New School Meets Old School – The IntelliPAP SmartCode Remote Therapy Monitoring System with Adherence Score – Doug Hudiburg

DeVilbiss Healthcare’s new SmartCode relies on the familiar telephone to relay information that providers can use to access crucial sleep therapy data. Doug Hudiburg, global sleep product manager for DeVilbiss Healthcare, says the new technology is designed to be easy to understand and simple to use for PAP users and diagnosticians.

Tell us about the SmartCode feature for the IntelliPAP?

Devilbiss Healthcare’s IntelliPAP® Standard and AutoAdjust® units are now more intelligent with the recent addition of the company’s new SmartCode remote therapy monitoring system with adherence score. The enhanced version of Smart-Code is now included in both the AutoAdjust® and Standard models without additional fees or equipment. Officials at the Somerset, PA-based company emphasize that the updated SmartCode will help satisfy new CPAP local coverage determination (LCD) requirements, at no additional cost to sleep professionals.

The technology is designed to be easy to understand and user-friendly. In the past, we have seen a lot of complex technology solutions that provide a lot of data, and a lot of granular detail, but people really need more basic measurements. SmartCode is simple, yet innovative, especially in light of current market needs. It provides a way for home care providers, who are typically tasked with collecting usage information, to retrieve compliance and therapy data using that most common of technology, the telephone. If you have a phone, and your patient has a phone, you can easily collect the data.

What is unique about the SmartCode for PAP users?

SmartCode uses a proprietary encryption method that allows summary therapy and device usage data to be compressed into onboard codes that are displayed on the IntelliPAP display panel. To access SmartCode data, clinicians or providers call patients and ask them to read a code off of the IntelliPAP machine’s digital screen. Providers then log onto to input the number and decipher the code. Compatible Internet browsers are Safari (typically with Apple computers), Internet Explorer, and Mozilla Firefox.

What type of user-data is produced?

A HIPAA-compliant report is ultimately generated that includes text and graphs, and these reports can be printed or saved to the provider’s computer. Additional useful information for demonstrating improvement includes 90th and 95th percentile pressure, high leak flow time, exhale puff and non-responding event index. With the AutoAdjust®, you can collect AHI, pressure plateau time (upper clinical prescription limit), and determine if there is a mask leak happening. All of this appears in the form of a code that appears on the LCD screen. It’s anywhere from 10 to 14 digits depending on which code you are using, and it contains all of the information for specific time frames.

The time frames are 1-day, 7-day, 30-day, and 90-day periods—all key measurements to determine compliance and therapy effectiveness. The IntelliPAP Standard CPAP generates two different SmartCodes. The first code is usage data from the previous 1-, 7-, 30-and 90-day periods. This SmartCode includes percentage of days at least 4 hours use, day count, days of at least 4 hours of use, and average-whilebreathing hours per day. The second code generated is SmartCode usage, which provides cumulative data since the start of therapy, including percentage of days at least 4 hours use, day count, days of at least 4 hours of use, average hours per day, and total-while-breathing hours.

Using data generated by the code, the web site generates a report that can be saved as a PDF and shared with referring physicians and/or payors. A hot topic is Medicare’s new LCD. Medicare requires that the report exists, but it does not require that the report be provided for billing.

Medicare currently describes acceptable PAP compliance as 4 hours per night usage over 30-consecutive days. How can the DeVilbiss SmartCode Remote Adherence Monitoring System assist with this goal?

One of the Medicare LCD requirements for reimbursement states that a patient must demonstrate clinical benefit of PAP by showing objective evidence of adherence. CMS defines adherence to therapy as use of PAP greater than or equal to 4 hours per night—on 70% of nights during a consecutive 30-day period—anytime during the first 3 months of initial usage. The Adherence Score objectively reports the percentage of the best consecutive 30 days of usage that meet the CPAP LCD requirements. The adjustable adherence threshold can be set to 4 or 5 hours with a default setting of 4 hours. Together, the Adherence Score and SmartCode allow health care providers to quickly satisfy Medicare LCD requirements for establishing CPAP compliance.

How can the SmartCode improve CPAP compliance?

In the past, providers have had to ask patients to reveal usage hours on a screen. Patients could either tell the truth or not tell the truth. But when you use a code, you really get accurate information, and that is good for patients who know exactly how they are doing on the therapy—and it is also good for the insurance information.

Most providers are familiar with the removable memory card that patients are required to send in via mail. One problem is that it’s more difficult for patients to remember to send in the card, so you end up calling the patient anyway. SmartCode allows you to better intervene with education as patients are getting acclimated. With the card approach, you can miss the opportunity to get the information early and coach the patient through those crucial first 2 weeks.

We like to point out that even Internet-based technologies usually still involve calling patients—so using the telephone is an ideal situation. If you can get the patient compliant in the first 1 to 2 weeks, it is a good precursor for what is going to happen 2 years down the road.

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