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protracted period, that’s not because America, all of a sudden went on a diet lost weight and there’s a lower incidence of sleep apnea. It’s just because people weren’t being diagnosed. So there’s going to have to be some period of time where there’s
a higher than historic level of folks being diagnosed and then ultimately treated.
HMEB: You mentioned home sleep testing. Do you think that in today’s environment, people will be more open to doing that?
Sheehan: I think people are warming to anything and every- thing that involves healthcare in the home, whether that’s diagnostic care or that’s actual therapy. That goes for things that HMEs involved with and not telehealth, obviously. I’m not turning over any regulatory rocks here, but telehealth is having a moment in the sun and telehealth really is the front end of need for HME, meaning that’s where you’re going to pick up on the fact that something is off in a patient’s life and perhaps a test should be ordered. And then that test can be interpreted remotely and then behind it, can come another telehealth hos- pital visit to satisfy payer requirements.
Anything related to healthcare in the home is having a moment in the sun, and frankly one that’s long overdue. This method of diagnosing and treating patients is the most logical way that the healthcare system should be designed. We should not be pushing patients in to acute care campuses to receive diagnoses for things that are very easily managed remotely. It’s not appropriate in terms of utilization of capital or the time that it takes patients to travel to a business, etc. So I think, absolute- ly it’s happening, it should happen, and it’s long overdue. Just pulling forward a trend that probably should have kicked off a decade ago.
HMEB: In talking about this trend towards more healthcare in the home, what have been the key lessons that your busi- ness and maybe sleep providers as a whole have learned? What do you think are going to be the lessons that are going to stick for good, given that “hospital in the home” context?
Sheehan: I think the first and biggest one is really, it was never about the technological limitations, right? The underpinnings for this movement to deliver more care in the home has been there, ready and sufficient for probably more than a decade. There was always this willingness capability for the system to adapt itself, to configure itself around more of a home-based care environment.
So when we couldn’t be near each other, that forced the hand, and everybody was then forced to use the tools that were around them and have been around them for a while. For many of us, we found the care delivery to be virtually seamless.
Change is hard in every industry. I think harder still in health- care because of the myriad regulations and different constitu- encies that influence policy within healthcare delivery, be it actual providers of care, then you’ve got the payers and the government and all these different people that have a stake in how things are done, I think does prevent at times innovation.
That’s the biggest lesson and I think, we’ll have to see the willingness of the various market participants, be it patients,
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payers, referral partners, to continue to have more of a home- based care environment once the pandemic has passed is TBD. There are a lot of people that benefit from a system wherein patients are reporting to a central campus where frankly, sometimes things are built at a higher rate and there’s more of a captive referral capability there.
Again, we’ll see as we reenter the world, but certainly, there was no limitation around the technology. It was really a limita- tion around people’s ability and willingness to change. That goes for patients as well as payers and referral partners.
HMEB: What about the patients? Maybe I’m just speaking from my own perspective, but it seems to me that the will among patients is to get more care in a home setting if they could do it.
Sheehan: No, I think you’re absolutely right. I do think there’s going to be friction, as a mandate comes down from leadership in an integrated healthcare system to drive more care back to the “campus,” if you will, (just to make up a term). Someone
like you, or frankly, myself might be very resistant when my physician tells me, “You need to come here to do this or to do that.” Whereas, other people, frankly, maybe older people, the Medicare patient population might be more willing to just listen to what their doctor tells them to do.
So there’s going to be a curious friction between what is patient preferred? What is most cost beneficial for the system at large? What does patient prefer? And then what is actually delivered?
What healthcare delivery ultimately looks like is going to be open. Will it offer much more choice, or will we be part of a network through our primary care provider that really locks us down and limits our access to telehealth and home-based health care solutions? That’s all TBD, and I think a story that they’re watching very closely now through the end of 2021.
HMEB: So, we might see a difference between what Medi- care patients what versus other patients, who are more willing to tell the healthcare system what they want, and that are more willing to get care in the home setting, lever- aging technology. Do you see the same thing with referral partners? Do you think there’s some who says, “yes, I want more in the home,” versus, “I want more people coming into the office?” What’s, what’s your take from the referral community?
Sheehan: It’s going to be all over the map because I think one person’s inefficiency in healthcare is another’s revenue stream, right? So to the extent that they’re levered to higher reimburse- ment through in-person visits versus telehealth, they’re going to vote with their pocketbook potentially and promote return- ing to the office as the only sole means to interface with them to provide care.
I think the more innovative, frankly, honest providers across healthcare are going to ultimately land on a hybrid model. There are clearly situations that warrant in-person visits and they need to continue. But what you can do is layer in additional touchpoints on a remote basis, and I think this gets to the real future of healthcare delivery.
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