Perfect Storm - Delivering the right therapy

As mentioned earlier... up until the mid-eighties the treatment of sleep apnea was exclusively the province of ENT surgeons. UUUP surgery and variants was a novel replacement for a trach. The commercialization of Dr. Sullivan's discovery of Continuous Positive Airway Pressure in the mid-eighties changed the landscape considerably. While ENT surgeons are still more likely to prescribe CPAP than other medical specialties - there are pulmonologists, neurologists, psychiatrists and even general practices physicians who are prescribing CPAP (on the basis of PSG). Once the prescription was written for this new therapy and it would be reimbursed by insurance - who would provide it? The Durable Medical Equipment industry of course. They have experience with delivering oxygen therapy to patients and this was the same thing, right? Wrong! CPAP is about as different from oxygen therapy as anything could be.

Oxygen therapy is straightforward, once the correct flow is determined. A driver would stop by and replace the tank every 30 days or so for as long as the patient was alive (which was never for very long, back in the day anyway). The practice of just dropping off the CPAP device and mask is something DMEs have done and in some cases still do - with disappointing results.

No real consideration (i.e. patient input) was given to the distribution model for CPAP once it became commercially available.

There you have it - the elements of the perfect storm: a condition that is more prevalent than previously thought, a system for testing that is better suited for research than for diagnosing an epidemic, and a distribution channel that fails to recognize that treating the condition requires something more than someone delivering a box to the door.

Next up... surviving the storm and moving ahead.