they are using a regulator or a conserver. A regulator will provide continuous flow at a given flow rate. A conserver will sense when the patient is breathing and only expel oxygen when the patient is breathing in. Most conservers allow the tanks to last three to five times longer, but can be up to 10 times as expensive as regulators and are not reimbursed by insurance companies so they are not always worth the extra cost.

What accessories will my client need?

All patients should be supplied with a cylinder wrench and a “No Smoking” sign (it is recommended that patients hang a sign on all entrances to the building as well as in the room where the oxygen is being delivered).

For portable tanks, a carrier bag or cart is recommended. The most common bags range in sizes from M6, which can hold M6, M4 and M2 cylinders, up to E bags, which can be attached to a wheelchair or scooter. M6 bags often have straps to keep smaller cylinders in place. This can help reduce bag inventory by not having to stock separate bags for patients with small tanks. Many different styles are available with the most common being shoulder bags, backpacks and wheelchair bags. Bag type can be based on the patient’s preference; however, it is recommended that all bags are made of nonflammable materials.

The final accessory needed is a regulator or conserver. When selecting one, keep in mind that there are two main types of valves on oxygen cylinders. CGA 870 styles are used on tanks that are size E and smaller. CGA 540 style valves are used on larger, nonportable tanks. So you will want to select the type of regulator or conserver that matches the valve on your patient’s cylinder.

Oxygen cylinder specs
Illustration by Patrick Holbrook, Sunset Healthcare Solutions

1da
2dp
3ea
4ep
5ha
6hp

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